Description and Prevalence of Spondyloarthritis in Patients with Anterior Uveitis: The SENTINEL Interdisciplinary Collaborative Project

doi:10.1016/j.ophtha.2016.03.010

Ophthalmology

Volume 123, Issue 8, August 2016, Pages 1632-1636

https://doi.org/10.1016/j.ophtha.2016.03.010 Get rights and content

Purpose

To describe and analyze the prevalence of spondyloarthritis (SpA) in patients with anterior uveitis (AU).

Design

Multicentric, observational, prospective study.

Participants

Consecutive patients with AU who were human leukocyte antigen (HLA)-B27 positive or HLA-B27 negative with more than 1 episode of AU separated by at least 3 months were selected. Patients with a previous diagnosis of SpA were excluded.

Methods

Included patients were evaluated by an ophthalmologist and a rheumatologist following a predefined visit schedule.

Main Outcome Measures

Sociodemographic and clinical variables including the diagnosis of SpA according to Assessment of SpondyloArthritis International Society (ASAS) criteria and an exhaustive ophthalmological examination (best-corrected visual acuity, intraocular pressure, biomicroscopic examination of the anterior and posterior segment of the eye, cataract evaluation, optical coherence tomography evaluating both the 1-mm central retina thickness and the optic nerve head and retinal nerve fiber layer, and visual field in a dark room with 1 eye patched) were collected. Baseline descriptive, bivariate, and concordance analyses were performed.

Results

We included 798 patients, mostly men (59%) with a mean age of 45 years; 60% were AU HLA-B27 positive, and 40% had recurrent negative AU HLA-B27. A total of 50.2% and 17.5% of patients presented axial and peripheral SpA according to ASAS criteria, respectively. Patients with AU who were HLA-B27 positive were more frequently diagnosed with axial (69.8% vs. 27.3%, P < 0.0001) and peripheral SpA (21.9% vs. 11.1%, P < 0.0001) than patients with recurrent negative AU HLA-B27. In general, we did not detect important differences between groups in the ophthalmologic variables.

Conclusions

A large percentage of patients with clinically significant AU have an undiagnosed SpA. This percentage is even higher if the HLA-B27 haplotype is positive.

Section snippets

Study Design

The SENTINEL project was an interdisciplinary, collaborative, multicenter, prospective study promoted by the Spanish Spondyloarthropathies Study Group of the Spanish Society of Rheumatology. For this purpose, a standardized protocol was generated. This project was approved by the ethics committee of one of the participating centers, and all patients signed the informed consent. A total of 66 centers (distributed throughout Spain) were recruited from October 2008 to February 2013.

Inclusion and Exclusion Criteria

We selected

Results

The study sample comprised 798 patients, most of whom were men (59%) with a mean age of 45±13 years (Table 1). A total of 475 patients (60%) were AU HLA-B27 positive, and 323 patients (40%) had recurrent negative AU HLA-B27.

At baseline, 77.8% of patients reported chronic back pain before age 45 years, and 44.1% of patients reported inflammatory back pain according to ASAS criteria. However, 60.4% of the study sample had a good response to nonsteroidal anti-inflammatory drugs, 35% of patients

Discussion

We have described the baseline results of what is to our knowledge the largest cohort of patients with AU who have been screened systematically for associated and underdiagnosed SpA. In our cohort, approximately half of patients with AU full-field new ASAS criteria for axial or peripheral SpA. This percentage was higher in the subgroup of patients who were HLA-B27 positive compared with those who were HLA-B27 negative.

It has been shown that those with HLA-B27-positive–associated AU have more

Acknowledgments

The authors thank M^a Jesús García de Yébenes for the statistical analyses and the rheumatologists and ophthalmologists who took part in the project.

