Background/Purpose:

Anterior uveitis (AU) is a common extraarticular manifestation in spondyloarthritis (SpA). The disease can precede the typical axial and peripheral features. Additionally, some studies had described the imaging signs of sacroiliac involvement in patients with AU lacking chronic back pain. The aim of this study was to examine patients with AU, to determine whether the patients already fulfil criteria for axial and/or peripheral SpA and to stratify risk factors for SpA development.

Methods:

We recruited 41 patients without prior rheumatologic diagnosis who developed at least one episode of AU. The clinical data were collected and rheumatology examinations were performed by trained rheumatologists. Magnetic resonance imaging (MRI) of sacroiliac joints (SIJ) was read by trained rheumatologist who was blinded to the patient data. Patients were further divided into SpA subsets (axial: imaging and clinical arm and peripheral SpA) fulfilling The Assessment of SpondyloArthritis international Society (ASAS) classification criteria¹ and non-SpA subset. The ASAS modified Berlin algorithm for diagnosis of axial SpA² (axSpA) was also applied.

Results: Altogether, 22.0% (n=9) patients referred inflammatory back pain, 48.8% (n=20) referred non-inflammatory back pain and 29.3% (n=12) did not refer back pain. Bone marrow edema (BME) was found in 48.8% (n=20) of all patients with AU, however 31.7% (n=13) had highly suggestive BME³ corresponding to typical findings in sacroiliitis. The diagnosis of SpA was confirmed in 41.5% (n=17) of all patients with AU, 26.8% (n=11) patients fulfil the imaging arm and 12.2% (n=5) fulfil the clinical arm of ASAS classification criteria for axSpA, 4.9% (n=2) patients fulfil ASAS classification criteria for peripheral SpA (one patient fulfil both axial and peripheral criteria). Two patients lacking back pain developed highly suggestive BME on SIJ. The diagnosis of axSpA according to the Ankylosing Spondylitis Disease Activity Score (ASDAS) modified berlin algorithm was confirmed in 41.5% (n=17) patients. Analysis of clinical characteristics showed significant difference between ASDAS in SpA vs. non-SpA (1.6 ±0.7 vs 0.8 ±0.6, p<0.001, respectively), and remained significant in axSpA and also in those fulfilling only imaging arm of axial SpA (i-axSpA) (p=0.002, p=0.016, respectively). The levels of CRP were significantly higher in SpA and axSpA compared to non-SpA subsets (9.5 ±10.3, 8.7 ±10.1 vs. 2.2 ±2.2 mg/L, p=0.005, p=0.009, respectively). Presence of back pain and inflammatory back pain were more often in SpA compared to non-SpA subsets (94.1% and 47.1% vs. 54.2% and 4.2%, p=0.006 and p=0.002 respectively).

Conclusion:

More than one third of patients with anterior uveitis fulfilled the criteria for axial or peripheral SpA. Furthermore, these patients had significantly higher presence of back pain, increased ASDAS and serum CRP levels. Inflammatory back pain was significantly more often in patients classified as axSpA.

Acknowledgement:

Supported by MH CR 023728, SVV 260373, AZV – 17-33127A

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-spondyloarthritis-in-patients-with-anterior-uveitis/