J Rheum Dis.  2018 Jan;25(1):28-33. 10.4078/jrd.2018.25.1.28.

Characteristics of Uveitis in Patients with Ankylosing Spondylitis in Korea: A Single-center Survey

• Koo BS
• Lim JW
• Shin JH
• Kim TH

• KMID: 2405018
• DOI: http://doi.org/10.4078/jrd.2018.25.1.28

Abstract

OBJECTIVE
Uveitis is the most common extra-articular manifestation occurring in patients with ankylosing spondylitis (AS). This study examined the characteristics of uveitis in patients with AS using a questionnaire survey.
METHODS
A questionnaire-based survey was given to patients enrolled in an AS registry at a rheumatology clinic in a tertiary hospital between September 2015 and December 2015. The patients responded to several questions and sub-questions related to uveitis.
RESULTS
A total of 750 patients participated in the survey. The number of patients diagnosed with uveitis in the ophthalmology department was 218 (29%). The most common symptoms in patients with uveitis were ocular injection (61%), eye pain (54%), and decreased visual acuity (51%). Interestingly, 91 of the 532 patients (17%) who had not been diagnosed with uveitis before also experienced similar symptoms, such as tearing, ocular injection, and eye pain. The number of patients who experienced a flare of uveitis more than once a year was 109 (50%), and 124 patients with uveitis responded that the treatment of AS had no significant effect on the prevention of uveitis recurrence.
CONCLUSION
The clinical characteristics of uveitis that patients experience was investigated through surveys. Because uveitis in patients with AS is not well diagnosed and treated, active screening for suspected symptoms and the prevention of a recurrence is needed.

Keyword

Uveitis; Ankylosing spondylitis; Surveys and questionnaires

MeSH Terms

Eye Pain
Humans
Korea*
Mass Screening
Ophthalmology
Recurrence
Rheumatology
Spondylitis, Ankylosing*
Surveys and Questionnaires
Tears
Tertiary Care Centers
Uveitis*
Visual Acuity

Figure

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  Figure 1. Eye symptoms among patients with and without uveitis.

Reference

1. Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis. 2008; 67:955–9.

2. Canouï-Poitrine F, Lekpa FK, Farrenq V, Boissinot V, Hacquard-Bouder C, Comet D, et al. Prevalence and factors associated with uveitis in spondylarthritis patients in France: results from an observational survey. Arthritis Care Res (Hoboken). 2012; 64:919–24.

3. Feltkamp TE, Ringrose JH. Acute anterior uveitis and spondyloarthropathies. Curr Opin Rheumatol. 1998; 10:314–8.

4. Haroon M, O'Rourke M, Ramasamy P, Murphy CC, FitzGerald O. A novel evidence-based detection of un-diagnosed spondyloarthritis in patients presenting with acute anterior uveitis: the DUET (Dublin Uveitis Evaluation Tool). Ann Rheum Dis. 2015; 74:1990–5.

5. Braun J, Baraliakos X, Listing J, Sieper J. Decreased incidence of anterior uveitis in patients with ankylosing spondylitis treated with the anti-tumor necrosis factor agents infliximab and etanercept. Arthritis Rheum. 2005; 52:2447–51.

6. Coates LC, McGonagle DG, Bennett AN, Emery P, Marzo-Ortega H. Uveitis and tumour necrosis factor blockade in ankylosing spondylitis. Ann Rheum Dis. 2008; 67:729–30.

7. Guignard S, Gossec L, Salliot C, Ruyssen-Witrand A, Luc M, Duclos M, et al. Efficacy of tumour necrosis factor blockers in reducing uveitis flares in patients with spondylarthropathy: a retrospective study. Ann Rheum Dis. 2006; 65:1631–4.

8. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984; 27:361–8.

9. Monnet D, Breban M, Hudry C, Dougados M, Brézin AP. Ophthalmic findings and frequency of extraocular manifestations in patients with HLA-B27 uveitis: a study of 175 cases. Ophthalmology. 2004; 111:802–9.

10. Pathanapitoon K, Dodds EM, Cunningham ET Jr, Rothova A. Clinical spectrum of HLA-B27-associated ocular inflammation. Ocul Immunol Inflamm. 2017; 25:569–76.

11. Berg IJ, Semb AG, van der Heijde D, Kvien TK, Hisdal J, Olsen IC, et al. Uveitis is associated with hypertension and atherosclerosis in patients with ankylosing spondylitis: a cross-sectional study. Semin Arthritis Rheum. 2014; 44:309–13.

12. Gaujoux-Viala C, Giampietro C, Gaujoux T, Ea HK, Prati C, Orcel P, et al. Scleritis: a paradoxical effect of etanercept? Etanercept-associated inflammatory eye disease. J Rheumatol. 2012; 39:233–9.

13. Kakkassery V, Mergler S, Pleyer U. Anti-TNF-alpha treatment: a possible promoter in endogenous uveitis? observational report on six patients: occurrence of uveitis following etanercept treatment. Curr Eye Res. 2010; 35:751–6.

14. Lim LL, Fraunfelder FW, Rosenbaum JT. Do tumor necrosis factor inhibitors cause uveitis? A registry-based study. Arthritis Rheum. 2007; 56:3248–52.

15. Verhagen FH, Brouwer AH, Kuiper JJ, Ossewaarde-van Norel J, Ten Dam-van Loon NH, de Boer JH. Potential predictors of poor visual outcome in human leukocyte antigen-B27-associated uveitis. Am J Ophthalmol. 2016; 165:179–87.