Background and ObjectiveAnkylosing spondylitis (AS) is an inflammatory disease, and choroidal thickness (CT) has been proposed and evaluated as a potential marker of systemic inflammation associated with AS and other inflammatory diseases. This study compared CT measurements taken from patients with severe AS disease activity without eye inflammation with those taken from healthy subjects.MethodsThis cross-sectional, multicenter study compared CT in 44 patients with high AS disease activity, and no history of eye inflammation with CT in 44 matched healthy subjects aged between 18 and 65 years. In the AS group, the correlation between CT and C-reactive protein, human leukocyte antigen (HLA) B27 positivity, disease duration, and disease activity was calculated.ResultsMean CT values of patients with AS were significantly higher in the right eye, the left eye, and the thickest choroid eye. The right eye mean CT was 338.3 ± 82.8 μm among patients with AS and 290.5 ± 71.2 μm among healthy subjects (p = 0.005). The left eye mean CT was 339.5 ± 84.7 μm for patients with AS and 298.4 ± 68.9 μm for healthy subjects (P = 0.015). The thickest choroid eye CT was 358.4 ± 82.1 μm among patients with AS and 314.1 ± 65.2 μm among healthy subjects (P = 0.006). We did not find a significant correlation between CT and disease activity, C-reactive protein, human leukocyte antigen B27 positivity, or disease duration.ConclusionsPatients with active AS but without a history of eye inflammation had a thicker choroid than healthy subjects. This finding suggests that CT is a marker of systemic inflammation in patients with inflammatory disease, regardless of known eye symptoms.

Introduction: Uveitis is the inflammation of the middle layer of the eye, the uvea, and is a major cause of blindness. None of the instruments used in clinical practice are, in themselves, sufficient to evaluate the course of uveitis. Therefore, it is necessary to develop instruments enabling standardized measurement of inflammatory activity. We developed a

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BackgroundStandardized and validated outcome measures of disease activity are lacking in the treatment and assessment of uveitis, making it difficult to compare efficacy and response to treatment. In 2014, this working group developed a composite index of ocular inflammatory activity, UVEDAI, which includes 7 variables. The index was validated in a subsequent study conducted in 2019.ObjectivesTo determine the interobserver reliability and to demonstrate the sensitivity to change of the UVEDAI index in patients with anterior and non-anterior uveitis who undergo pharmacological treatment.MethodsThe design is an observational, longitudinal, prospective, multicentre study in 7 Spanish hospitals. Patients over 18 years of age diagnosed with active uveitis were included. A complete baseline visit was performed by two ophthalmologists who determined ocular inflammatory activity with the UVEDAI index independently and without contact between them. Ophthalmologist 1 made a new visit at 4 weeks to determine the change in the level of uveal inflammatory activity using the UVEDAI index. The interobserver reliability analysis was performed by calculating the Intraclass Correlation Coefficient (ICC), with the values of the variables and the UVEDAI index obtained by ophthalmologist 1 and ophthalmologist 2 in the most inflamed eye at the baseline visit. Sensitivity to change in the UVEDAI index was assessed at 4 weeks from the start of pharmacological treatment by determining the Clinically Relevant Change (CCR) defined as a change in UVEDAI of 0.8 points between the baseline visit and the 4-week visit.ResultsA total of 111 patients were included, 54.1% were male and the mean age at the time of the visit was 49.9 years. 36.9% of uveitis were idiopathic uveitis, and 58.6% were anterior uveitis. The UVEDAI value was calculated from the score obtained in the 7 variables of the index. The mean value recorded in the most inflamed eye at the baseline visit by ophthalmologist 1 was 1.9, being 1.2 points for anterior uveitis and 2.8 points for intermediate/posterior uveitis. In the interobserver reliability analysis, the ICC for the UVEDAI value was 0.9, and when compared to the mean UVEDAI values obtained by the two ophthalmologists for the most inflamed eye at the baseline visit, no statistically significant differences were found (p-value>0.05), neither for the total sample nor differentiating by anatomical location. As for sensitivity of UVEDAI change, statistically significant differences (p-value=0.00) were found when comparing the mean values of the index measured by ophthalmologist 1 at the baseline visit and at 4 weeks, both in the overall sample and differentiating by anatomic location of uveitis. In all cases, the index value decreased significantly by more than 1 point at the 4-week visit after pharmacological treatment.ConclusionThe interobserver reliability of the UVEDAI was high in the total sample and in the different variables. Furthermore, the index was sensitive in determining the change in inflammatory activity after treatment in both anterior uveitis and intermediate/posterior uveitis/panuveitis. We believe it is an index of activity that could be used both in routine clinical practice and in clinical studies and trials to compare results objectively.Reference[1]Pato-Cour E, Martin-Martinez MA, Castelló A, et al. Development of an activity disease score in patients with uveitis (UVEDAI). Rheumatol Int. 2017;37(4):647-65.Figure Interobserver ReliabilityDifferences obtained in the UVEDAI index score by ophthalmologist 1 and 2 at the baseline visit.Figure 1.Table Sensitive to ChangeMean value and difference in UVEDAI index value measured by ophthalmologist 1 in the active eye at baseline and at 4 weeks.Table 1.Anatomical LocationAnteriorIntermediate/Posterior/PanuvetisTotalUVEDAI INDEX baseline.opht.1*1,2 ± 1,62,8 ± 1,81,9 ± 1,8UVEDAI INDEX visit 4 wks.opht1*0,2 ± 0,51,2 ± 1,50,6 ± 1,1UVEDAI difference1.041.541.25p-value0.000.000.00*mean ± standard deviationDisclosure of InterestsNone Declared.

and on behalf of the ChOroidal Thickness in ESpondylitis (COnTEST) Study Group Objective: Choroidal thickness (CT) has been evaluated as a marker of systemic inflammation in ankylosing spondylitis (AS). This study evaluates the CT of AS patients before and after 6 months of biological treatment.Methods: This longitudinal multicenter study evaluated CT in 44 AS patients. The correlations between CT and C-reactive protein (CRP) with disease activity indices were calculated. The concordance between CT and CRP was determined. We assessed factors associated with response to treatment. Clinically important improvement was defined as a decrease in Ankylosing Spondylitis Disease Activity Score of 1.1 points or greater.Results: Forty-four eyes in patients aged 18 to 65 years were included. Mean CT values were significantly higher at baseline than after 6 months of treatment (baseline: 355.28 ± 80.46 μm; 6 months: 341.26 ± 81.06 μm; p < 0.001). There was a 95% concordance between CT and CRP at baseline and 6 months. Clinically important improvement was associated with lower baseline CT and age as independent factors (odds ratios, 0.97 [95% confidence interval, 0.91-0.93; p = 0.009] and 0.81 [95% confidence interval, 0.7-0.95; p = 0.005]), with baseline CT of less than 374 μm (sensitivity 78%, specificity 78%, area under the curve 0.70, likelihood ratio 3.6).Conclusions: Choroidal thickness decreased significantly after 6 months of biological treatment in all treatment groups. Choroidal thickness and CRP had a 95% concordance. A high CTwas associated with a risk of biological treatment failure. Choroidal thickness can be considered a useful biomarker of inflammation and a factor associated with response to treatment in AS.