SAT0015 Uveitis as the initial clinical manifestation in patiens with spondyloarthopathies

Abstract

Background Undifferentiated arthritis could be an early stage or forme fruste of a definite rheumatic disease. Objectives The purpose of this poster is to describe the evolution of 40 patients (>16 years) in our hospital, with seronegative mono-oligoarthritis, HLA B27 negative, without axial involvement, that at the onset of the disease did not meet the criteria to be included in any other defined arthropathy. Methods Forty patients (21 females and 19 males) with seronegative undifferentiated oligoarthritis, without axial involvement, that could not be typified as rheumatic disease of the rheumatoid, psoriatic, enteropathic, gouty, or reactive type, were studied retrospectively. In all patients the presence of crystals in their synovial fluid was discared as well as skin or eye symptoms, infectious diseases (Salmonella, Shigella, Yersinia, Ureaplasma and mycobacteria) or associated connective-tissue disease. Results The mean age at the onset of oligoarthritis was 42.1 years (44.9 for males and 36.3 for females). The average duration of follow-up was 11.1 years (range 24-1). Eight (28%) of the 40 patients had just one joint affected while the remaining patients presented with 4 or less involved joints. In 8 of our cases (20%) the disease resolved spontaneously. In 12 patients (30%), a definitive diagnosis was made after an average of 4.1 years (range 13-1) from the onset to the final diagnosis. Among these 12 patients, 5 were diagnosed as gout, 2 as arthropathy associated with inflammatory bowel disease, 2 as psoriatic arthritis, 2 as rheumatoid arthritis and one case of SAPHO associated arthropathy. In the remaining patients the disease followed a chronic course and no improvement was detected. Only 16 of the 40 patients received specific antirheumatic drug therapy: 10 of the 20 cases in which the disease took a chronic course and for which no diagnosis was reached. Conclusion We would like to stress that no rheumatologist would deny the difficulty implied in diagnosing and managing patients with undifferentiated mono-oligoarthritis that do not fit into any typified rheumatic disease. Nevertheless, although 50% of our patients have not yet been definitively diagnosed after a 6.5 year average follow-up, a final diagnosis has been reached for 30% of the total number in a 4.1-year period on the average.

Unusual Case of Vogt-Koyanagi-Harada Disease Associated with SAPHO Syndrome: A Case Report

“…Furthermore, ocular inflammation associated with SAPHO syndrome is rare. Fernández-Melón and associates [3] reviewed 394 patients with uveitis having spondyloarthropathies and reported only one patient with SAPHO syndrome. Yabe and associates [4] reported two cases of SAPHO syndrome accompanied by Behçet's disease.…”

Manifestations oculaires au cours des spondyloarthrites en Guinée

“…La précocité d'apparition de l'atteinte oculaire par rapport à l'atteinte articulaire amène les ophtalmologues à faire rechercher une spondyloarthrite. Les uvéites antérieures majoritaires dans notre étude ont été décrites en Espagne [18] où elles représentaient 94,4% des cas. Ce résultat corrobore avec les données de la littérature où dans 90 % des cas, l'uvéite est antérieure [14,16,19].…”

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“…The significance of AAU in SpA is that of a negative prognostic marker: it is associated with higher disease activity scores, with decreased mobility and functionality and, most importantly, with a higher degree of structural damage [22,23]. So, the importance of AAU in early diagnosis of SpA lies in the facts the AAU is often the first manifestation in aroud 41% of patients with SpA, between 41 and 77% of patients with AAU have actual undiagnosed SpA, which is important as the medium time between onset and diagnosis of disease is around 7 years [24][25][26][27][28].…”