Strong Association Between Uveitis and Ankylosing Spondylitis

Dr. Borenstein discusses relationship between back pain and eye symptoms in ankylosing spondylitis.

by Dr. David Borenstein M.D. updated 1/2019

According to two recently published studies, recognizing the association between uveitis and ankylosing spondylitis (AS) would hasten the diagnosis and result in earlier treatment.

Question: What are the symptoms of iritis?

About 40% of patients with AS will develop iritis or uveitis. Iritis that occurs in association with AS, is twice as common in males as females. The iris is the part of the eye that gets smaller or larger depending on the amount of light entering the eye. Since the iris becomes inflamed, light entering the eye will cause the iris to move and cause significant eye pain. The eye may also become red. Decreased vision may also be associated with the onset of iritis. If left untreated, iritis can result in significant loss of vision. Treatment by an ophthalmologist with steroid drops or injections can be helpful. Anti-TNF antibodies may be effective in controlling iritis in individuals who are resistant to steroid treatment.

In a survey of 2367 AS patients in Spain 410 (17.5%) reported uveitis. About half of the individuals had uveitis prior to the diagnosis of AS and half developed it after they were diagnosed. In addition, 80% of the individuals with uveitis were also HLA-B27 positive. (1)

Similarly, a Czech study measured the prevalence of ankylosing spondylitis in patients who had uveitis. A total of 41 patients with uveitis were evaluated for inflammatory back pain and were radiographed with magnetic resonance imaging for the presence of bone marrow edema. The diagnosis of AS was confirmed in 41.5% of patients. (2)

References:

  1. Ladehesa-Pineda M et al. Uveitis as first symptom in patients with spondyloarthritis. Data from the Spanish registry Regisponser (abstract) Arthritis Rheumatol 2018;70 (suppl 10)

  2. Bubova K et al. Prevalence of spondyloarthritis in patients with anterior uveitis (abstract 1646). Arthritis Rheumatol 2018;70 (suppl 10)

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