Background Uveitis can be the first manifestation in patients with spondyloarthropathy (spA).
Objectives To investigate the frecuency and pattern of presentation uveitis as the first clinical manifestation in patients with spA.
Methods In this study we include the patients with uveitis attended simoultaneosly by ophthalmologists and rheumatologists in our Uveitis Clinic between June 1997 and October 2000. A clinical preestablished protocol based on the pattern of uveitis and the patient´s symptoms was used to achieve diagnosis in each case. Diagnostic evaluation included, a clinical history, an ophthalmologic examination, hemogram, biochemistry, ESR, a fluorescent treponemal antibody absortion test, urinary test and a chest x-ray. In addition, in patients with previous flares of uveitis a pelvis x-ray was done. Any type of studies were ordered according to protocol.
Results Date from 376 were recorded in our date base. Seventy (18.6%) had some type of spA, 49 (70% of patients with spA) were male and the mean age of this group was 44.7, SD:15.7. Forty patients (57%) were previously diagnosed (33 ankylosing spondylitis (AS), 4 Reiter´s syndrome (RS), 2 inflammatory bowel disease (EII) and 1 undifferentiated spA (UspA)); thirty (43%) were undiagnosed and uveitis was the first manifestation (15 AS, 5 psoriatic arthritis (PA), 4 RS, 4 EII, 1 UspA and 1 SAPHO). The most frequent clinical pattern was acute (only one was chronic), anterior (only two were panuveitis) and unilateral (only four were bilateral) uveitis. There were two main keys to achieve the diagnosis of spA that were the recurrence of a type of pattern of uveitis (acute, recurrent and unilateral) and the presence of lumbar or articular pain in addition to the uveitis flare. HLA B27 was found in 47 (66%) patients, 37 AS, 4 RS, 4 PA, one UspA and one SAPHO syndrome. All patients received local treatment. Sistemic corticosteroids, sulfasalazine and metotrexate was associated in 8, 8 and 1 patient respectively.
Conclusion Uveitis was the first manifestation in 43% of the patients with spA, attended prospectively in a multidisciplinary outpatient clinic of uveitis. That is why the collaboration between ophthalmologics and rheumatologics contribute to a better diagnosis and treatment of patients. In case in which this close collaboration could not be possible, all patients with acute unilateral recurrent uveitis and those with rheumatic complains, should be referred to a rheumatologist, in spite of the absence of rheumatic symptoms.
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