Uveitis an indicator of spondyloarthropathies

COS 2012, July 5 - Close to half of patients presenting with uveitis may have inflammatory back pain, according to findings from a study at a single ophthalmology clinic. Ophthalmologists may be the first medical professionals these patients encounter about this complaint, and the specialists should ask their patients specific questions about back pain, says Dr. Clara Chan from the University of Toronto.

She presented results of a study to determine the prevalence of inflammatory back pain in a cohort of patients with anterior uveitis.

"Recognition that the back pain is inflammatory in nature is very important," she said. It can lead to an earlier diagnosis of spondyloarthropathy and appropriate treatment. She noted that spondyloarthropathies include conditions such as ankylosing spondylitis, reactive arthritis or Reiter syndrome, psoriatic arthritis, enteropathic spondylitis and other undifferentiated spondyloarthropathies.

Rationale

It had been recognized that spondyloarthropathies were associated with about 33% of anterior uveitis, but a study was needed to address the fact that there are limited data on the prevalence of inflammatory back disease in the this patient population in Canada, Chan said. Recognizing that a patient's back pain is inflammatory can lead to referral to a rheumatologist.

Study design

This was a retrospective cohort study. Patients with anterior uveitis were recruited from an ophthalmologist's clinic over a 10-month period in 2008 and were asked to complete a survey. Patients were classified as having inflammatory back pain if they had two or more positive responses to four validated inflammatory back pain scenarios: presence of morning stiffness for more than 30 minutes; improvement in back pain with exercise but not with rest; awakening from back pain during the second half of the night only; presence of alternating buttock pain.

Patients were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); quality of life was measured with the EuroQol (EQ-5D) questionnaire. Patients rated their health score in categories of mobility, ability with self-care, ability with usual activities, amount of pain and discomfort, and whether they had anxiety. Twenty-five patients underwent further rheumatologic examination to confirm the cause of back pain.

Findings

A total of 141 patients completed the survey. Of these 66 (46.8%) had inflammatory back pain. More women than men had this condition: 44 and 22, respectively. Activity and quality-of-life scores for those with inflammatory back pain were lower than those for patients with no inflammatory back pain (p = 0.0048).

In this study, the most common causes of anterior uveitis were: idiopathic (31.9%), HLA-B27-related (14.2%), ankylosing spondylitis (10.6%), infectious causes (10.6%). In the subgroup analysis of 25 patients, 64% were classified as having inflammatory back pain.

Conclusion

"Ophthalmologists should use the four [validated] back pain questions to screen patients with anterior uveitis, and therefore initiate earlier referral for rheumatologic assessment," Chan noted.