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Insights Into Uveitis in Association With Spondyloarthritis From a Large Patient Survey

Keck, Katie M. MD; Choi, Dongseok PhD; Savage, Laurie M.; Rosenbaum, James T. MD

JCR: Journal of Clinical Rheumatology: April 2014 - Volume 20 - Issue 3 - p 141–145
doi: 10.1097/RHU.0000000000000087
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Background Uveitis is reported to be the most common extra-articular feature in spondyloarthritis (SpA).

Objective The objective of this study was to investigate the relationship between uveitis and SpA in a cohort identified from a survey.

Methods Eight hundred sixty-three respondents completed a survey conducted by the Spondylitis Association of America. Data on baseline demographics, quality of life, medication use, and joint involvement were compared in SpA patients with and without uveitis. Logistic regression analysis was used to identify characteristics associated with the presence of uveitis.

Results Of the 863 respondents, 168 (19.5%) reported a diagnosis of uveitis. Baseline demographics including sex, age, and ethnicity were similar between the uveitis and no-uveitis groups. The presence of uveitis had a significant positive association with the use of the biologic drug infliximab (adjusted odds ratio [ORadj] = 1.66, P = 0.044), “lower jaw” involvement (ORadj = 1.60, P = 0.015), heel involvement (ORadj = 1.51, P = 0.023), and a diagnosis of arthritis associated with inflammatory bowel disease (ORadj = 1.92, P = 0.005). It had a significant negative association with the use of the biologic drug etanercept (ORadj = 0.49, P = 0.011) or a coexisting diagnosis of diabetes (ORadj = 0.02, P = 0.020).

Conclusions The relationship of uveitis to medication presumably reflects the choice of a specific tumor necrosis factor inhibitor in the setting of a history of uveitis. One prior study has also correlated heel pain and uveitis, thus supporting the validity of the association and suggesting potentially a common pathogenesis. Because diabetes has been proposed as a risk factor for uveitis, the negative association is surprising and may distinguish the pathogenesis of uveitis in association with SpA from other forms of uveitis.

Supplemental digital content is available in the text.

From the Departments of *Ophthalmology and †Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR; ‡Spondylitis Association of America, Los Angeles, CA; §Department of Medicine, OregonHealth & Science University, and ∥Devers Eye Institute, Portland, OR.

The survey was funded through the Spondylitis Association of America by Johnson & Johnson (New Brunswick, NJ). This work was funded in part by Research to Prevent Blindness, the Stan and Madelle Rosenfeld Family Trust, and the William and Mary Bauman Foundation.

The authors declare no conflict of interest.

Correspondence: James T. Rosenbaum, MD, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239. E-mail: rosenbaj@ohsu.edu.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.jclinrheum.com).

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.