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Research ArticleAccepted Article

High prevalence of previously undiagnosed axial spondyloarthritis in patients referred with anterior uveitis and chronic back pain - the SpEYE study

Rianne Elise van Bentum, Frank D. Verbraak, Sanne Wolf, Jenny Ongkosuwito, Maarten Boers, H. Stevie Tan and Irene E. van der Horst-Bruinsma
The Journal of Rheumatology February 2022, jrheum.210345; DOI: https://doi.org/10.3899/jrheum.210345
Rianne Elise van Bentum
Departments of Rheumatology and Ophthalmology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands. Department of Ophthalmology, Bergman clinics, Zaandam, the Netherlands. Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CONFLICTS OF INTEREST: The authors declare no conflicts of interest for this study. Address correspondence to Prof. dr. I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam University Medical Centre - location VUmc, Department of Rheumatology room ZH0D53, PO Box 7057, Postal Code 1007 MB Amsterdam, The Netherlands. E-mail: ie.vanderhorst@amsterdamumc.nl
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Frank D. Verbraak
Departments of Rheumatology and Ophthalmology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands. Department of Ophthalmology, Bergman clinics, Zaandam, the Netherlands. Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CONFLICTS OF INTEREST: The authors declare no conflicts of interest for this study. Address correspondence to Prof. dr. I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam University Medical Centre - location VUmc, Department of Rheumatology room ZH0D53, PO Box 7057, Postal Code 1007 MB Amsterdam, The Netherlands. E-mail: ie.vanderhorst@amsterdamumc.nl
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Sanne Wolf
Departments of Rheumatology and Ophthalmology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands. Department of Ophthalmology, Bergman clinics, Zaandam, the Netherlands. Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CONFLICTS OF INTEREST: The authors declare no conflicts of interest for this study. Address correspondence to Prof. dr. I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam University Medical Centre - location VUmc, Department of Rheumatology room ZH0D53, PO Box 7057, Postal Code 1007 MB Amsterdam, The Netherlands. E-mail: ie.vanderhorst@amsterdamumc.nl
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Jenny Ongkosuwito
Departments of Rheumatology and Ophthalmology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands. Department of Ophthalmology, Bergman clinics, Zaandam, the Netherlands. Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CONFLICTS OF INTEREST: The authors declare no conflicts of interest for this study. Address correspondence to Prof. dr. I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam University Medical Centre - location VUmc, Department of Rheumatology room ZH0D53, PO Box 7057, Postal Code 1007 MB Amsterdam, The Netherlands. E-mail: ie.vanderhorst@amsterdamumc.nl
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Maarten Boers
Departments of Rheumatology and Ophthalmology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands. Department of Ophthalmology, Bergman clinics, Zaandam, the Netherlands. Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CONFLICTS OF INTEREST: The authors declare no conflicts of interest for this study. Address correspondence to Prof. dr. I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam University Medical Centre - location VUmc, Department of Rheumatology room ZH0D53, PO Box 7057, Postal Code 1007 MB Amsterdam, The Netherlands. E-mail: ie.vanderhorst@amsterdamumc.nl
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H. Stevie Tan
Departments of Rheumatology and Ophthalmology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands. Department of Ophthalmology, Bergman clinics, Zaandam, the Netherlands. Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CONFLICTS OF INTEREST: The authors declare no conflicts of interest for this study. Address correspondence to Prof. dr. I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam University Medical Centre - location VUmc, Department of Rheumatology room ZH0D53, PO Box 7057, Postal Code 1007 MB Amsterdam, The Netherlands. E-mail: ie.vanderhorst@amsterdamumc.nl
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Irene E. van der Horst-Bruinsma
Departments of Rheumatology and Ophthalmology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands. Department of Ophthalmology, Bergman clinics, Zaandam, the Netherlands. Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CONFLICTS OF INTEREST: The authors declare no conflicts of interest for this study. Address correspondence to Prof. dr. I.E. van der Horst-Bruinsma, MD, PhD, Amsterdam University Medical Centre - location VUmc, Department of Rheumatology room ZH0D53, PO Box 7057, Postal Code 1007 MB Amsterdam, The Netherlands. E-mail: ie.vanderhorst@amsterdamumc.nl
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Abstract

Objective To reduce the diagnostic delay in axial spondyloarthritis (axSpA), guidelines recommend to refer patients with acute anterior uveitis (AAU) and chronic back pain (CBP) to a rheumatologist. This observational study evaluated the prevalence of previously unrecognized axSpA in AAU patients with CBP in daily practice, referred by ophthalmologists who had received instructions to increase awareness.

Methods All AAU patients referred with CBP (≥3 months, started <45 years of age), from five Ophthalmology clinics underwent rheumatologic assessment, including pelvic X-rays. Patients with previously diagnosed rheumatic disease and established other cause of AAU were excluded. The primary endpoint was a clinical axSpA diagnosis by the rheumatologist.

Results Eighty-one patients fulfilled the referral criteria (52% male, 56% HLA-B27 positive, median age 41 years, median CBP duration 10 years). In total, 58% (n=47) had recurring AAU, of whom 87% already had CBP during previous AAU attacks. After assessment, 23% (n=19) of patients were clinically diagnosed with definite-axSpA (10/19 radiographic), 40% (n=32) were suspicious of axSpA and 37% (n=30) did not have axSpA. AxSpA was diagnosed more often in men (33% of the men versus 13% of women).

Conclusion A high prevalence of axSpA was found in AAU patients referred because of CBP. There was substantial diagnostic delay in the majority of patients with recurring AAU, as many already had back pain during previous AAU flares. In AAU, screening for CBP and prompt referral has a high diagnostic yield, and should consistently be promoted among ophthalmologists.

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The Journal of Rheumatology
Vol. 52, Issue 6
1 Jun 2025
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Accepted manuscript
High prevalence of previously undiagnosed axial spondyloarthritis in patients referred with anterior uveitis and chronic back pain - the SpEYE study
Rianne Elise van Bentum, Frank D. Verbraak, Sanne Wolf, Jenny Ongkosuwito, Maarten Boers, H. Stevie Tan, Irene E. van der Horst-Bruinsma
The Journal of Rheumatology Feb 2022, jrheum.210345; DOI: 10.3899/jrheum.210345

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Accepted manuscript
High prevalence of previously undiagnosed axial spondyloarthritis in patients referred with anterior uveitis and chronic back pain - the SpEYE study
Rianne Elise van Bentum, Frank D. Verbraak, Sanne Wolf, Jenny Ongkosuwito, Maarten Boers, H. Stevie Tan, Irene E. van der Horst-Bruinsma
The Journal of Rheumatology Feb 2022, jrheum.210345; DOI: 10.3899/jrheum.210345
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