Therapeutic advances in musculoskeletal disease · 2026
Recurrent uveitis unveiling axial spondyloarthritis: is inflammatory back pain always the main road to diagnosis? A monocentric cohort.
СтатьяНазвание и аннотация: Перевод в очереди
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Rai Alessandra, Crescentini Filippo, Citriniti Giorgia, Oliva Marianna, Macaluso Federica, Macchioni Pierluigi, Cimino Luca, Bolletta Elena, Gozzi Fabrizio, Gentile Pietro, De Simone Luca, Salvarani Carlo, Possemato Niccolò
Аннотация
BACKGROUND: Nongranulomatous acute anterior uveitis (NG-AAU) is the most common extra-articular manifestation of spondyloarthritis (SpA) and may be a warning sign of previously undiagnosed axial SpA (ax-SpA).
OBJECTIVE: Given the known diagnostic delay of ax-SpA, this study aimed to determine the prevalence of previously undiagnosed ax-SpA among NG-AAU patients and to characterize the clinical features of ax-SpA identified through uveitis.
DESIGN: Cross-sectional study.
METHODS: This monocentric study included consecutive NG-AAU patients referred to a tertiary ophthalmologic center between August 2024 and August 2025. All patients underwent a comprehensive rheumatologic assessment, including human leukocyte antigen B27 (HLA-B27) testing and sacro-iliac joint magnetic resonance imaging (MRI). Ultrasound evaluation of entheses and symptomatic joints was also performed. SpA diagnosis was established by expert opinion based on clinical, laboratory, and imaging findings.
RESULTS: Among 68 NG-AAU patients, 38 without a previous rheumatic diagnosis were included. Sixteen (43.2%) received a new diagnosis of ax-SpA, and none with peripheral SpA. HLA-B27 positivity was more frequent in ax-SpA than in non-SpA patients (56% vs 33%). All ax-SpA patients reported prior episodes of back pain, although inflammatory back pain was present in only 56.3% at the time of evaluation. Mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores and symptom duration were significantly higher in ax-SpA patients (p = 0.005 and p = 0.041, respectively). MRI revealed active sacroiliitis in 62.5% and erosions in 75% of newly diagnosed ax-SpA patients. Only 68.7% of new diagnoses fulfilled the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for ax-SpA.
CONCLUSION: Nearly half of NG-AAU patients had previously unrecognized ax-SpA, often presenting with mild or atypical axial symptoms. These findings highlight the importance of integrated ophthalmologic and rheumatologic evaluation to facilitate earlier ax-SpA diagnosis.
OBJECTIVE: Given the known diagnostic delay of ax-SpA, this study aimed to determine the prevalence of previously undiagnosed ax-SpA among NG-AAU patients and to characterize the clinical features of ax-SpA identified through uveitis.
DESIGN: Cross-sectional study.
METHODS: This monocentric study included consecutive NG-AAU patients referred to a tertiary ophthalmologic center between August 2024 and August 2025. All patients underwent a comprehensive rheumatologic assessment, including human leukocyte antigen B27 (HLA-B27) testing and sacro-iliac joint magnetic resonance imaging (MRI). Ultrasound evaluation of entheses and symptomatic joints was also performed. SpA diagnosis was established by expert opinion based on clinical, laboratory, and imaging findings.
RESULTS: Among 68 NG-AAU patients, 38 without a previous rheumatic diagnosis were included. Sixteen (43.2%) received a new diagnosis of ax-SpA, and none with peripheral SpA. HLA-B27 positivity was more frequent in ax-SpA than in non-SpA patients (56% vs 33%). All ax-SpA patients reported prior episodes of back pain, although inflammatory back pain was present in only 56.3% at the time of evaluation. Mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores and symptom duration were significantly higher in ax-SpA patients (p = 0.005 and p = 0.041, respectively). MRI revealed active sacroiliitis in 62.5% and erosions in 75% of newly diagnosed ax-SpA patients. Only 68.7% of new diagnoses fulfilled the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for ax-SpA.
CONCLUSION: Nearly half of NG-AAU patients had previously unrecognized ax-SpA, often presenting with mild or atypical axial symptoms. These findings highlight the importance of integrated ophthalmologic and rheumatologic evaluation to facilitate earlier ax-SpA diagnosis.