scholarly journals The Prevalence of MRI-Defined Sacroiliitis and Classification of Spondyloarthritis in Patients with Acute Anterior Uveitis: A Longitudinal Single-Centre Cohort Study

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 161
Author(s):  
Kristyna Bubova ◽  
Lenka Hasikova ◽  
Katerina Mintalova ◽  
Monika Gregova ◽  
Petr Kasalicky ◽  
...  
Keyword(s):  
Back Pain ◽  
Anterior Uveitis ◽  
Chronic Back Pain ◽  
Classification Criteria ◽  
Acute Anterior Uveitis ◽  
Asas Classification Criteria ◽  
Active Sacroiliitis ◽  
New Feature ◽  
Active Inflammation

Background: Acute anterior uveitis (AAU) is a relatively common extra-musculoskeletal manifestation of axial spondyloarthritis (axSpA); however, data on the prevalence of active sacroiliitis in patients with AAU are limited. Methods: 102 patients with AAU and 39 healthy subjects (HS) underwent clinical assessment and sacroiliac joint MRI. Patients with absence of active sacroiliitis were reassessed after two years. International Spondyloarthritis Society (ASAS) classification criteria for axSpA (regardless of patient’s age) and expert opinion for definitive diagnosis of axSpA were applied. Results: Although chronic back pain was equally present in both groups, bone marrow edema (BME) in SIJ and BME highly suggestive of axSpA was found in 52 (51%) and in 33 (32%) patients with AAU compared with 11 (28%) and none in HS, respectively. Out of all AAU patients, 41 (40%) patients fulfilled the ASAS classification criteria for axSpA, and 29 (28%) patients were considered highly suggestive of axSpA based on clinical features. Two out of the 55 sacroiliitis-negative patients developed active sacroiliitis at the two-year follow-up. Conclusions: One-third of patients with AAU had active inflammation on SIJ MRI and clinical diagnosis of axSpA. Therefore, patients with AAU, especially those with chronic back pain, should be referred to a rheumatologist, and the examination should be repeated if a new feature of SpA appears.

scholarly journals Is a positive family history of spondyloarthritis relevant for diagnosing axial spondyloarthritis once HLA-B27 status is known?

Rheumatology ◽  
2019 ◽  
Vol 58 (9) ◽  
pp. 1649-1654 ◽  
Author(s):  
Miranda van Lunteren ◽  
Désirée van der Heijde ◽  
Alexandre Sepriano ◽  
Inger J Berg ◽  
Maxime Dougados ◽  
...  
Keyword(s):  
Back Pain ◽  
Family History ◽  
Anterior Uveitis ◽  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Positive Family History ◽  
Hla B27 ◽  
Acute Anterior Uveitis ◽  
Negative Results ◽  
History Of

Abstract Objectives A positive family history (PFH) of spondyloarthritis, in particular a PFH of AS or acute anterior uveitis, is associated with HLA-B27 carriership in chronic back pain patients. As it is unknown, the study aimed to investigate if a PFH contributes to diagnosing axial spondyloarthritis (axSpA) once HLA-B27 status is known. Methods In axSpA-suspected patients from the Assessment of SpondyloArthritis international Society (ASAS), DEvenir des Spondyloarthropathies Indifférenciéés Récentes (DESIR) and SPondyloArthritis Caught Early (SPACE) cohorts, logistic regression analyses were performed with HLA-B27 status and PFH according to the ASAS definition (ASAS-PFH) as determinants and clinical axSpA diagnosis as outcome at baseline. Analyses were repeated with a PFH of AS or acute anterior uveitis. Results In total, 1818 patients suspected of axSpA were analysed (ASAS n = 594, DESIR n = 647, and SPACE n = 577). In patients from the ASAS, DESIR and SPACE cohorts, respectively 23%, 39% and 38% had an ASAS-PFH, 52%, 58% and 43% were HLA-B27 positive, and 62%, 47% and 54% were diagnosed with axSpA. HLA-B27 was independently associated with an axSpA diagnosis in each cohort but an ASAS-PFH was not [ASAS cohort: HLA-B27 odds ratio (OR): 6.9 (95% CI: 4.7, 10.2), ASAS-PFH OR: 0.9 (95% CI: 0.6, 1.4); DESIR: HLA-B27 OR: 2.1 (95% CI: 1.5, 2.9), ASAS-PFH OR: 1.0 (95% CI 0.7, 1.3); SPACE: HLA-B27 OR: 10.4 (95% CI: 6.9, 15.7), ASAS-PFH OR: 1.0 (95% CI: 0.7, 1.5)]. Similar negative results were found for PFH of AS and acute anterior uveitis. Conclusion In three independent cohorts with different ethnical backgrounds, ASAS, DESIR and SPACE, a PFH was not associated independently of HLA-B27 with a diagnosis of axSpA. This indicates that in the vast majority of patients presenting with back pain, a PFH does not contribute to the likelihood of an axSpA diagnosis if HLA-B27 status is known.

