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.
CONCLUSION: 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.