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THU0068 Clinical Risk Factors Associated with the Development of Systemic Disease in Patients with Isolated HLA-B27 Uveitis
  1. C. Vázquez-Triñanes1,
  2. A. Rivera1,
  3. M. Freire1,
  4. M. Alonso1,
  5. I. Villaverde1,
  6. M. Pérez-Rodríguez2,
  7. M. del Pozo3,
  8. B. Sopeña1
  1. 1Thrombosis and Vasculitis Unit
  2. 2Infectious Disease Unit
  3. 3Clinical Laboratory, H. Xeral, Vigo, Spain

Abstract

Background HLA-B27 uveitis has been defined as a unilateral acute syndrome without associated systemic disease [1]. However, in some patients the ocular disease precedes the occurrence of systemic diseases as ankylosing spondylitis (AS), reactive arthritis (ReA), spondyloarthritis (SpA), undifferentiated spondyloarthritis (UspA), SpA associated with psoriasis and SpA associated with inflammatory bowel disease (SpA-IBD)

Objectives To determine how many patients with isolated HLA-B27 uveitis will develop systemic disease and to identify the clinical risk factors associated with their occurrence

Methods Patients with HLA-B27 and at least 1 episode of uveitis diagnosed by an ophthalmologist were identified among all adult patients (>14 years) consecutively typed for HLA-B27 in our hospital from January 1, 2006 to December 31, 2011. These patients were seen in our Unit to perform a complete rheumatologic examination to look for prior or concurrent systemic disease associated with HLA-B27. Also, a comprehensive clinical, radiological and analytical evaluation to exclude autoimmune and infectious diseases that may cause uveitis was carried out. Follow-up was defined as the period of time from the first episode of uveitis confirmed by an ophthalmologist to the latest medical evaluation. Values are shown as average and standard deviation (SD) and percentage for quantitative and qualitative variables respectively. The T test and chi squared are used for comparisons

Results During the 6 years of study period 1803 patients were typed for HLA-B27, of which 293 tested positive (16%). Of these patients, 42 (14%) had at least 1 episode of uveitis. 14 of these patients (33%) were excluded from the study because prior or concurrent systemic disease related with HLA-B27 positivity (8 AS, 4 UspA, 1 ReA, 1 SpA-IBD). So, a cohort of 28 patients with isolated HLA-B27 uveitis, 15 males (54%), 36.9years ± 14.19 (15-60), was follow-up during a mean of 7.7 years ±5.89 (1-20). 9 patients (33%) developed systemic disease: 5 AS, 3 UspA and 1 SpA-IBD. The diagnosis of the systemic disease was made 3.7 years ±4 (0.5-12) after the onset of uveitis. Bilateral uveitis (including alternating uveitis) was identified as the only significant risk factor for the development of systemic disease, OR 8.3 (95% confidence interval 1.25-55.35, p=0.03), so a multivariate analysis was not performed.The risk for systemic disease was 1.8 times greater for patients with bilateral HLA-B27 uveitis than for patients with unilateral involvement. Significant differences with age, gender, location of the uveitis, chronicity, response to treatment and ophthalmic complications were not found between patients with isolated uveitis and those who developed systemic diseases

Conclusions A third of patients who present with isolated HLA-B27 uveitis will develop associated systemic disease. Bilateral ocular involvement was identified as the only significant risk factor for the occurrence of systemic disease in the present cohort

References

  1. Jakob E, Reuland MS, Mackensen F, Harsch N, Fleckenstein M, Lorenz HM, et al. Uveitis Subtypes in a German Interdisciplinary Uveitis Center- Analysis of 1916 Patients. J Rheumatol 2009; 36:127-36

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.5872

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