Background/Purpose: Uveitis is the most frequent extra-articular manifestation of spondylarthritis (SpA), characterized by a sudden onset, often unilateral, anterior and recurrent and may be the first clinical manifestation of the disease. The lack of standardized and validated outcome measures in uveitis makes it difficult to evaluate the efficacy and refractoriness to treatment and determine factors associated with adverse outcomes. The objective of our study was to develop a prognostic outcome score for patients with uveitis associated with spondylarthritis (SpA-U) and determine factors associated with adverse outcomes in uveitis associated to SpA-U in patients under systemic treatment.

Methods: The prognostic outcome score was defined by visual acuity, inflammation in anterior chamber (anterior chamber cells, hypopyon, presence of fibrin, active posterior keratic precipitates), presence of synechia, pupilar membrane, epiretinal membrane or any complications (macular oedema, vitritis, panuveitis, peripheral ulcerative keratitis), and refractoriness to 2 or more d/csDMARDs (conventional synthetical disease-modifying anti-rheumatic drug) or 1 or more bDMARD (biological disease-modifying anti-rheumatic drug) treatment. The prognostic outcome score ranked from 0 (good) to 5 (bad). Factors associated with adverse outcomes in uveitis were studied using linear regression. For categorical factors, marginal averages and their standard errors are displayed together with linear regression coefficients with 95% confidence intervals (CI). For continuous factors, averages and standard deviations are reported in addition to linear regression coefficients with 95% CI. For each variable, two regression coefficients are reported: unadjusted and adjusted for age at diagnosis and sex.

Results: 42 patients were included, 59.5% were male, with a mean age at diagnosis of 36.6±11.9 years and with a total of 190 uveitis outbreaks. Time since diagnosis was 12.5±7.9 years. 64.4% of patients had uveitis as disease onset. 52.4% were overweight (BMI≥30 kg/m2), 16.7% were former/active smokers. 28.6% of patients had a family history of SpA. 14.3% had 1-2 uveitis outbreaks, 47.6% had 3-5 uveitis outbreaks and 38.1% had 6-11 uveitis outbreaks. 102 (53.7%) uveitis outbreaks fulfilled 1 criterion, 38 (20%) uveitis outbreaks fulfilled 2 criteria, 19 (10%) uveitis outbreaks fulfilled 3 criteria and 5 (2.6%) uveitis outbreaks fulfilled 4 or more. The results of the linear regression model revealed that the uveitis was more severe in patients with smoking history (β=0.34), axial and peripheral involvement (β=0.43), a BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) >4 (β=0.32), positive HLA-B27 (β=0.29), female sex (β=0.19), patients with CRP (C-reactive protein) elevation (β=0.002) and a history of bilateral ocular involvement (β=0.32) while shorter disease evolution (β=-0.02) and normal vitamin D levels (β= -0.03) were associated with a better outcome.

Conclusion: We identified factors associated with adverse outcomes in SpA-U by developing a prognostic outcome score that integrates ocular inflammatory activity, ocular complications and refractoriness to treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-adverse-outcomes-in-uveitis-related-to-spondylarthritis-spa-u-development-of-a-prognostic-outcome-score-in-patients-with-spa-u/