Only 17% of patients with uveitis receive systemic disease evaluation, diagnoses
DESTIN, Fla. — Despite the common association with autoimmune diseases, just 17% of patients with uveitis are evaluated for, or diagnosed with, a systemic autoimmune disease when receiving ophthalmology care, according to a presenter at the 2019 North American Young Rheumatology Investigator Forum.
“As you know, uveitis is the most common inflammatory eye disease, and it is frequently associated with systemic autoimmune diseases,” Nancy S. Harrison, MD, a fellow at the the University of Mississippi Medical Center, told attendees. “The prevalence is difficult to determine, but according to previous studies, it is usually about 40% to 55% of uveitis cases that are related to a secondary autoimmune disease. These include spondyloarthritides, psoriatic arthritis, IBDs, Behçet’s disease, and others, as well as a few cases of Sjögren’s syndrome and lupus.”
To evaluate the diagnostic prevalence of systemic autoimmune diseases among patients being assessed for uveitis by an ophthalmologist, Harrison and colleagues analyzed data for 1,096 adult patients at a tertiary referral center. Patients were diagnosed with uveitis and followed from Jan. 1, 2013, to March 31, 2018. The researchers used an online visit processing tool to search for diagnostic codes for uveitis, as well as for commonly associated systemic autoimmune diseases.
The researchers then cross-referenced their search results using three additional data reviews, focusing on medications used by the patients, as well as laboratory and imaging evaluation, and referral to a rheumatologist. The prevalence of systemic disease diagnoses was then determined and compared to historical data.
According to Harrison, 17% of patients included in the study had a concomitant diagnosis or an evaluation for a systemic autoimmune disease. In addition, just 22% of patients had a diagnosis of an underlying infectious cause, of which only 1% was due to malignancy. Among the diagnoses of systemic autoimmune disease, of nonspecific connective tissue disease was the most common, followed by sarcoidosis and vasculitis. A total of 18 patients, or 1.6%, were diagnosed with seronegative spondyloarthritides, while HLA-B27 was evaluated in just 67 patients, or 6.1% of the whole. Of those who were evaluated for HLA-B27, 50% were positive.
“Our data suggests that patients with uveitis may not be adequately evaluated for autoimmune systemic diseases,” Harrison said. “The prevalence of secondary autoimmune diseases was only 17% in our cohort, whereas in previous studies it was 40% to 55%. In addition, about 50% to 60% of patients with uveitis have a positive HLA-B27, which our data did show, with about 50% being positive. However, only 6.1% in our cohort were evaluated for HLA-B27.” – by Jason Laday
Harrison NS. Missed opportunity? Evaluation for systemic autoimmune diseases with uveitis may not be optimal. Presented at: North American Young Rheumatology Investigator Forum; May 1, 2019; Destin, Fla.
Disclosure: Harrison reports no relevant financial disclosures.