Association of Uveitis with Radiographic Progression in Patients with Axial Spondyloarthritis: A Propensity Score Matching Analysis

Abstract

Objective. Acute anterior uveitis (AAU) is the most common extra-articular manifestation in patients with axial spondyloarthritis (axSpA). However, the relationship between AAU and radiographic progression in axSpA remains unclear. Hence, we investigated whether the presence of AAU is associated with radiographic structural damage in patients with axSpA. Methods. Clinical and radiographic data were obtained from 253 patients with axSpA. Radiographic progression over 2 years was assessed using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Progression was defined as mSASSS worsening by ≥two units. Using propensity score (PS) matching, differences between patients with and without AAU were analyzed. Results. The proportion of progressors among patients with AAU was lower than that of patients without AAU (13.6% vs. 29.5%, p=0.058). The rate of increase in mSASSS and number of syndesmophytes were lower in patients with AAU than patients without AAU (0.57±1.37 vs. 1.02±1.79, p=0.085 and 0.46±1.45 vs. 0.83±1.62, p=0.158). In multivariate regression analysis, presence of AAU was independently associated with slowed radiographic progression (odds ratio [95% confidence interval] 0.21 [0.07, 0.67], p=0.004). Conclusion. PS-matched axSpA patients with AAU showed significantly less radiographic progression than those without AAU. (J Rheum Dis 2019;26:248-256)

Autoantibodies against Protein Phosphatase Magnesium-Dependent 1A as a Biomarker for Predicting Radiographic Progression in Ankylosing Spondylitis Treated with Anti-Tumor Necrosis Factor Agents

“…Several studies have determined clinical parameters that are useful for the prediction of radiographic progression in AS patients [16][17][18]. That is, the presence of syndesmophytes at baseline, increased acute phase reactants, male sex, older age, presence of uveitis, and smoking are considered to be predictors of radiographic progression.…”

A Propensity Score Matching Analysis Showed the Significant Association of Anterior Uveitis With Radiographic Progression in Axial Spondyloarthritis

“…Several cross-sectional studies failed to demonstrate any association between AAU and radiographic progression in patients with AS [12][13][14] and SpA [15], whereas another study reported that a history of AAU was independently associated with more severe radiographic damage in patients with AS [16]. In contrast to these previous observations, Kim, et al reported that a history of AAU was the only independent variable indicating less severe mSASSS changes in their PS-matched axSpA patients and, interestingly, other variables that have been known to be associated with progression of spinal damage were not found to be significant [10]. Although the reason for this discrepancy is not fully understood, the retrospective design of the study, relatively small number of patients, differences in the AAU prevalence between patient populations, and the possibility of index event bias should be considered when interpreting their results.…”

“…As axSpA includes a vast array of clinical manifestations and progress slowly over the years, the effect of certain clinical parameters on the disease course remain poorly identified. In this regard, the study by Kim et al [10] can be meaningful. This report is the first to evaluate the impact of various clinical variables on mSASSS changes in Korean axSpA patients using PS matching analysis.…”

“…In the recent issue of Journal of Rheumatic Diseases, Kim et al [10] investigated the association between acute anterior uveitis (AAU) and radiographic progression of axSpA using a propensity score (PS) matching analysis. Their study enrolled 253 patients with axSpA classified based on the Assessment of Spondyloarthritis International Society classification criteria and examined various clinical parameters, including age, sex, smoking status, HLA-B27 status, history of extra-articular manifestations (uveitis, psoriasis, inflammatory bowel disease, peripheral arthritis, and enthesitis), ASDAS-CRP, as well as mSASSS.…”