Prevalence of spondyloarthritis in 504 Chinese patients with HLA‐B27‐associated acute anterior uveitis

Chung, Yu-Mei; Liao, Hsien‐Tzung; Lin, Kuan Chia; Lin, Yuan-Chih; Chou, Chung Tei; Chen, Chun Hsiung; Tsai, CY

doi:10.1080/03009740802385423

Cited by 47 publications

(37 citation statements)

References 23 publications

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“…59-61 HLA-B27 anterior uveitis is more prevalent in males with 66.5-75% of patients being male. 63, 64 This is important because HLA-B27 anterior uveitis is one of the most common types of uveitis in Western countries, accounting for 50-80% of anterior uveitis patients. 60, 61, 63, 65-67 Recently, a genome-wide association study showed that a single allele of HLA-B27 conferred an odds ratio (OR) of 66.8 for developing acute anterior uveitis and homozygosity conferred an OR of 130.6 when compared to HLA-B27 negative controls.…”

Section: Male Predominant Uveitides With Systemic Involvementmentioning

confidence: 99%

The Role of Sex in Uveitis and Ocular Inflammation

Yeung¹,

Popp²,

Chan³

2015

International Ophthalmology Clinics

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Uveitides can be due to non-infectious and infectious etiologies. It has been observed that there is a gender difference with a greater preponderance of non-infectious uveitis in women than in men. This review will describe both non-infectious and infectious uveitides and describes some of the current autoimmune mechanisms thought to be underlying the gender difference. It will specifically look at non-infectious uveitides with systemic involvement including juvenile idiopathic arthritis, spondyloarthopathies, sarcoidosis, Behçet’s disease, and Vogt-Koyanagi-Harada disease and at uveitides without systemic involvement including sympathetic ophthalmia, birdshot chorioretinitis, and the white dot syndromes. Infectious uveitides like acute retinal necrosis, progressive outer retinal necrosis, and cytomegalovirus mediated uveitis will be mentioned. Different uveitides with female- or male- predominance are presented and discussed.

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Section: Male Predominant Uveitides With Systemic Involvementmentioning

confidence: 99%

The Role of Sex in Uveitis and Ocular Inflammation

Yeung¹,

Popp²,

Chan³

2015

International Ophthalmology Clinics

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“…It is the most common form of anterior uveitis, accounting for 18–32% of all cases of anterior uveitis1. The typical phenotypes of HLA-B27-associated AAU are acute onset of unilateral alternating, non-granulomatous acute anterior uveitis, being characterized by significant cellular and protein extravasation into the aqueous humor including fibrin and hypopyon in the anterior chamber, high tendency for recurrences, and significant association with other HLA-B27-related diseases such as seronegative spondyloarthropathies (SpA)2. Considering the high frequency of recurrent attacks and sever ocular complication, AAU is regarded as a potentially sever threat to version.…”

mentioning

confidence: 99%

Imbalance of Th17/Treg cells in pathogenesis of patients with human leukocyte antigen B27 associated acute anterior uveitis

Zhuang

Wang

Zhu

et al. 2017

Sci Rep

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Th17 and regulatory T cells, involved in the pathogenesis of several autoimmune diseases, are new lineages of CD4+ T helper cells. However, the role of their imbalance in human leukocyte antigen B27-associated acute anterior uveitis has not been elucidated. In our study, the percentages of Th17 and Treg cells, their molecular markers and related factors in peripheral blood of patients and healthy controls were measured by flow cytometry, real-time RT-PCR and ELISA. We observed a remarkable increase of CD4+ and CD4+IL-17+ T cells in peripheral blood of patients compared to controls. The molecular markers and related factors of Th17 cell were also showed a distinct elevation. Interestingly, we observed an obvious decrease of CD4+CD25+Foxp3+ T cells and Foxp3 mRNA level in patients. The ratio of Th17/Treg in patients was dramatically higher than controls. Moreover, the ratio of Th17/Treg cells had a more significantly positive correlation with the disease activity score than Th17 cells whereas Treg cells had a negative correlation. Our findings demonstrated a distinct increase of Th17 cells and a significant decrease of Treg cells in patients compared to controls. The imbalance of Th17 and Treg cells may play a vital role in the pathogenesis of the disease.

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“…These 387 patients with SpA had an earlier onset of uveitis (p=0.01) and a greater number (six or more) of flares (p= 0.03) when compared with the 117 AAU patients without SpA [28]. Interestingly, Munoz-Fernandez et al evaluated presence of enthesis lesions in patients with idiopathic recurrent AAU and noted that a high percentage of patients with HLA-B27-positive recurrent AAU without features of SpA showed evidence of enthesis lesions similar to those observed in patients with SpA.…”

Section: Undiagnosed Spa Common Among Patients Presenting With Uveitismentioning

confidence: 93%

“…For example, in a study, 18 % of 394 anterior uveitis patients had SpA, and for 41 % of these SpA patients, uveitis was the first interaction with medical care for underlying SpA [27]. Now, if we look at the prevalence of underlying SpA in HLA-B 27-positive uveitis patients only, it has been reported to be very high, and two recent studies have shown this to be as high as 76 % [28,29].…”

Section: Undiagnosed Spa Common Among Patients Presenting With Uveitismentioning

confidence: 99%

Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

2015

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Ankylosing spondylitis (AS) and related forms of spondyloarthritis (SpA) are associated with some extra-articular features, and the most common symptomatic association is with acute anterior uveitis (AAU). Thus, approximately 40 % of patients with AS will experience a sudden onset of a unilateral anterior uveitis sometime during the course of their disease. Patients with AAU, especially those who are HLA-B27 positive, should be questioned about inflammatory low back pain and also evaluated for other clinical features of SpA. Since a prolonged delay in diagnosis is common among SpA patients and occurrence of AAU may be the reason for their first interaction with medical care, occurrence of AAU presents a unique opportunity for identifying such undiagnosed SpA patients. Therefore, a novel evidence-based algorithm called Dublin Uveitis Evaluation Tool (DUET) has been proposed to guide ophthalmologists and primary care physicians to refer appropriate AAU patients to rheumatologists. In a large two-phase study, approximately 40 % of patients presenting with idiopathic AAU were noted to have undiagnosed SpA, and DUET algorithm was noted to have excellent sensitivity (96 %) and specificity (97 %). It has a positive likelihood ratio (LR) 41.5 and negative LR 0.03. In most instances, the eye inflammation responds well to corticosteroid and mydriatic eye drops and without the need for additional therapy. Use of oral corticosteroids is reserved for patients, especially with associated chronic inflammatory bowel disease or psoriatic arthritis presenting with bilateral, chronic, anterior, and/or intermediate uveitis, and this treatment is rarely needed for more than a couple of weeks. A very small percentage may be more refractory to such treatment and require potential novel therapies, including the use of tumor necrosis factor blockers.

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Prevalence of spondyloarthritis in 504 Chinese patients with HLA‐B27‐associated acute anterior uveitis

Abstract: The prevalence of SpA was high in the Chinese population with HLA-B27-associated uveitis. The association with SpA indicated an earlier age of uveitis onset and a greater likelihood of having a higher number of uveitis attacks.

Cited by 47 publications

References 23 publications

The Role of Sex in Uveitis and Ocular Inflammation

The Role of Sex in Uveitis and Ocular Inflammation

Imbalance of Th17/Treg cells in pathogenesis of patients with human leukocyte antigen B27 associated acute anterior uveitis

Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

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