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Clinical characteristics of psoriatic arthritis and axSpA patients with uveitis
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To describe the clinical characteristics and risk factors for uveitis flare in our psoriatic arthritis and axSpA patient cohorts and to describe possible associations of the different disease domains and uveitis flares.
Retrospective analysis of patients followed prospectively in the SpA and PsA clinics at the Toronto western hospital (January 2004–December 2020).
Of the 3306 included, 1724 patients had axSpA and 1582 PsA. 30.2% of the axSpA cohort, and 7.6% of the PsA population were diagnosed with uveitis. The annual rate of flares per person at risk was 12.1% in the axSpA cohort, vs 1.7 in the PsA. In the axSpA patients, 68% were HLA*B27+, compared 16% of the PsA patients. In the axSpA cohort, higher CRP (HR 1.009, p = .004) increased the risk of a uveitis flare, while biologic agents decreased the risk of flare (HR .702, p = .040) in patients with uveitis. In the PsA cohort, being HLA*B27+ (HR 3.084, p = .007) increased the risk of a uveitis flare, while being on a DMARD decreased the risk of a flare in patients with uveitis (HR .262, p = .0088).
Uveitis is a common complication seen in inflammatory arthritis, with a prevalence of 30% in the SpA vs 7.6% in PsA. Uveitis is more common in the axSpA population than in PsA. Even though HLA-B27 is more common in the axSpA population, it constitutes a risk for uveitis only in the PsA population.
Describir las características clínicas y los factores de riesgo de las recaídas de uveítis en nuestras cohortes de pacientes con artritis psoriásica (APs) y espondilitis anquilosante axial (axSpA), así como describir las posibles asociaciones de los diferentes dominios de la enfermedad y los brotes de uveítis.
Análisis retrospectivo de pacientes seguidos prospectivamente en las clínicas de espondilitis y artritis psoriásica en el Toronto Western Hospital, entre enero del 2004 y diciembre del 2020.
De los 3.306 pacientes incluidos, 1.724 tenían axSpA y 1.582 APs. El 30,2% de la cohorte de axSpA y el 7,6% de la población con APs fueron diagnosticados con uveítis. La tasa anual de recaídas por persona en riesgo fue del 12,1% en la cohorte de axSpA, frente al 1,7% en la APs. En los pacientes con axSpA, el 68% eran HLA-B27⁺, en comparación con el 16% de los pacientes con APs. En la cohorte de axSpA, una PCR más alta (HR: 1,009; p = 0,004) aumentó el riesgo de brote de uveítis, mientras que los agentes biológicos lo redujeron (HR: 0,702, p = 0,040) en pacientes con uveítis. En la cohorte de artritis psoriásica, ser HLA-B27⁺ (HR: 3,084; p = 0,007) aumentó el riesgo de brote de uveítis, mientras que estar en un DMARD convencional disminuyó el riesgo de brote en pacientes con uveítis (HR: 0,262; p = 0,0088).
La uveítis es una complicación frecuente de la artritis inflamatoria, con una prevalencia del 30% en la espondilitis anquilosante axial, frente al 7,6% en la APs. La uveítis es más común en la población con axSpA que en la APs. Si bien HLA-B27 es más común en la población con espondilitis anquilosante axial, constituye un riesgo de uveítis solo en la población con APs.
Uveitis and immunosuppressive treatment: Experience in a multidisciplinary uveitis unit
2023, Revista Colombiana de Reumatologia
Por su asociación con enfermedades y tratamiento sistémicos, la uveítis requiere un abordaje multidisciplinario; no obstante, existen pocos estudios en unidades de uveítis en Latinoamérica.
Describir las características clínicas y terapéuticas en pacientes con uveítis asistidos en la Unidad de Uveítis del Hospital de Clínicas Dr. Manuel Quintela de Montevideo, Uruguay.
Estudio observacional, descriptivo, transversal en pacientes ≥ 15 años, atendidos de octubre del 2018 a enero del 2020 con diagnóstico de uveítis.
Se incluyeron 103 pacientes, con una mediana de edad de 47 años, y 71 (68,9%; p < 0,01) fueron mujeres. La clasificación anatómica fue: uveítis anterior 46,6%, intermedia 1%, posterior 7,8% y panuveítis 44,7%. La etiología se identificó en 58 (56,3%) pacientes, 32 (31,1%) fueron idiopáticas y 13 (12,6%) continuaban en estudio etiológico. Las enfermedades autoinmunes sistémicas se presentaron en el 26,2%, siendo más frecuente la enfermedad de Vogt-Koyanagi-Harada (5,8%). Las espondiloartritis fueron el 5,8% de los casos. La etiología infecciosa se observó en el 19,4%, en tanto que la toxoplasmosis ocular predominó en el 10,7%. El 71,1% de las uveítis no infecciosas requirieron tratamiento inmunosupresor sistémico, siendo el metotrexate el más usado en uveítis anterior (46,4%) e intermedia (100%), y la azatioprina en uveítis posterior (100%) y panuveítis (42,9%). Ocho pacientes (13,6%) requirieron la combinación de ≥ 2 fármacos; de ellos, el 37,5% tuvo uveítis anterior asociada con artritis idiopática juvenil y el 37,5% presentó panuveítis idiopática.
