Session Type: Abstract Submissions (ACR)
Background/Purpose: Anterior uveitis (AU) is the most common form of uveitis in western countries with an annual incidence rate of about eight new cases for every 100,000 inhabitants. AU may occur in the absence of associated systemic disease. However, it has been reported that about 25% of AU patients have an associated systemic condition; the most commonly associated one being seronegative spondyloarthritis (SpA). Since many of the conditions initially diagnosed as idiopathic anterior uveitis are later found to be a SpA-associated disorder, we hypothesised that a higher than expected rate of associated-SpA might be found by using a systematic clinical evaluation protocol in AU patients.
Methods: Prospective multicentre non-comparative cohort study. Patients with no previous diagnosis of any associated immune-mediated condition and clinically significant AU were included in this study. Clinically significant AU was defined as either recurrent AU (at least two episodes) or non-recurrent HLAB27 + associated AU. All patients included in the study underwent a complete physical and ophthalmologic examination and a thorough check-up of their systems including x-ray and MRI study of the sacroiliac joints, for those in which SpA was clinically suspected.
Results: A total of 199 patients from 29 tertiary referral centres were included in the study. From all included patients suffering from AU, 148 patients (74.3%) were HLAB27+. After an initial systematic clinical evaluation protocol, 122 patients (61.3%) were newly diagnosed with a type of spondyloarthritis, of which 94 patients (47.2%) fullfilled the ASAS criteria for axial spondyloarthritis and 28 patients (14%) fullfilled the ASAS criteria for peripheral spondyloarthritis. A positive HLAB27 haplotype was found in 89 (94%) of patients newly diagnosed with axial spondyloarthritis and in 20 (71.4%) of those patients newly diagnosed with peripheral spondyloarthritis. Other associated diagnoses included ankylosing spondylitis, diagnosed based on New York criteria, in 78 patients (39.2%), psoriasis in 10 patients (5%), inflammatory bowel disease in 3 patients (1.5%), and reactive arthritis in 1 patient (0.5%).
Conclusion: These preliminary results show that in a large prospective cohort almost 75% of patients with clinically significant idiopathic AU have an associated underlying SpA which more than double that of previously reported prevalence. The diagnosis of idiopathic uveitis seems to depend greatly on the extent of the evaluation for an underlying condition. These results should be considered in the management and therapeutic decision-making for patients with recurrent AU.
M. Cordero Coma,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-spondyloarthritis-in-anterior-uveitis-patients-the-sentinel-study/