Abstract
Background: Acute anterior uveitis (AAU) is a relatively common extra-musculoskeletal manifestation of axial spondyloarthritis (axSpA); however, data on the prevalence of active sacroiliitis in patients with AAU are limited. Methods: 102 patients with AAU and 39 healthy subjects (HS) underwent clinical assessment and sacroiliac joint MRI. Patients with absence of active sacroiliitis were reassessed after two years. International Spondyloarthritis Society (ASAS) classification criteria for axSpA (regardless of patient’s age) and expert opinion for definitive diagnosis of axSpA were applied. Results: Although chronic back pain was equally present in both groups, bone marrow edema (BME) in SIJ and BME highly suggestive of axSpA was found in 52 (51%) and in 33 (32%) patients with AAU compared with 11 (28%) and none in HS, respectively. Out of all AAU patients, 41 (40%) patients fulfilled the ASAS classification criteria for axSpA, and 29 (28%) patients were considered highly suggestive of axSpA based on clinical features. Two out of the 55 sacroiliitis-negative patients developed active sacroiliitis at the two-year follow-up. Conclusions: One-third of patients with AAU had active inflammation on SIJ MRI and clinical diagnosis of axSpA. Therefore, patients with AAU, especially those with chronic back pain, should be referred to a rheumatologist, and the examination should be repeated if a new feature of SpA appears.
Highlights
Non-infectious acute anterior uveitis (AAU) is an autoimmune inflammatory disease that accounts for at least 50% of the cases of non-infectious uveitis
Patients with Acute anterior uveitis (AAU) had more first-degree relatives with extra-musculoskeletal manifestation of axial spondyloarthritis (axSpA) and participated less frequently in regular sport activities compared to healthy subjects (HS) (17 (17%) vs. 0 (0%) and 34 (33%) vs. 23 (59%); p = 0.003 and 0.007; respectively)
The majority of AAU patients was HLA-B27 positive compared to HS (77 (75%) vs. 2 (5%) respectively, p < 0.0001)
Summary
Non-infectious acute anterior uveitis (AAU) is an autoimmune inflammatory disease that accounts for at least 50% of the cases of non-infectious uveitis. HLA-B27 is known as a highly significant risk factor for the development of spondyloarthritis (SpA), a chronic inflammatory rheumatic disease affecting the axial skeleton as well as the peripheral joints [2]. AAU is the most common extra-musculoskeletal manifestation of axial SpA (axSpA) and is found in about one-third of patients during the course of the disease and may even precede its onset [3,4,5]. AAU in patients with SpA or in the HLA-B27-positive subjects presents with specific features. It always manifests as an acute, relapsing, serofibrinous, and non-infectious intraocular inflammation unilaterally. Acute anterior uveitis (AAU) is a relatively common extra-musculoskeletal manifestation of axial spondyloarthritis (axSpA); data on the prevalence of active sacroiliitis in patients with AAU are limited. Patients with AAU, especially those with chronic back pain, should be referred to a rheumatologist, and the examination should be repeated if a new feature of SpA appears
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