Se logró establecer la etiología en más de la mitad de los pacientes con uveítis, siendo más frecuentes la toxoplasmosis ocular, la enfermedad de VKH y la asociada con SpA. Un alto porcentaje de las uveítis no infecciosas requirieron tratamiento inmunosupresor sistémico, siendo el metotrexate y la azatioprina los más utilizados.
Due to its association with systemic diseases and treatment, uveitis requires a multidisciplinary approach; however, there are few studies in uveitis units in Latin America.
To describe the clinical and therapeutic features of patients treated in the Uveitis Unit of the Hospital de Clínicas Dr. Manuel Quintela in Montevideo, Uruguay.
Observational, descriptive, cross-sectional study in patients aged ≥15 years, attended from October 2018 to January 2020 with a diagnosis of uveitis.
One hundred and three patients were included, with a median age of 47 years and 71 (68.9%; P<.01) were women. The anatomical classification was anterior uveitis 46.6%, intermediate 1%, posterior 7.8%, and panuveitis 44.7%. The aetiology was identified in 58 (56.3%) patients, 32 (31.1%) were idiopathic and 13 (12.6%) were still under aetiological study. Systemic autoimmune diseases occurred in 26.2%, with Vogt-Koyanagi-Harada disease being the most frequent (5.8%). Spondyloarthritis accounted for 5.8% of the cases. Infectious aetiology was observed in 19.4%, with ocular toxoplasmosis predominant in 10.7%. Seventy-one percent of non-infectious uveitis required systemic immunosuppressive treatment, with methotrexate being the most used in anterior (46.4%) and intermediate (100%) uveitis, and azathioprine in posterior (100%) and panuveitis (42.9%). Eight patients (13.6%) required the combination of ≥2 drugs; of them, 37.5% had anterior uveitis associated with juvenile idiopathic arthritis and 37.5% had idiopathic panuveitis.
The aetiology was established in more than half the patients with uveitis. The most frequent were ocular toxoplasmosis, VKH disease, and associated SpA disease. A high percentage of non-infectious uveitis required systemic immunosuppressive treatment, with methotrexate and azathioprine being the most used.
Uveitis as the first symptom in spondyloarthritis and its association with the evolution of the disease. Results from the REGISPONSER registry
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Décrire la date de survenue de l’uvéite antérieure aiguë (UAA) par rapport aux premiers symptômes rhumatismaux et déterminer son association à l’évolution de la spondyloarthrite (SpA) en ce qui concerne l’activité, les lésions structurelles, la capacité fonctionnelle et le traitement.
Il s’agit d’une étude transversale s’appuyant sur les données du registre REGISPONSER (registre national des SpA de la société espagnole de rhumatologie). Trente et un centres ont participé et les patients atteints de SpA selon les critères de l’ESSG ont été inclus entre 2004 et 2007. La classification des patients s’est faite selon la date de survenue de l’uvéite par rapport aux premiers signes rhumatismaux (antérieure, simultanée ou postérieure à l’apparition des symptômes). Nous avons comparé les caractéristiques cliniques, l’activité de la maladie, les lésions radiographiques et la capacité fonctionnelle entre les « UAA survenues avant/simultanément aux premiers symptômes rhumatismaux » et les « UAA survenues après les premiers symptômes ». Pour finir, nous avons analysé l’impact de la date de survenue de l’UAA sur le recours aux anti-rhumatismaux modificateurs de la maladie conventionnels et biologiques (respectivement DMARDcs et DMARDb)
Au total, 2367 patients ont été inclus dans le registre REGISPONSER avec une prévalence de l’UAA de 16,2 % (379 patients). Les patients dont l’UAA précédait/accompagnait les premiers signes rhumatismaux (n = 59) affichaient une meilleure capacité fonctionnelle (BASFI, OR : 0,85 [0,73–0,99]) et des lésions structurelles moins marquées (BASRI au rachis, OR : 0,88 [0,79–0,99]). De plus, dans ce groupe de patients, l’âge d’apparition des premiers symptômes de SpA était plus avancé (OR : 1,05 [1,02–1,09]) et le délai diagnostique plus court (OR : 0,90 [0,84–0,96]) comparativement aux patients ayant développé une UAA après l’apparition des manifestations rhumatismales (n = 229). Aucune différence statistiquement significative concernant l’utilisation des DMARD n’a été observée (27,9 % vs 23,2 % pour l’utilisation des DMARDcs et 15,3 % vs 20,3 % pour l’utilisation des DMARDb chez les patients avec une UAA survenue respectivement avant/simultanément vs après les premiers signes rhumatismaux).
