Original article
Human Leukocyte Antigen-B27–Associated Uveitis: Long-term Follow-up and Gender Differences

https://doi.org/10.1016/j.ajo.2007.11.009Get rights and content

Purpose

To evaluate clinical features and gender differences in human leukocyte antigen (HLA)-B27–associated acute anterior uveitis (AAU) in long-term follow-up.

Methods

The clinical records of 177 HLA-B27–positive patients (96 males [54%] and 81 females [46%]) who sought treatment for acute anterior uveitis (AAU) at the University Medical Center Utrecht between January 1995 and December 2005 were evaluated. All patients had a minimum follow-up of at least one year. The clinical data were analyzed at standardized intervals (one, five, and 10 years after the onset of uveitis).

Results

Average age at onset of AAU was 36 years, with no differences between males and females. HLA-B27–associated systemic disease developed earlier in males than in females (31 vs 37 years; P = .021). Consequently, at onset of AAU, HLA-B27–associated systemic disease were more frequent in males than in females (25/75 [33%] males vs nine/54 [17%] females; P = .030); however over time, males and females were at equal risk of developing a HLA-B27–associated systemic disease. Bilateral uveitis developed more frequently in females (6/45 [13%] of males vs 11/35, [31%] of females; P = .05). In none of the patients did bilateral visual acuity of less than 0.5 develop after the follow-up of 10 years.

Conclusions

The long-term visual prognosis of HLA-B27–associated AAU was favorable, despite the frequent attacks of severe AAU. At the onset of AAU, the prevalence of HLA-B27–associated systemic disease was more frequent in males, but after the onset of uveitis, the risk of developing a HLA-B27–associated systemic disease is similar for both males and females.

Section snippets

Methods

In this retrospective study, the clinical records of all 288 patients with HLA-B27–associated AAU seen at the University Medical Centre in Utrecht between January 1995 and December 2005 were evaluated. In the present series were included all 177 patients with a follow-up time of at least one year and in whom complete records could be traced.

Our hospital is a tertiary referral center, and all patients with uveitis (the exception being the patients with the first episode of anterior uveitis who

Results

General characteristics of all patients are given in Table 1. The male-to-female ratio was 1.1:1, and the average age at onset of uveitis was 36 years, with no differences between males and females. The onset of HLA-B27–associated systemic diseases diagnosed by a rheumatologist occurred earlier in males than in females (30 vs 37 years; P = .021), with similar results for AS solely (Table 1).

The average number of attacks per followed year was 0.9, with no differences between males and females.

Discussion

Our study documents a good visual prognosis for patients with HLA-B27–associated AAU in the long-term follow-up and illustrates that the risk of developing HLA-B27–associated systemic diseases over time was similar in male and female patients. However, an associated systemic disorder developed in males at an earlier age and usually before the onset of uveitis, in contrast to female patients, in whom systemic disease developed approximately six years later and mainly after the onset of uveitis.

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