AAU is known to be the most common EAM of axial SpA. In this study, the minimum prevalence of axial SpA in AAU was 20.2%; nearly one-quarter of these patients previously undiagnosed despite years of back pain – representing a substantial hidden burden of disease. HLA-B27 diagnosis is often the trigger for referral of patients with AAU to rheumatology. However, nearly one-half of patients identified as missed diagnoses were HLA-B27 negative. Similarly, nearly two-thirds of new diagnoses would have been missed if using inflammatory back pain rather than chronic back pain as a referral strategy – supporting the presence of inflammatory back pain as an axial SpA feature rather than mandatory criterion for referral, in line with Assessment of Spondyloarthritis International Society (ASAS)-endorsed recommendations for early referral. Due to the high prevalence of axial SpA among individuals presenting with AAU, the authors thereby recommend that all individuals with AAU and chronic back pain with onset before the age of 45 should be referred to rheumatology regardless of HLA-B27 status, gender or number of episodes of AAU.
In the present paper, the authors developed The Dublin Uveitis Evaluation Tool (DUET) algorithm – which prompts referral to rheumatology if a patient has AAU, is HLA-B27 positive, or has co-existing psoriasis or peripheral arthritis. The algorithm was found to have high sensitivity and specificity (96% and 97% respectively) – potentially implicating HLA-B27 as the ‘anchor criterion’ for the ASAS classification criteria clinical arm. However, importantly, in the prior study discussed by Sykes et al., nearly one-half of patients identified as missed diagnoses were HLA-B27 negative. These patients would therefore have remained lost if utilising the DUET algorithm. A cohort of 101 patients with AAU and know prior diagnosis of SpA was used to develop the algorithm; whereby 41.6% were found to have undiagnosed SpA.
Aim: To determine the prevalence and risk factors for uveitis in spondyloarthritis (SpA) patients.
Results: Prevalence of uveitis was 18.7%. The disease duration was 9.3 ± 7 years and 5.4 ± 4.5 years in uveitis and no uveitis groups respectively (P ≤ .001). Family history of SpA was positive in 45.2% in the uveitis group (P ≤ .001). The frequency of axial SpA was 92.9% and 73.8% in the uveitis and no uveitis groups respectively (P ≤ .008). The mean BASDAI was 2.4 ± 1.9 and 3.3 ± 2.8 in uveitis and no uveitis groups respectively (P = .050). In multivariate logistic regression analysis, among the selected variables, family history of SpA (odds ratio [OR] =3.697; 95% CI =1.616-8.457; P = .002) and duration of disease (OR =1.089; 95% CI =1.004-1.181; P = .039) were independently associated with the occurrence of uveitis.
Conclusions: The prevalence of uveitis was 18.7%. The family history and the disease duration of SpA were independently associated with uveitis.
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