Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

Muhammad A. Khan, Muhammad Haroon, James T. Rosenbaum

Research output: Contribution to journalReview article

21 Scopus citations

Abstract

Ankylosing spondylitis (AS) and related forms of spondyloarthritis (SpA) are associated with some extra-articular features, and the most common symptomatic association is with acute anterior uveitis (AAU). Thus, approximately 40 % of patients with AS will experience a sudden onset of a unilateral anterior uveitis sometime during the course of their disease. Patients with AAU, especially those who are HLA-B27 positive, should be questioned about inflammatory low back pain and also evaluated for other clinical features of SpA. Since a prolonged delay in diagnosis is common among SpA patients and occurrence of AAU may be the reason for their first interaction with medical care, occurrence of AAU presents a unique opportunity for identifying such undiagnosed SpA patients. Therefore, a novel evidence-based algorithm called Dublin Uveitis Evaluation Tool (DUET) has been proposed to guide ophthalmologists and primary care physicians to refer appropriate AAU patients to rheumatologists. In a large two-phase study, approximately 40 % of patients presenting with idiopathic AAU were noted to have undiagnosed SpA, and DUET algorithm was noted to have excellent sensitivity (96 %) and specificity (97 %). It has a positive likelihood ratio (LR) 41.5 and negative LR 0.03. In most instances, the eye inflammation responds well to corticosteroid and mydriatic eye drops and without the need for additional therapy. Use of oral corticosteroids is reserved for patients, especially with associated chronic inflammatory bowel disease or psoriatic arthritis presenting with bilateral, chronic, anterior, and/or intermediate uveitis, and this treatment is rarely needed for more than a couple of weeks. A very small percentage may be more refractory to such treatment and require potential novel therapies, including the use of tumor necrosis factor blockers.

Original languageEnglish (US)
Article number59
JournalCurrent rheumatology reports
Volume17
Issue number9
DOIs
StatePublished - Sep 3 2015

Keywords

  • Acute anterior uveitis
  • Ankylosing spondylitis
  • Anti-tumor necrosis factor
  • DUET algorithm
  • Diagnosis
  • HLA-B27
  • Inflammatory bowel disease
  • Iritis
  • Psoriatic arthritis
  • Spondyloarthritis
  • Treatment
  • Uveitis

ASJC Scopus subject areas

  • Rheumatology

Fingerprint Dive into the research topics of 'Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye'. Together they form a unique fingerprint.

  • Cite this