Uveitis as the initial clinical manifestation in patients with spondyloarthropathies.
OBJECTIVE
To investigate the frequency and pattern of presentation of uveitis as the first clinical manifestation to prompt diagnostic evaluation in patients with spondyloarthropathies (SpA).


METHODS
Patients with uveitis were attended simultaneously by ophthalmologists and rheumatologists in our Uveitis Clinic between June 1997 and October 2000. An established clinical protocol based on the pattern of uveitis and the patient's symptoms was used to determine diagnosis. Evaluation included clinical history, ophthalmologic examination, hemogram, biochemistry, erythrocyte sedimentation rate, the fluorescent treponemal antibody absorption test, urinalysis, and chest radiograph. Additional studies were requested according to the protocol.


RESULTS
Data from 394 patients were recorded in our database. Seventy-two (18%) had some type of SpA; their mean age was 44.7 years (SD 15.7) and 51 (71.8%) were men. Forty-two patients (59%) of the SpA group had been previously diagnosed. In the 30 (41%) who were undiagnosed, uveitis was the first manifestation to prompt diagnostic evaluation. The most frequent clinical pattern was acute unilateral anterior uveitis. The 2 main keys to confirm the diagnosis of SpA were the presence of recurrent acute unilateral uveitis and low back or joint pain, in addition to the uveitis flare. HLA-B27 was found in 94% of patients.


CONCLUSIONS
In 41% of the patients diagnosed with SpA, uveitis was the first clinical sign, suggesting that collaboration between ophthalmologists and rheumatologists greatly aids the diagnosis and treatment of these patients. When this close collaboration is not possible, all patients with rheumatic complaints and recurrent acute unilateral uveitis should be referred to a rheumatologist.
Rheumatology and Ophthalmology Services, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain. jfernandezmel@yahoo.es
Julia
J
Fernández-Melón
Santiago
S
Muñoz-Fernández
Ventura
V
Hidalgo
Gema
G
Bonilla-Hernán
Armel
A
Schlincker
Antonio
A
Fonseca
José
J
Vieitez
Emilio
E
Martín-Mola
D000328:Adult; D005260:Female; D015796:HLA-B27 Antigen / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013166:Spondylitis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D014605:Uveitis / Q000209:etiology* / Q000276:immunology
D015796:HLA-B27 Antigen