Acute anterior uveitis should prompt screening for axial spondyloarthritis
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Acute anterior uveitis in first-degree relatives of axial spondyloarthritis probands should trigger a screening for axial SpA, according to researchers in the Annals of the Rheumatic Diseases.
“Here, we report features from patients’ clinical history that best predict presence of [axial SpA (axSpA)] for the large number of [first-degree relatives (FDR)] who developed the disease during these 35 years,” Sjef M. van der Linden, MD, of the University of Bern, in Switzerland, and colleagues wrote. “We evaluated whether presence at early age of chronic inflammatory low back pain (CIBP) and occurrence of features of acute anterior uveitis (AAU) are associated with onset of axSpA.”
To determine which factors may serve as strong predictors of axial SpA in first-degree relatives, van der Linden and colleagues began a study in 1985 where every member of the Swiss Ankylosing Spondylitis Patient Society was invited to take part in a family study. A total of 1,178 people participated in the study, including 363 axial SpA probands and 806 first-degree relatives. Participants completed a survey, regardless of any known rheumatic disease.
Non-pregnant participants also underwent a pelvic radiography to screen for sacroiliitis. Radiographs were available or obtained for 360 of the 363 patients. Those without a radiography were excluded from analysis.
Linden and colleagues conducted the follow-up portion of the study in 20219, in which participants were asked to complete a survey consisting of 157 questions detailing ankylosing spondylitis manifestations. Axial SpA diagnoses in 1985 were based on clinical findings and the pelvic radiographs. All new cases in the 2019 follow-up were considered to be axial AS, and may have been radiographic or non-radiographic, due to a lack of radiographic data in the 2019 respondents.
Among first-degree relatives positive for HLA-B27, axial SpA was found in 25.4% to 26.3% of respondents and was independent of radiographic sacroiliitis status, according to the researchers. Acute anterior uveitis occurred in 38.2% of first-degree relatives with axia SpA, compared with 11.6% of first-degree relatives without axia SpA (OR = 4.74 95%; CI, 2.15-10.47).
Chronic inflammatory back pain at baseline failed to predict later manifestation of AS, but combining chronic inflammatory back pain with pain or discomfort at the thoracic spine, as well as anterior chest wall, offered an 83.1% sensitivity and 87.2% specificity for current cases of axial SpA, the researchers wrote.
“Occurrence of chronic inflammatory back pain (CIBP) in FDR of axSpA probands is not a reliable predictor of later development of axSpA,” van der Linden and colleagues wrote. “However, occurrence of acute anterior uveitis and/or a combined occurrence of CIBP and pain/discomfort in the thoracic spine and at anterior chest wall, enhance early clinical suspicion and early diagnosis of axSpA among FDR of axSpA patients.”
They added: “Occurrence of AAU among FDR of patients with axSpA calls for screening for the disease, but presence of CIBP among young FDR has no long-term predictive value for the diagnosis axSpA.”
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This article by van der Linden et al. provides research on what factors are predictive in first-degree relatives of patients with axial spondyloarthritis. When a patient is diagnosed, one question often is how concerned they should be that their child or other relative may develop spondyloarthritis.
We know there is an increase of occurrence in family members, which is often an additional worry added on to an already stressful situation for the patient. This article can be helpful for health care providers when assessing first-degree family members, highlighting the importance of early intervention (such as routine eye exams) as well as providing clarity on early predictive symptoms.
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