Arthritis Rheumatol. 2022 Jul 29. doi: 10.1002/art.42315. Online ahead of print.
ABSTRACT
OBJECTIVE: To analyse the prevalence of spondyloarthritis (SpA) in patients with acute anterior uveitis (AAU), to identify parameters associated with SpA presence, and to evaluate referral algorithms.
METHODS: Prospectively recruited consecutive patients with non-infectious AAU underwent structured rheumatologic assessment including magnetic resonance imaging of sacroiliac joints allowing a definitive diagnosis/exclusion of concomitant SpA. Fisher's exact test and Mann-Whitney U test were used to compare AAU patients with and without SpA. Furthermore, logistic regression analyses were performed. Sensitivity, specificity, positive predictive value, positive and negative likelihood ratios were analysed for referral strategies.
RESULTS: Out of 189 AAU patients, 106 (56%) were diagnosed with SpA. The majority (93%) had predominantly axial SpA, 7 patients peripheral SpA. In 74 patients (70%), the SpA diagnosis was established for the first time. In multivariable logistic regression analysis, psoriasis (OR 12.5 [95%CI 1.3-120.2]), HLA-B27 positivity (OR 6.3 [95%CI 2.4-16.4]), elevated CRP (OR 4.8 [95%CI 1.9-12.4]) and male sex (OR 2.1 [95%CI 1.1-4.2]) were associated with SpA presence. None of the ophthalmologic parameters were predictive for SpA. The Dublin Uveitis Evaluation Tool showed higher specificity for SpA recognition than the ASAS referral tool (42% vs. 28%), which had a slightly higher sensitivity (78% vs. 80%). However, both referral strategies would have missed more than 20% of SpA patients.
CONCLUSION: We revealed a high prevalence of both, overall and previously undiagnosed, SpA in AAU patients. Therefore, we propose rheumatologic evaluation for all AAU patients with musculoskeletal symptoms.
PMID:35905288 | DOI:10.1002/art.42315