Background Acute anterior uveitis (AAU) is the most common type of uveitis and could be the leading sign for de novo diagnosis of spondyloarthropathies (SpA), the most frequent systemic diseases related to anterior uveitis (AU). The occurrence of AU often doesn't parallel articular disease activity. There is a male predominance around 2-3:1 using MRI scans of the sacroiliac joints1, women are underdiagnosed.
Objectives 1.Definition of clinical profile and etiological typification in female patients with AU referred to an Uveitis Unit in a tertiary hospital. 2.Describe the differences due to age at onset of ocular disease. 3.Study of clinical behaviour in women with AU with de novo diagnosis of SpA.
Methods Observational cross-sectional descriptive study in women with complicated and relapsing AU referred to HUC from Jan 2005 to Dec 2014 for non-infectious systemic disease screening or established disease control. Etiological typification according to the ocular presentation and affectation pattern was made. Used criteria: EA NY, ASAS 2009, FIWOS 2010. Statistical analysis: Chi-square test.
Results From 698 patients referred, 170 were female with a median age 50,7 years (±17,03) and a median follow-up of 9,05 years (±8). Ocular presentation in 7/170 women had a childhood-onset (<16 years), in 24/170 women had an elderly-onset (≥65 years). Ocular pattern and diagnosis based on age at onset of ocular disease are shown in image 1. 14% patients (24/170) developed another inflammatory ocular affectation. 60,5% patients developed ocular complications. Related to diagnosis highlights macular edema associated with sarcoidosis (33,3%)(p<0.025). Etiological typification: 12% of patients (21/170) had previous rheumatological diagnosis. Adult-onset (12%), elderly-onset (12%),against childhood-onset (43%):7 ankylosing spondylitis (AS)(4%) with median age at diagnosis 40,4 years,2 undifferentiated SpA (1,2%), others (1 multiple sclerosis, 1 ulcerative colitis)(1,2%). 16% of women had SpA as de novo diagnosis: 10 AS, 2 psoriatic SpA, 2 SAPHO syndrome, 2 enteropathic SpA (Crohn, Whipple), 5 non-radiographic SpA (3%). Half of the patients had AU as first sign of disease, after inflammatory lumbalgia in 16% of patients and concomitant begin in the remaining patients. Median age at diagnosis 48,5 years with mean time to develop AU of 9,6 years.
Conclusions 1. 24,3% of patients were women who had AU. 14% had elderly-onset of ocular disease and 4% had childhood-onset. 2. Most frequent ocular patterns were RUAAU and UAAU, with predominance in adult and elderly onset groups, respectively. In childhood-onset group CAU was predominant. 60,5% of women developed ocular complications, highlighting synechiae and cataracts. 3.Etiological typification highlights idiopathic AU (28%) and AU secondary to SpA (18,4%) in women, is still relevant B27 associated UAAU in elderly-onset and JA in childhood-onset. 4. SpA was de novo diagnosed in 16% of women, with non-radiographic axial SpA in a 3%. AU was the leading sign in half of the patients.
Van der Horst BruinsmA IE et al. Female patients with ankylosing spondylitis:analysis of the impact of gender across treatment studies. Ann Rheum Dis 2013;72:1221-4.
Disclosure of Interest None declared