Presence of multiple spondyloarthritis (SpA) features is important but not sufficient for a diagnosis of axial spondyloarthritis: data from the SPondyloArthritis Caught Early (SPACE) cohort

2017 ◽  
Vol 76 (6) ◽  
pp. 1086-1092 ◽  
Author(s):  
Z Ez-Zaitouni ◽  
P A C Bakker ◽  
M van Lunteren ◽  
I J Berg ◽  
R Landewé ◽  
...  
Keyword(s):  
Back Pain ◽  
Human Leucocyte Antigen ◽  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Classification Criteria ◽  
Hla B27 ◽  
Sacroiliac Joints ◽  
Asas Classification Criteria ◽  
Early Cohort ◽  
Made In

ObjectivesConcerns have been raised about overdiagnosis of axial spondyloarthritis (axSpA). We investigated whether patients with chronic back pain (CBP) of short duration and multiple SpA features are always diagnosed with axSpA by the rheumatologist, and to what extent fulfilment of the Assessment of SpondyloArthritis International Society (ASAS) axSpA criteria is associated with an axSpA diagnosis.MethodsBaseline data from 500 patients from the SPondyloArthritis Caught Early cohort which includes patients with CBP (≥3 months, ≤2 years, onset <45 years) were analysed. All patients underwent full diagnostic workup including MRI of the sacroiliac joints (MRI-SI) and radiograph of sacroiliac joints (X-SI). For each patient, the total number of SpA features excluding sacroiliac imaging and human leucocyte antigen B27 (HLA-B27) status was calculated.ResultsBefore sacroiliac imaging and HLA-B27 testing, 32% of patients had ≤1 SpA feature, 29% had 2 SpA features, 16% had 3 SpA features and 24% had ≥4 SpA features. A diagnosis of axSpA was made in 250 (50%) of the patients: 24% with ≤1 SpA feature, 43% with 2 SpA features, 62% with 3 SpA features and 85% with ≥4 SpA features. Of the 230 patients with a positive ASAS classification 40 (17.4%) did not have a diagnosis of axSpA. HLA-B27 positivity (OR 5.6; 95% CI 3.7 to 8.3) and any (MRI-SI and/or X-SI) positive imaging (OR 34.3; 95% CI 17.3 to 67.7) were strong determinants of an axSpA diagnosis.ConclusionsIn this cohort of patients with CBP, neither the presence of numerous SpA features nor fulfilment of the ASAS classification criteria did automatically lead to a diagnosis axSpA. Positive imaging was considered particularly important in making a diagnosis of axSpA.

Predictive validity of the ASAS classification criteria for axial and peripheral spondyloarthritis after follow-up in the ASAS cohort: a final analysis

2016 ◽  
Vol 75 (6) ◽  
pp. 1034-1042 ◽  
Author(s):  
Alexandre Sepriano ◽  
Robert Landewé ◽  
Désirée van der Heijde ◽  
Joachim Sieper ◽  
Nurullah Akkoc ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Age Of Onset ◽  
Unknown Origin ◽  
Final Analysis ◽  
Clinic Visit ◽  
Classification Criteria ◽  
Sensitivity Analyses ◽  
Asas Criteria ◽  
Asas Classification Criteria

