High Prevalence of Previously Undiagnosed Axial Spondyloarthritis in Patients Referred With Anterior Uveitis and Chronic Back Pain: The SpEYE Study

Abstract

Objective.To reduce the diagnostic delay in axial spondyloarthritis (axSpA), guidelines recommend referring patients with acute anterior uveitis (AAU) and chronic back pain (CBP) to a rheumatologist. This observational study in daily practice evaluated the prevalence of previously unrecognized axSpA in patients with AAU who were referred by ophthalmologists because of concurrent CBP.Methods.All patients with AAU referred with CBP (≥ 3 months, age of onset < 45 yrs) from 5 ophthalmology clinics underwent rheumatologic assessment, including pelvic radiographs. Patients with previously diagnosed rheumatic disease and AAU due to other causes were excluded. The primary endpoint was a clinical axSpA diagnosis by the rheumatologist.Results.Eighty-one patients fulfilled the referral criteria (52% male, 56% HLA-B27 positive, median age 41 yrs, median CBP duration 10 yrs). In total, 58% (n = 47) had recurring AAU, of whom 87% already had CBP during previous AAU attacks. After assessment, 23% (n = 19) of patients were clinically diagnosed with definite axSpA (10/19 radiographic), 40% (n = 32) with suspicion of axSpA, and 37% (n = 30) with no axSpA. AxSpA was diagnosed more often in men (33% of the men vs 13% of the women).Conclusion.A high prevalence of axSpA was found in patients with AAU referred because of CBP. There was substantial diagnostic delay in the majority of patients with recurring AAU, as many already had CBP during previous AAU flares. In AAU, screening for CBP and prompt referral has a high diagnostic yield and should consistently be promoted among ophthalmologists.