Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Acute Anterior Uveitis in Ankylosing Spondylitis: Clinical Characteristics and Impact of Biologic Therapy.
Lui1, Nai Lee, O'Shea3, Finbar (Barry) D., Shen2, Hua, Cook2, Richard J., Inman4, Robert D.
Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
Department of Statistics and Actuarial Science, University of Waterloo, Canada
St James's Hospital, Dublin, Ireland
Toronto Western Hospital, Toronto, ON, Canada
To describe the characteristics of acute anterior uveitis (AAU), impact of biologic therapy on the incidence of AAU and to indentify predictors of AAU flare in an ankylosing spondylitis (AS) prospective longitudinal cohort.
We conducted a retrospective study of all AS patients developing AAU in a longitudinal AS cohort. All patients met the modified New York criteria for AS. Demographics and clinical characteristics (age of AS and AAU onset, HLA-B27 status) were recorded. Recurrence rates and impact of anti-TNF therapy were evaluated. Logistic regression analysis was used to determine predictors of AAU flare.
Among the 464 AS patients, 132 patients with history of AAU were evaluated (28.4%). The mean age at onset of AAU is 31.7 years, higher than the age of AS onset (22.5) and diagnosis of AS (30.2) respectively. 10.2% (N=9) of patients developed AAU prior to the onset of AS symptoms, with a mean of 2.9 ± 2.4 years; while 77.3% (N=68) developed AAU after a mean of 11.5 ± 6.4 years following the onset of AS symptoms. There was no difference in the occurrence of AAU in male or female patients (p=0.19). 88.6% (N=109) of patients with AAU were associated with the HLA-B27 gene (OR 2.39, p=0.01). AS patients with history of AAU had more frequent enthesitis (p=0.024) but did not appear to require more anti-TNF therapy compared to AS patients without AAU (54.9% versus 45.1%; p=0.47). Following the commencement of anti-TNF, the AAU flare rate was 3.69 flares per 100 patient-yr compared to 15.72 flares per 100 patient-yr in AS patients who were treated with non-steroidal anti-inflammatory drugs (NSAIDs). There was no differential association with any particular biologic agent in 12 patients who developed AAU while on anti-TNF therapy. There was no correlation of indicators of higher AS disease activity (ESR, CRP, BASDAI or BASFI scores) at the time of AAU flares.
HLA-B27 is a strong predictor of AAU in AS patients. Higher incidence of enthesitis in AAU patients may suggest a potential similarity in the underlying pathogenic process between the two sites. Biologic therapy reduced the incidence of AAU. The incidence of AAU flare while on anti-TNF therapy is low and did not correlate with AS disease activity.
To cite this abstract, please use the following information:
Lui, Nai Lee, O'Shea, Finbar (Barry) D., Shen, Hua, Cook, Richard J., Inman, Robert D.; Acute Anterior Uveitis in Ankylosing Spondylitis: Clinical Characteristics and Impact of Biologic Therapy. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :512