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Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

  • Spondyloarthritis (MA Khan, Section Editor)
  • Published:
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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.

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Conflict of Interest

Muhammad A. Khan has consulted for Abbvie, Amgen, Novartis, Celgene, Janssen, and Crescendo Bioscience.

Muhammad Haroon is a member of advisory boards for Abbvie and Celgene Ireland.

James T. Rosenbaum has consulted for Abbvie, UCB, Allergan, EMD Serono, Novartis, Regeneron, Xoma, Santen, Genentech, Sanofi, Portage, Topivert, Cavtherx, and Auventx.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Muhammad A. Khan

  2. Division of Rheumatology, Department of Medicine, University Hospital Kerry, Kerry, Ireland

    Muhammad Haroon

  3. University College Cork, Cork, Ireland

    Muhammad Haroon

  4. Legacy Devers Eye Institute, Legacy Health System, Portland, Oregon

    James T. Rosenbaum

  5. Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon

    James T. Rosenbaum

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  1. Muhammad A. Khan
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Correspondence to Muhammad A. Khan.

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Khan, M.A., Haroon, M. & Rosenbaum, J.T. Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye. Curr Rheumatol Rep 17, 59 (2015). https://doi.org/10.1007/s11926-015-0536-x

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