DOI: http://dx.doi.org/10.18203/2349-3933.ijam20174300

Uveitis of spondyloarthritis in Indian subcontinent: a cross sectional study

Fini Ninan, John Mathew, Swetha Sara Philip, Deepa John, Debashish Danda, Sheeja Susan John

Abstract


Background: The seronegative spondyloarthritis (SpA) are known to have intimate association with ocular inflammatory disease. While anterior uveitis accounts for 50-92% of all cases of uveitis in the West, it ranges between 28 and 50% in the Asian countries. The aim of this study was to document the clinical profile of uveitis in patients with spondyloarthritis in the Indian subcontinent.

Methods: In our hospital based cross sectional study, 166 patients fulfilling Assessment of SpondyloArthritis international Society’ (ASAS) criteria for spondyloarthritis (SpA) were evaluated for evidence and nature of uveitis, including by a slit lamp bio microscope. The characteristics of Uveitis were defined as per the SUN (Standardization of Uveitis Nomenclature) Working Group criteria. 84.3% (140) of the patients were male.

Results: Ankylosing spondylitis was the commonest type of spondyloarthritis accounting for 69.3% patients. Evidence of past or present uveitis was found in 16.3% patients. Of the patients with uveitis 96.3% had anterior uveitis. 88.9% of the patients had redness of the eye, and 85.2% reported pain in the eye during an episode of uveitis. Mean duration of musculoskeletal symptoms prior to the diagnosis of SpA was 4.36 years. Of the 24 patients who could recall the course of uveitis 70.8% (17) had recurrent episodes. As a complication of uveitis 18.5% had cataract, and 14.8% had posterior synechiae. 78.3% patients were HLA-B27 positive. 19.2% of HLA-B27 positive patients had uveitis, whereas only 5.6% out of the 36 HLA-B27 negative patients had uveitis.

Conclusions: The proportion of patients with uveitis in our study (16.3%) was considerably less than in other studies. The characteristics and profile of uveitis in our cohort of SpA patients from the Indian subcontinent were similar to those previously reported in literature.


Keywords


HLA B27, Spondyloarthritis, Uveitis

Full Text:

PDF

References


Chang JH, McCluskey PJ, Wakefield D. Acute anterior uveitis and HLA-B27. Surv Ophthalmol. 2005;50(4):364-88.

Pato E, Bañares A, Jover JA, Fernández-Gutiérrez B, Godoy F, Morado C, et al. Undiagnosed spondyloarthropathy in patients presenting with anterior uveitis. J Rheumatol. 2000;27(9):2198-202.

Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68 Suppl 2:ii1-44.

Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509-16.

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. Ophthalmol. 2004;111(4):802-9.

Prakash S, Mehra NK, Bhargava S, Vaidya MC, Malaviya AN. Ankylosing spondylitis in North India: a clinical and immunogenetic study. Ann Rheum Dis 1984;43(3):381-5.

Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int. 2003;23(2):61-6.

Aggarwal R, Malaviya AN. Clinical characteristics of patients with ankylosing spondylitis in India. Clin Rheumatol. 2009;28(10):1199-205.

Tay-Kearney ML, Schwam BL, Lowder C, Dunn JP, Meisler DM, Vitale S, et al. Clinical features and associated systemic diseases of HLA-B27 uveitis. Am J Ophthalmol. 1996;121(1):47-56.

Linssen A, Meenken C. Outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis. Am J Ophthalmol. 1995;120(3):351-61.

Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis. 2008;67(7):955-9.

Maza MS. Seronegative Spondyloarthropathies. In: Foster CS, Vitale AT. Diagnosis and treatment of uveitis. Philadelphia: W B Saunders; 2002:581-600.

Whitcup SM. Anterior Uveitis. In: Nussenblatt RB, Whitcup SM, editors. Uveitis Fundamentals and Clinical Practice. 4th ed. China: Elsevier; 2010:251-64.

Lyons JL, Rosenbaum JT. Uveitis associated with inflammatory bowel disease compared with uveitis associated with spondyloarthropathy. Arch Ophthalmol. 1997;115(1):61-4.

Rosenbaum JT. Characterization of uveitis associated with spondyloarthritis. J Rheumatol. 1989;16(6):792-6.

Rodriguez A, Akova YA, Pedroza-Seres M, Foster CS. Posterior segment ocular manifestations in patients with HLA-B27-associated uveitis. Ophthalmol. 1994;101(7):1267-74.

Khan MA, Kushner I, Braun WE. Association of HLA-A2 with uveitis in HLA-B27 positive patients with ankylosing spondylitis. J Rheumatol. 1981;8(2):295-8.