Ophthalmic findings and frequency of extraocular manifestations in patients with HLA-B27 uveitis: a study of 175 cases

Abstract

Objective: To analyze ocular and extraocular manifestations in patients with HLA-B27-associated uveitis.

Design: Large, observational case series.

Participants: One hundred seventy-five consecutive patients with HLA-B27-associated uveitis seen in a single center between January 1996 and March 2001.

Methods: Features of uveitis were noted and patients were referred systematically to rheumatologists. The history of previous uveitis attacks and extraocular manifestations of spondyloarthropathy was recorded. Assessments of spondyloarthropathies were based on criteria established by the European Spondyloarthropathy Study.

Main outcome measures: Percentage of patients with extraocular manifestations. The time between the first episode of uveitis and symptoms or diagnosis of extraocular disease was estimated. Characteristics of uveitis were analyzed.

Results: The male-to-female ratio was 1.3 to 1, and the median age at the time of the first attack of uveitis was 31 years. An HLA-B27-associated extraocular disorder was seen in 136 cases (77.7%). Of these, ankylosing spondylitis was diagnosed in 81 patients (46.3%) and presumed in 17 (9.7%). Undifferentiated spondyloarthropathy was observed in 21 patients (12%) and other HLA-B27-associated diseases in 17 patients (9.7%). The onset of extraocular symptoms occurred at a younger age (mean+/-standard deviation [SD], 26.4+/-11.1 years) than the first attack of uveitis (mean+/-SD, 34.0+/-14.1 years; P<0.0001). The diagnosis of an extraocular disease was made only after the appearance of ophthalmic manifestations in 88 of 136 patients. Among 117 patients (66.9%) with more than 1 episode of uveitis, same eye attacks were observed in 48 of 117 patients (41.0%), more than the expected percentage than attacks of a random eye (P<0.0001). The median +/- SD frequency of active episodes of uveitis was 0.8+/-0.6 per year and decreased as the duration of the disease lengthened (P<0.0001). Patients with extraocular disease had a greater total number of attacks of uveitis (P = 0.02), but other ophthalmic findings did not differ between patients with and without an extraocular disorder.

Conclusions: Uveitis is frequently the first indication of a previously undiagnosed HLA-B27-associated extraocular disease. The most common of these diseases are spondyloarthropathies.