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AB0711 Review of management of HLA B27 positive uveitis patient attending a tertiary hospital – how good are we?
  1. B Kapoor1,
  2. K Periyasamy1,
  3. M Babbington1,
  4. A Moorthy2
  1. 1Ophthalmology
  2. 2Rheumatology, Leicester Royal Infirmary, Leicester, United Kingdom

Abstract

Background Delay in diagnosing Spondyloarthroapthy is well documented. One of the reasons for the delay is the presentation of these group of patients to different specialties due to variety of extra articular manifestations. Acute anterior uveitis (AAU) is the most common extra-articular manifestation in HLA B27 positive spondyloarthropathies, occurring in 30–50% of cases [1]. It can occur before the onset of rheumatologic symptoms [2,3]. However quite often this group of patients is not routinely referred to or seen by the rheumatologist for further evaluation.

Objectives

  • To assess the ophthalmologist practice in evaluating patients with AAU for inflammatory back pain or other Rheumatological diagnoses.

  • To identify the number of HLA B27 requests made for uveitis patients.

  • To identify the referral rate of HLA B27 uveitis patients to Rheumatologists for evaluation.

Objectives

Methods We conducted a retrospective pilot study to assess all patients with AAU presenting over a period of one-week to our busy teaching hospital eye casualty which serves over one million population. All patients with Iritis were identified from eye causality records and medical case notes were obtained. A standard proforma was designed and piloted with few case notes initially. Modified proforma was subsequently used to collect the data which was collated and analysed using EXCEL spread sheet.

Results A total of 62 patients (n=62) with AAU presented to eye casualty over a one-week period. Case notes of 49 patients could be procured. Majority of the patients were Caucasians (n=35) while the rest were Asians (n=12) and blacks (n=2). Sex ratio was nearly equal with 25 patients being males and the rest females. Most of our patients' age ranged between 20 to 60 years. 60% patients had a history of recurrent iritis. Out of these 9 patients had bilateral uveitis and 14 were unilateral. In 6 patients, the laterality was not documented. A history for spondyloarthropathy was elicited in only 14 patients by the ophthalmologist at the time of initial assessment. Out of these 14 patients Inflammatory back pain history was positive in 10 patients. Only 17 out of 62 (27%) patients had HLA B27 checked and it was noted to be positive in 5. Amongst the 5 HLA B27 positive patients 2 patients were referred to rheumatology whereas 2 patients were already under rheumatology.

Conclusions We observed that there is a clear lack of understanding in eliciting effective rheumatology history in patients with recurrent anterior uveitis and requesting HLA B27 appropriately. Therefore, a need for a clear pathway for managing patient presenting with recurrent uveitis and HLA B27 positivity for evaluation of Inflammatory back pain. Clear local guidelines and pathway need to be developed to provide effective care. Good communication between the Ophthalmologist and Rheumatologist is key in early diagnosis and effective management of this deforming condition.

References

  1. Khan AK. A worldwide overview: the epidemiology of HLA-B27 and associated spondyloarthritides. In: Calin A, Taurog JD, eds. The Spondylarthritides. Oxford: Oxford University Press, 1998: 17–26.

  2. Careless DJ, Inman RD. Acute anterior uveitis: clinical and experimental aspects. Semin Arthritis Rheum. 1995 Jun. 24(6):432–41.

  3. Chang JH, McCluskey PJ, Wakefield D. Acute anterior uveitis and HLA-B27. Surv Ophthalmol. 2005 Jul-Aug. 50(4):364–8.

References

Disclosure of Interest None declared

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