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: Acute anterior uveitis (AAU) is the most common extra-articular feature of spondyloarthropathies (SpA) over the course of the disease. Around 33% of patients with SpA present with AAU1. To better characterize patients with SpA and AAU we aimed to determine the prevalence of AAU in patients with SpA seen in our clinic, and to compare demographic, clinical characteristics and treatment in patients with and without uveitis.
Methods: We conducted a retrospective study of all patients with SpA with and without uveitis seen at our rheumatology clinic between January 2016 and June 2017. Patients were identified from our rheumatology repository using ICD-10 codes (M45, M46.1, M46.8, M46.9, H20.00-02, H20.04, H20.1, H20.9, H22) and administrative claim codes for the same period of time. Charts were reviewed to confirm the diagnoses. Extracted data included patient demographics, laboratory investigations, HLA-B27 typing, current and previous treatments with nonsteroidal anti-inflammatory drugs (NSAIDs), non-biologic and biologic disease-modifying antirheumatic drugs (DMARDs). To assess disease activity, we calculated RAPID3 scores based on a Multidimensional Health Assessment Questionnaire (MDHAQ) routinely completed by our patients. RAPID3 has been previously shown to be useful in this population2. Comparison between patients with and without uveitis was performed using Student’s t-test for differences between means and chi2 for proportions.
Results: A total of 190 patients with SpA were identified: 48% with ankylosing spondylitis (AS), 26% with psoriatic arthritis (PsA), 22% with undifferentiated SpA and 4% with SpA associated with inflammatory bowel disease (IBD). Prevalence of uveitis differed by etiology: 17% in SpA in this series, 25% in AS, 4% in PsA-associated SpA, 9.5% in undifferentiated SpA, and 57% in IBD-associated SpA (p=0.001, Table). Overall, 39.5% of patients were HLA-B27 positive, the antigen was more frequently detected in patients with uveitis than without uveitis, 69.7% and 33.1%, respectively (p<0.001), and interestingly, those with AAU had less pain (p=0.03). Delay to SpA diagnosis tended to be longer in patients with uveitis, 12.3 (11.2) versus 7.9 (9.5) years but did not reach statistical significance. There were no significant differences in age, gender, clinical, laboratory characteristics and treatment between the two groups (Table).
Conclusion: In our SpA population the prevalence of uveitis was lower than expected, and there were significant differences by underlying disease. There was a delay to diagnosis of SpA of about 8 years, which tended to be longer in patients with uveitis. New screening strategies in collaboration with ophthalmology may lead to earlier diagnosis, treatment and better patient outcomes.
References:
1. Ann Rheum Dis 2008; 67:955-9.
2. RMD Open. 2016; 2(2): e000235).
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Table: Patient Demographics and Clinical Characteristics according to presence of uveitis |
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ALL N=190 |
Non-uveitis |
Uveitis |
p |
|
n = 157 (83%) |
n = 33 (17%) |
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Age, yrs. mean (SD) |
45.9 (15.1) |
45.5 (15.5) |
47.8 (13.1) |
0.43 |
|
Male, n (%) |
113 (59.5%) |
93 (59.2%) |
20 (60.6%) |
0.88 |
|
Diagnostic delay for SpA, years (SD) |
7.9 (9.5) |
7.2 (9.1) |
12.3 (11.2) |
0.09 |
|
SpA subgroup |
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|
AS |
92 (48%) |
69 (75%) |
23 (25%) |
<0.001 |
|
PsA-Associated |
49 (26%) |
47 (96%) |
2 (4%) |
|
|
Undifferentiated |
42 (22%) |
38 (90%) |
4 (10%) |
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|
IBD-Associated |
7 (4%) |
3 (43%) |
4 (57%) |
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HLA-B27 positivity, n (%) |
75 (39.5%) |
52 (33.1%) |
23 (69.7%) |
<0.001 |
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Family History of SpA, n (%) |
24 (12.6%) |
17 (10.8%) |
7 (21.2%) |
0.10 |
|
Enthesitis, n (%) |
21 (11.1%) |
19 (12.1%) |
2 (6.1%) |
0.48 |
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Peripheral Arthritis, n (%) |
123 (64.7%) |
103 (65.6%) |
20 (60.6%) |
0.57 |
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Abnormal CRP (>8mg/L), n (%) |
61 (32.1%) |
49 (31.2%) |
12 (36.4%) |
0.65 |
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Imaging evidence of Sacroiliitis, n (%) |
123 (64.7%) |
97 (61.8%) |
26 (78.8%) |
0.08 |
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RAPID3 (0-30), mean (SD) |
17.4 (1.42) |
18.2 (11.7) |
13.7 (13.2) |
0.12 |
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Pain on a VAS (0-10), mean(SD) |
4.7 (0.38) |
5.1 (3.1) |
3.1 (3.1) |
0.03 |
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Current treatment |
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NSAIDs, n (%) |
188 (98.9%) |
156 (99.4%) |
32 (96.9%) |
0.67 |
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Non-biologic DMARDs |
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– Methotrexate |
27 (14.2%) |
24 (15.3%) |
3 (9.1%) |
0.26 |
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– Sulfasalazine |
7 (3.7%) |
6 (3.8%) |
1 (3%) |
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– Combination |
6 (3.1%) |
5 (3.2%) |
1 (3%) |
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– Others (HCQ, leflunomide, AZA) |
10 (5.3%) |
8 (5.1%) |
2 (6.1%) |
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Biologic DMARDs |
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– Adalimumab |
50 (26.3%) |
37 (23.6%) |
13 (39.4%) |
0.13 |
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– Etanercept |
33 (17.4%) |
29 (18.5%) |
4 (12.1%) |
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– Infliximab |
24 (12.6%) |
20 (12.7%) |
4 (12.1%) |
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– Others (golimumab, secukinumab, ….) |
21 (11%) |
16 (10.2%) |
5 (15.2%) |
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Abbreviations: SpA, spondyloarthropathy; AS, ankylosing spondylitis; PsA, psoriatic arthritis; IBD, inflammatory bowel disease; CRP, C-reactive protein; NSAID, nonsteroidal anti-inflammatory drug; DMARD, disease-modifying antirheumatic drug, HCQ-hydroxychloroquine, AZA-azathioprine |
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To cite this abstract in AMA style:
Gevorgyan O, Sarran RD, Merrill PT, Block JA, Castrejon I. Prevalence of Anterior Uveitis in Patients with Spondyloarthropathy in a Single US Academic Center: A Retrospective Study from Routine Care [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/prevalence-of-anterior-uveitis-in-patients-with-spondyloarthropathy-in-a-single-us-academic-center-a-retrospective-study-from-routine-care/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-anterior-uveitis-in-patients-with-spondyloarthropathy-in-a-single-us-academic-center-a-retrospective-study-from-routine-care/