Les patients qui présentaient un premier épisode d’UAA avant/simultanément aux premiers symptômes rhumatismaux avaient une forme moins sévère de la maladie (meilleure capacité fonctionnelle et dommages structuraux limités) et un délai diagnostique plus court ; cependant, la date de survenue de l’UAA n’a montré aucun effet sur les traitements administrés.
Spondyloarthritis
2022, Clinical Immunology: Principles and Practice, Sixth Edition
Spondyloarthritis (SpA) comprises a group of diseases characterized by axial, entheseal, and peripheral joint inflammation in the setting of overlapping nonmusculoskeletal inflammatory manifestations (skin, eye, and gut) and a tendency toward familial aggregation. Typically, autoantibodies are not formed in patients with SpA. The group of diseases includes axial spondylitis (AxSpA), of which ankylosing spondylitis (AS) is the most severe form, and peripheral spondylarthritis, which includes reactive arthritis, psoriatic arthritis (PsA), enteropathic arthritis, and “undifferentiated spondyloarthritis.” Susceptibility to AxSpA has a strong genetic component. In total, over 133 genes have been identified for AS, more than 60 for psoriasis/psoriatic arthritis, and nearly 200 for inflammatory bowel disease. The most commonly recognized genetic factor is the human leukocyte antigen (HLA)-B27, associated especially with AxSpA and PsA. Some susceptibility genes are involved in the T-helper 17 (Th17) and antigen-processing/-presenting pathways. The development of classification criteria and advances in imaging allow for earlier diagnosis. Striking advances have also occurred in treatment with the introduction of biological therapies, such as anti–tumor necrosis factor (TNF), interleukin-17 (IL-17), interleukin-23 (IL-23), and Janus kinase inhibitor therapies.
Uveitis as the first symptom in spondyloarthritis and its association with the evolution of the disease. Results from the REGISPONSER registry
2021, Joint Bone Spine
To describe the time of onset of acute anterior uveitis (AAU) relative to the appearance of rheumatic symptoms and to determine its association with the evolution of the spondyloarthritis (SpA) in terms of activity, structural damage, functional ability and treatment.
This was a cross-sectional study with data extracted from the REGISPONSER (SpA Registry of the Spanish Rheumatology Society). Thirty-one centres participated, and patients with SpA according to the ESSG criteria were included from 2004 to 2007. Patients were classified according to the time of uveitis appearance with regard to rheumatic symptom onset (before, concomitant with, or after rheumatic symptom onset). We compared the clinical characteristics, disease activity, radiographic damage and functional ability between “AAU before or concomitant with rheumatic symptoms” and “AAU after rheumatic symptoms onset”. Finally, we compared whether the time of appearance of AAU had an impact on the use of conventional and biological disease-modifying antirheumatic drugs (csDMARDs and bDMARDs, respectively).
A total of 2367 patients were included in REGISPONSER, with an AAU prevalence of 16.2% (379 patients). Patients with AAU before/concomitant with rheumatic symptom onset (n = 59) exhibited better functional ability (BASFI, OR 0.85 [0.73-0.99]) and less structural damage (spinal BASRI, OR 0.88 [0.79-0.99]). Additionally, this group of patients was older at SpA symptom onset (OR 1.05 [1.02-1.09]) and had a shorter diagnosis delay (OR 0.90 [0.84-0.96]) compared patients with AAU after rheumatic symptom onset (n = 229). No statistically significant differences in the use of DMARDs were noted (27.9% vs 23.2% for csDMARD use and 15.3% vs 20.3% for bDMARD use in patients with AAU before or concomitant with rheumatic symptom onset vs after rheumatic symptom onset, respectively).
Patients presenting with a first episode of AAU before/concomitant with the onset of rheumatic symptoms had less severe disease (better functional ability and less structural damage) and a shorter diagnosis delay; however, the time of AAU onset did not impact the treatments received.

