Incidence of Uveitis in Patients with Spondyloarthritis: The Impact of Biologics Era.a Multicenter Study Using Data from International ASAS-Comospa Study

Hernán Maldonado Ficco¹, Rodolfo Perez-Alamino², Christian A. Waimann³, José A. Maldonado-Cocco⁴, Anna Moltó⁵, Maxime Dougados⁶, Robert B.M. Landewé⁷, Désirée van der Heijde⁸ and Filip van Den Bosch⁹, ¹Rheumatology Section, Hospital San Antonio de Padua, Río Cuarto- Córdoba, Argentina, ²Rheumatology Department, Hospital de Clínicas Pte. Dr. Nicolás Avellaneda, Tucumán, Argentina, ³Hospital Dr. Hector Cura, Olavarria, Argentina, ⁴Buenos Aires University, University of Buenos Aires School of Medicine. Argentina, Buenos Aires, Argentina, ⁵Rheumatology Department, Hôpital Cochin, AP-HP, Paris, France, ⁶Hopital Cochin, Paris, France, ⁷Amsterdam Rheumatology & Clinical Immunology Center and Zuyderland Medical Center, Amsterdam; Heerlen, Netherlands, ⁸Leiden University Medical Center, Leiden, Leiden, Netherlands, ⁹Department of Rheumatology, University of Ghent, Ghent, Belgium, Ghent, Belgium

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: extraarticular manifestations, spondylarthritis and uveitis

Session Information

Date: Monday, October 22, 2018

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster II: Clinical/Epidemiology Studies

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Uveitis is a common extra-articular manifestation in Spondyloarthritis (SpA). The purpose of this study was to analyze incidence of uveitis in SpA patients during the last decade and to evaluate the impact of the biologic therapies on this incidence.

Methods: This study is an ancillary analysis of the ASAS-COMOSPA study and included patients fulfilling ASAS SpA criteria from 22 countries. We calculated overall cumulative incidence of uveitis and evaluated difference across continents and clinical phenotypes. Patients were stratified according to date of disease onset [before 2000 and after 2000 (Biologics Era)]. We performed univariate and logistic multivariate models looking for risk factors associated with uveitis. A p-value of 0.05 was considered statistically significant.

Results: We included 3984 patients. 65% were male with a mean disease duration was 15 ±12 years and mean age at disease onset of 28 ±13 years. HLA-B27 were positive in 72%. 805 patients developed uveitis, with a cumulative incidence of 0.20 in 32137 patient-years from disease onset. Median time to develop uveitis was 9 (p25-p75=3-16) years and it was present at disease onset in 5% of patients. Inflammatory bowel disease (IBD) showed the higher frequency of uveitis (33%), enthesitis (24%), axial involvement (22%), peripheral arthritis (20%), dactylitis (19%) and psoriasis (13%). 94% of patients with IBD and 89% of patients with enthesitis, also presented axial involvement. 88% of patient with uveitis were HLA-B27 positive and 17% had first/second degree relatives with uveitis.Patients who meet ASAS Peripheral Criteria showed less frecuency of uveitis than those who meet ASAS Axial Criteria (11% vs 23%, p<0.01).Europe show a significantly higher cumulative incidence of uveitis (0.23) than Asia (0.20), Latin-America (0.17), North-America 0.15 and Africa 0.18.Patients with disease diagnosis after 2000 showed a lower cumulative incidence of uveitis than those with disease diagnosis before 2000 year (14% vs 27%, p<0.01).Risk factors associated with uveitis were HLA-B27 positive, family history of uveitis, enthesopathy and/or IBD. (table 1).

Conclusion: One fifth of patient with SpA developed uveitis.HLA-B27 positive and family history of uveitis were associated with higher risk of uveitis. Patients from Europe showed the highest frequency. Patients with disease onset after biologics development had a lower cumulative incidence of uveitis, but after adjust for multiple confounders, did not reach statistical significance.

Table 1. logistic multivariate analysis using uveitis as dependent variable.

Dependent variable=Uveitis	Adjusted Odd Ratios
	OR (CI⁹⁵)	p
Female	1.06 (0.85-1.31)	>0.20
Disease duration (years)	1.03 (1.02-1.05)	<0.01
HLA-B27 positive	3.25 (2.41-4.39)	<0.01
Family history of uveitis	4.33 (3.07-6.12)	<0.01
Peripheral arthritis	1.00 (0.80-1.24)	>0.20
Peripheral enthesitis	1.27 (1.03-1.57)	0.03
Dactylitis	1.08 (0.78-1.48)	>0.20
Axial involvement	0.83 (0.50-1.40)	>0.20
Psoriasis	0.68 (0.50-0.93)	0.02
IBD	2.20 (1.51-3.21)	<0.01
Continent (Africa=0)
Asia	0.85 (0.51-1.40)	>0.20
Europe	0.76 (0.46-1.24)	>0.20
Latin-America	0.83 (0.47-1.47)	>0.20
North-America	1.13 (0.57-2.27)	>0.20
ASAS peripheral criteria	0.89 (0.60–1.33)	>0.20
Disease onset >=2000 year (Biologics Era)	0.79 (0.58–1.08)	0.14

Disclosure: H. Maldonado Ficco, None; R. Perez-Alamino, None; C. A. Waimann, None; J. A. Maldonado-Cocco, Pfizer, Merck Sharp Dohme, Sanofi – Aventis, Novartis, Bristol Myers Squibb, Roche, Boehringer Ingelheim, Schering – Plough, Abbott, UCB, Eli Lilly, Gilead, 5, 8; A. Moltó, MSD, AbbVie, Pfizer, UCB Pharma, 2, 5; M. Dougados, AbbVie, Eli Lilly, Merck, Novartis, Pfizer, UCB Pharma, 2, 5; R. B. M. Landewé, None; D. van der Heijde, None; F. van Den Bosch, AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Co., Janssen, Merck, Novartis, Pfizer, Sanofi, UCB, 2, 5, 8.

To cite this abstract in AMA style:

Maldonado Ficco H, Perez-Alamino R, Waimann CA, Maldonado-Cocco JA, Moltó A, Dougados M, Landewé RBM, van der Heijde D, van Den Bosch F. Incidence of Uveitis in Patients with Spondyloarthritis: The Impact of Biologics Era.a Multicenter Study Using Data from International ASAS-Comospa Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/incidence-of-uveitis-in-patients-with-spondyloarthritis-the-impact-of-biologics-era-a-multicenter-study-using-data-from-international-asas-comospa-study/. Accessed .

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