ObjectiveTo establish the predictive validity of the Assessment of SpondyloArthritis international Society (ASAS) spondyloarthritis (SpA) classification criteria.Methods22 centres (N=909 patients) from the initial 29 ASAS centres (N=975) participated in the ASAS-cohort follow-up study. Patients had either chronic (>3 months) back pain of unknown origin and age of onset below 45 years (N=658) or peripheral arthritis and/or enthesitis and/or dactylitis (N=251). At follow-up, information was obtained at a clinic visit or by telephone. The positive predictive value (PPV) of the baseline classification by the ASAS criteria was calculated using rheumatologist's diagnosis at follow-up as external standard.ResultsIn total, 564 patients were assessed at follow-up (345 visits; 219 telephone) with a mean follow-up of 4.4 years (range: 1.9; 6.8) and 70.2% received a SpA diagnosis by the rheumatologist. 335 patients fulfilled the axial SpA (axSpA) or peripheral SpA (pSpA) criteria at baseline and of these, 309 were diagnosed SpA after follow-up (PPV SpA criteria: 92.2%). The PPV of the axSpA and pSpA criteria was 93.3% and 89.5%, respectively. The PPV for the ‘clinical arm only’ was 88.0% and for the ‘clinical arm’±‘imaging arm’ 96.0%, for the ‘imaging arm only’ 86.2% and for the ‘imaging arm’+/-‘clinical arm’ 94.7%. A series of sensitivity analyses yielded similar results (range: 85.1–98.2%).ConclusionsThe PPV of the axSpA and pSpA criteria to forecast an expert's diagnosis of ‘SpA’ after more than 4 years is excellent. The ‘imaging arm’ and ‘clinical arm’ of the axSpA criteria have similar predictive validity and are truly complementary.

Long-Term Follow-up of Patients With Chronic Back Pain Treated in a Multidisciplinary Rehabilitation Program

Spine ◽  
1995 ◽  
Vol 20 (7) ◽  
pp. 801-806 ◽  
Author(s):  
Tom C. Lanes ◽  
Eugene F. Gauron ◽  
Kevin F. Spratt ◽  
Theodore J. Wernimont ◽  
Ernest M. Found ◽  
...  
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Rehabilitation Program ◽  
Multidisciplinary Rehabilitation ◽  
Long Term Follow Up

scholarly journals Use of intracameral tenecteplase for rapid resolution of intraocular fibrin in acute anterior uveitis

2020 ◽  
Vol 2 (1) ◽  
pp. 42-47
Author(s):  
Wen Yee Lee ◽  
Wee Min Teh ◽  
Kiet Phang Ling ◽  
Norlina Mohd Ramli ◽  
Haslina Mohd Ali
Keyword(s):  
Visual Acuity ◽  
Anterior Chamber ◽  
Anterior Uveitis ◽  
Effective Means ◽  
Cost Effective ◽  
Acute Anterior Uveitis ◽  
Rapid Resolution ◽  
Fibrin Formation

Two patients presenting with acute anterior uveitis (AAU) and severe fibrinous reaction in the anterior chamber were given an injection of intracameral tenecteplase (50 microgram/0.1 ml). In both patients with AAU, complete rapid fibrin resolution and synechiolysis occurred within three days after intracameral tenecteplase injection. Significant visual acuity improvement was also seen in both patients and there were no complications observed throughout the follow-up duration of up to six months after administration of treatment. As tenecteplase has many superior properties compared to other medications in its class and can also be diluted and stored for up to a year under specific conditions, it may be an efficacious, safe and cost-effective means of treating severe AAU with fibrin formation.

Extra-articular manifestations: uveitis

2016 ◽  
Author(s):  
James T. Rosenbaum
Keyword(s):  
Clinical Manifestation ◽  
Anterior Uveitis ◽  
Chronic Back Pain ◽  
Experimental Models ◽  
Hla B27 ◽  
Acute Anterior Uveitis ◽  
Treatment Considerations ◽  
Appropriate Therapy ◽  
Definition Of ◽  
Relationship Of

Acute anterior uveitis (AAU) is the most common, extra-articular, clinical manifestation of spondyloarthritis. In some patients, it is the dominant manifestation. This chapter reviews the definition of uveitis, the epidemiology of uveitis, the differential diagnosis, the relationship of HLA-B27 to uveitis, laboratory testing for suspected HLA-B27-associated uveitis, treatment considerations, and experimental models in which both uveitis and spondylitis co-exist. Although acute anterior uveitis rarely precedes spondyloarthritis, acute anterior uveitis is often the clue that chronic back pain is due to sacroiliac inflammation. Uveitis is sometimes the dominant clinical manifestation of spondyloarthritis and it can influence the choice for appropriate therapy.

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