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: *Supplemental material is available at www.aaojournal.org.

: Financial Disclosure(s): The author(s) have made the following disclosure(s): E.L.S.: Fees − AbbVie; Board membership – AstraZeneca; Consultant fees – MSD, Novartis; Grants − AbbVie, MSD, Roche, Pfizer, UCB, Gebro, Grunenthal, Celgene; Payment − for manuscript preparation from AbbVie and Pfizer, for education presentations from BMS and Roche.

: M.C-.C.: Speaker honoraria − AbbVie, Allergan, Angelini; Honoraria in advisory boards − AbbVie and Allergan.

: The SENTINEL project was funded by the Spanish Foundation of Rheumatology.

: Author Contributions:

: Conception and design: Juanola, Cordero-Coma

: Data collection: Juanola, Cordero-Coma

: Analysis and interpretation: Juanola, Santamaría, Cordero-Coma

: Obtained funding: Not applicable

: Overall responsibility: Juanola, Santamaría, Cordero-Coma

: See Editorial on page 1630.

^∗: Members of the SENTINEL Working Group are available in the Appendix (www.aaojournal.org).

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Original articleDescription and Prevalence of Spondyloarthritis in Patients with Anterior Uveitis: The SENTINEL Interdisciplinary Collaborative Project

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Study Design

Inclusion and Exclusion Criteria

Results

Discussion

Acknowledgments

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Prevalence of spondyloarthritis in 504 Chinese patients with HLA-B27-associated acute anterior uveitis

Scand J Rheumatol

Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review

Ann Rheum Dis

Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease

Clin Rheumatol

Early spondyloarthritis in multiracial society: differences between gender, race, and disease subgroups with regard to first symptom at presentation, main problem that the disease is causing to patients, and employment status

Rheumatol Int

Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop

Am J Ophthalmol

Original article
Description and Prevalence of Spondyloarthritis in Patients with Anterior Uveitis: The SENTINEL Interdisciplinary Collaborative Project