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Spondyloarthritis
Original article
Prevalence of axial spondyloarthritis in patients with acute anterior uveitis: a cross-sectional study utilising MRI
  1. Mark P Sykes1,
  2. Louise Hamilton1,
  3. Colin Jones2 and
  4. Karl Gaffney1
  1. 1 Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  2. 2 Department of Ophthalmology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  1. Correspondence to Dr Mark P Sykes; drmarksykes{at}hotmail.co.uk

Abstract

Objective Acute anterior uveitis (AAU) is the most common extra-articular manifestation of axial spondyloarthritis (axSpA). In this study, patients presenting with AAU were evaluated clinically and with MRI in order to estimate the prevalence of axSpA.

Methods Consecutive patients presenting to a university teaching hospital between February 2014 and March 2015 with AAU were invited to participate. Those with a history of chronic back pain (CBP) beginning <45 years were evaluated clinically and with MRI of thoracolumbar spine and sacroiliac joints.

Results Of 366 patients with AAU, 57 had a pre-existing diagnosis of axSpA; 77 others fulfilled the study eligibility criteria and 73 (95%) completed the study. Seventeen patients (23.3%) were diagnosed with axSpA by an experienced rheumatologist; of these, eight were human leucocyte antigen-B27 negative. Including those with a previous diagnosis, this equates to a minimum axSpA prevalence of 20.2%; one-quarter of patients were previously undiagnosed.

Conclusion This is the first study to actively search for the presence of axSpA in unselected patients presenting with AAU utilising MRI as an essential part of the assessment. There is a significant burden of undiagnosed axSpA in patients with AAU, but there does not appear to be a simple mechanism for screening. We recommend that ophthalmologists refer all patients with AAU with CBP, onset <45 years, to rheumatology for further evaluation.

  • ankylosing spondylitis
  • spondyloarthritis
  • magnetic resonance imaging
  • low back pain

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000553

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    Footnotes

    • Contributors All authors were involved in the data collection and had input into the final report.

    • Funding This study was funded by AbbVie Ltd.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ethical approval was provided by NRES Committee East of England – Norfolk (reference number 13/EE/0442).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Additional data may be available by contacting the corresponding author.