Objectives To describe the characteristics of ocular involvement in spondyloarthritis in an ocular inflammation interdisciplinary unit.
Methods This descriptive study include the patients with uveitis secondary to spondyloarthritis or inflammatory bowel disease (IBD) treated by the rheumatologist from January 2012 to December 2016 in an ocular inflammation multidisciplinary unit. Demographic characteristics, aetiology, ocular involvement pattern, and systemic therapy data were collected and analysed.
Results From 276 patients evaluated by the rheumatologist, 111 (40.2%) were uveitis secondary to systemic inflammatory diseases. Within this group, the uveitis associated with spondyloarthritis (including also IBD) were the most frequent (68 patients, 61%). Focusing on this group, 57.4% were male with a mean age of 49±15.8 years. 73.5% were HLAB27 positive and 76% had radiologic sacroiliitis. In 24 patients (35.3%) the diagnosis of spondyloarthritis was made after the anamnesis in the uveitis unit. The diagnosis was already known in the other cases. The spondyloarthritis subtypes are described in the table.
According to the anatomical distribution, 95.6% were anterior uveitis (AU), followed by the intermediate and posterior ones (1,5% both). 85.3% has unilateral involvement and 10.3% bilateral. Relapsing acute AU was the most frequent pattern (73.5%), followed by non-relapsing acute AU (16.2%) and chronic AU (7.4%).
24 patients (35.3%) required treatment with DMARD to achieve uveitis control. The most commonly used drugs were salazopyrine (7 patients), methotrexate (6 patients), mycophenolate (1), and in another 6 patients anti-TNF treatment was started or the previous dose of the biological was adjusted.
The visual acuity (VA) was not perfect (VA≠1 in both eyes) in 35% in the first collected visit. 28% (19 patients) had cataract, and 19% (13) had ocular hypertension. Only 1 patient had bilateral cystoid macular edema. Follow-up data were available for 43 patients and VA was stable in 47%, worsening in 23% and improving in 30% (median follow-up time 23 months, IQR: 6–41)
Conclusions Our work confirms that in spondyloarthritis the most frequent pattern of ocular involvement is relapsing acute AU. Spondyloarthritis diagnosis was made at the uveitis unit in 35% of patients. More than one-third of patients required systemic therapy for ocular involvement control. Thirty-five percent of the patients had a reduced VA, remaining stable or improving in most, during the follow-up.
Disclosure of Interest None declared