Guidelines encourage sending individuals with acute anterior uveitis (AAU) and chronic back pain (CBP) to a rheumatologist to decrease the diagnosis delay in axial spondyloarthritis (axSpA). For observational research in everyday practice, researchers looked at the frequency of previously undetected axSpA in AAU patients referred by ophthalmologists for concomitant CBP.
All patients with AAU referred with CBP (≥ 3 months, age of onset < 45 yrs) from 5 ophthalmology clinics had a rheumatologic evaluation, including pelvic radiography. Patients with pre-existing rheumatic illness and AAU from other causes were excluded. The primary endpoint was a rheumatologist’s clinical diagnosis of axSpA.
The referral requirements were met by 81 patients (52% male, 56% HLA-B27 positive, median age 41 yrs, median CBP duration 10 yrs). In all, 58% (n=47) had recurrent AAU, with 87% having CBP from prior AAU assaults. Following evaluation, 23% (n=19) of patients were clinically diagnosed with confirmed axSpA (10/19 radiographic), 40% (n=32) with axSpA suspicion, and 37% (n=30) with no axSpA. AxSpA was diagnosed more frequently in men (33% of the men vs. 13% of the women).
Patients with AAU who were referred due to CBP had a significant incidence of axSpA. Most patients with repeating AAU experienced a significant diagnostic delay, as many had CBP during previous AAU flares. Screening for CBP and rapid referral has a good diagnostic yield in AAU and should be advocated frequently among ophthalmologists.