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DOI: 10.48087/BJMS.2026.130313
Authors: Sabrina HAID, Sihem KOURTAA, Naouel KHALDOUN, Imen MEGATELI, Aicha LADJOUZE-REZIG, Fella HANNI
Affiliations: Department of Rheumatology. EHS Ben Aknoun, Algiers, Algeria.
Abstract
Background: Spondyloarthritis (SpA) comprises a group of chronic inflammatory rheumatic diseases affecting the axial skeleton and/or peripheral joints, and frequently associated with extra-articular manifestations that contribute substantially to disease burden and reduced quality of life. Acute anterior uveitis (AAU) represents the most common extra-articular manifestation and may adversely affect long-term visual prognosis. This study aimed to determine the prevalence of uveitis and to identify factors associated with its occurrence in patients with SpA. Methods: In this prospective observational cohort study, 1,285 patients with SpA fulfilling the ASAS classification criteria and followed in routine rheumatology practice were included. Data regarding history of uveitis, demographic and clinical characteristics, disease activity, structural damage, and treatments were collected. Factors associated with uveitis were assessed using univariate and multivariate logistic regression analyses. Results: Uveitis was reported in 206 patients (16%). The mean age at uveitis onset was 28 ± 10 years. Uveitis was symptomatic in 98% of cases, unilateral in 65.5%, and represented the inaugural manifestation in 32.6% of patients. A recurrent course was observed in 93.7% of cases, while complications occurred in 5.8%, including synechiae, papillary edema, glaucoma, and severe visual impairment. Patients with uveitis were older at diagnosis (42 vs. 37 years) and had longer disease duration (15 vs. 12 years). Axial involvement, inflammatory back pain, and heel enthesitis were more frequent in this group. In multivariate analysis, independent factors associated with uveitis included axial SpA (OR 1.50; 95% CI 1.10–2.00; p = 0.01), inflammatory back pain (OR 2.00; 95% CI 1.30–3.10; p = 0.002), heel enthesitis (OR 1.30; 95% CI 1.17–2.10; p = 0.003), older age at diagnosis (OR 1.03 per year; 95% CI 1.01–1.04; p = 0.001), and longer disease duration (OR 1.04 per year; 95% CI 1.02–1.05; p = 0.001). Juvenile onset, peripheral or polyarticular involvement, anterior chest wall pain, HLA-B27 positivity, structural damage, and comorbidities were not significantly associated with uveitis. Conclusion: Uveitis affects approximately 16% of patients with SpA and is characterized by a highly recurrent course with potential sight-threatening complications. Older age at diagnosis, longer disease duration, axial involvement, inflammatory back pain, and heel enthesitis were identified as independent predictors. Early recognition and close collaboration between rheumatologists and ophthalmologists are essential to preserve long-term visual outcomes in patients with SpA.
Keywords: HLA-B27; anterior uveitis; acute anterior uveitis; ankylosing spondylitis – associated uveitis; HLA-B27 – associated uveitis, peripheral spondyloarthritis, spondyloarthritis, uveitis.