Triggering Factors Associated With a New Episode of Recurrent Acute Anterior Uveitis

Abstract

To identify triggering factors for the next inflammatory episode of recurrent acute anterior uveitis (RAAU), a 1:1 case-control study was conducted. Patients with recent acute anterior uveitis and matched controls were interviewed using Srithanya Stress Test (ST-5) and questionnaires about potential triggering factors. Asymptomatic controls were matched for age (±5 years), sex, and HLA-B27. There were 39 pairs of cases and controls. Within 1-month before the interview, patients who recently experienced a uveitis attack demonstrated higher mean ST-5 scores (3.7±2.9 vs 0.7±1.1) and shorter sleep time (6.3±1.4 vs 7.4±0.7) compared with their controls. In the multivariate conditional logistic regression analysis, ST-5 score ≥3 (OR 9.17; 95%CI 1.15-72.84, p=0.036) and sleep time <7 hours per day (OR 11.57; 95% CI 1.42-94.55, p=0.022) were more likely to trigger a uveitis attack in RAAU accounted for age, sex, and HLA-B27 positivity of the patients. Other suspected triggering factors were not found to have any significant association. In short, emotional stress and inadequate sleep are the major triggering factors that lead to the future episode of acute anterior uveitis in RAAU. Both physical and emotional stress management may be helpful to minimize recurrences and further complications.

Analysis of the clinical diagnosis and treatment of uveitis

“…These findings suggest that patients with uveitis should be actively tested for different etiologies, and that the combination of etiologic and symptomatic treatment results in a faster recovery and better outcomes. Other studies have shown that stress and lack of sleep may contribute to the recurrence of anterior uveitis, while exercise, smoking, and alcohol consumption are not associated with recurrence (22). Other researchers have found that air pollution leads to increased levels of inflammatory cytokines and exacerbates the autoimmune inflammatory response (23).…”

“…Guidelines for the treatment of uveitis include glucocorticoids as first-line therapy, immunomodulatory drugs such as cyclosporine A, methotrexate, azathioprine, and Mycophenolate Mofetil as second-line therapy, and biological agents [tumor necrosis factor-alpha antagonists (TNF-α) or interferon-alpha] as third-line therapy (24,25). Neti et al (22) found that slowrelease glucocorticoid injections were rapidly effective in improving visual acuity, with 86% improvement in visual acuity, 27% improvement in pain and 26% improvement in vitreous inflammatory clouding. Posarelli et al (26) found that systemic steroids were used in 42.86% of the patients with uveitis, and the most common ocular complications were cataracts and an increased IOP, but there was no statistical correlation with systemic steroid application.…”

Acute anterior hypopyon uveitis after non-penetrating ocular trauma in a patient with ankylosing spondylitis and HLA-B27 positivity

“…Chan et al [3] found that back pain and stiffness at diagnosis and the presence of complications during the presenting episode of uveitis conferred a higher risk of AAU reactivation (odds ratios 2.29 and 3.86, respectively). Neti et al examined patients with recurrent AAU using questionnaires and found that those with a higher Srithanya Stress Test score and less than seven hours of sleep time had higher chances of recurrences (odds ratio 9.07 and 12.12 respectively) [11]. None of the patients reported eye trauma before AAU reactivation [11].…”

“…Neti et al examined patients with recurrent AAU using questionnaires and found that those with a higher Srithanya Stress Test score and less than seven hours of sleep time had higher chances of recurrences (odds ratio 9.07 and 12.12 respectively) [11]. None of the patients reported eye trauma before AAU reactivation [11]. The present case and those previously reported [4][5][6] suggest that trauma may also be a risk factor for the initiation of an AAU episode in HLA-B27 positive patients.…”