A referable clinical pattern of spondyloarthritis-associated uveitis

Costin Traian Mitulescu,Liliana-Mary Voinea,Radu Ciuluvică,Sînziana Istrate,Claudiu Costinel Popescu,Constantin Laurențiu Oprea,Denisa Predețeanu

doi:10.22336/rjo.2018.23

Abstract

Objective. The aim of the study was to identify a clinical pattern of spondyloarthritis (SpA)-associated uveitis in order to facilitate proper rheumatologic referral by ophthalmologists. Methods. Demographic data were recorded and acute phase reactants were measured using standard methods between May and August 2017, for all adult patients (age > 18 years) presenting with acute uveitis (standardization of uveitis nomenclature). Afterwards, they were referred to a rheumatology clinic to be screened for the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria of SpA. SpA and non-SpA patients were then compared using appropriate statistical tests (significant if p < 0.05). All the patients offered a written informed consent and the study was approved by the local ethics committee. Results. The sample included 67 subjects, of whom 32 (47.8%) were classified with SpA, of whom 21 were known with this diagnosis (median disease duration of 13.6 years), while 11 (34.4% of the SpA subgroup) fulfilled the ASAS classification criteria for SpA without a prior diagnosis. Compared to non-SpA patients, SpA patients were more frequently male urban dwellers, they were significantly younger, they had a higher prevalence of HLA-B27 and recurrent uveitis, and they had higher median of C-reactive protein and lower median of white blood counts. Conclusions. Uveitis is an important revelatory manifestation of SpA. Young men presenting in an ophthalmology department with acute anterior uveitis and inflammatory back pain should be referred to a rheumatology unit. Abbreviations: AAU = Acute Anterior Uveitis, AS = Ankylosing Spondylitis, ASAS = Assessment Of Spondyloarthritis International Society, CRP = C-Reactive Protein, ESR = Erythrocyte Sedimentation Rate, HLA = Human Leukocyte Antigen, IBP = Inflammatory Back Pain, IBD = Inflammatory Bowel Disease, IL = Interleukin, MRI = Magnetic Resonance Imaging, Nsaids = Non-Steroidal Anti-Inflammatory Drugs, SD = Standard Deviation, Spa = Spondyloarthritis, Tnfα = Tumour Necrosis Factor Alpha, WBC = White Blood Count.

Highlights

Spondyloarthritis (SpA) is a group of chronic inflammatory diseases which have common genetic predisposition (HLA-B27) and clinical features such as chronic inflammatory back pain (IBP) revealed by sacroiliac bone oedema and sacroiliitis in young adults, sometimes with asymmetric oligo-articular involvement of large joints
The Assessment of Spondyloarthritis International Society (ASAS) proposed classification criteria for axial SpA patients [1,2]: patients aged less than 45 years with back pain for more than 3 months can be categorized with axial SpA if they have either sacroiliitis on imaging and at least one SpA feature, either HLAB27 or at least two other SpA features
Assessment of SpondyloArthritis International Society (ASAS) proposed classification criteria for peripheral SpA [4]: a patient with arthritis or enthesitis or dactylitis is classified with peripheral SpA if he or she has at least one of the following criteria: psoriasis, inflammatory bowel disease (IBD), preceding infection, HLA-B27, uveitis, sacroiliitis on imaging; or at least two of the following criteria: arthritis, enthesitis, dactylitis, IBP in the past, positive family history for SpA

Summary

Introduction

Spondyloarthritis (SpA) is a group of chronic inflammatory diseases which have common genetic predisposition (HLA-B27) and clinical features such as chronic inflammatory back pain (IBP) revealed by sacroiliac bone oedema and sacroiliitis in young adults, sometimes with asymmetric oligo-articular involvement of large joints. Sacroiliitis is defined either as bilateral grade 2– 4 or as unilateral grade 3–4 sacroiliitis on standard radiographs, fulfilling the modified New York criteria [3], either sacroiliac bone marrow oedema/ osteitis on magnetic resonance imaging (MRI). The cited SpA features include inflammatory back pain, arthritis, uveitis, heel enthesitis, dactylitis, psoriasis, inflammatory bowel disease, good response to non-steroidal anti-inflammatory drugs (NSAIDs), and family history of SpA, HLA-B27, and elevated C reactive protein (CRP). ASAS proposed classification criteria for peripheral SpA [4]: a patient with arthritis or enthesitis or dactylitis is classified with peripheral SpA if he or she has at least one of the following criteria: psoriasis, IBD, preceding infection, HLA-B27, uveitis, sacroiliitis on imaging (radiographs or MRI); or at least two of the following criteria: arthritis, enthesitis, dactylitis, IBP in the past, positive family history for SpA. The diagnosis of peripheral SpA is used until the patient fulfils the classification criteria for a definite disease from the SpA group

Methods

Results

Conclusion