TOPLINE

Among patients with nongranulomatous acute anterior uveitis (NG-AAU) who had no prior rheumatic diagnosis, more than 40% were newly diagnosed with axial spondyloarthritis (ax-SpA) after rheumatologic evaluation. Many of these patients had atypical axial symptoms.

METHODOLOGY

• Researchers conducted a cross-sectional study to determine the prevalence of previously undiagnosed ax-SpA in 68 patients with NG-AAU (mean age, 43.1 years; 54.4% women) referred from an eyecare unit in Italy between August 2024 and August 2025.
• A total of 38 patients without previously diagnosed rheumatic disease underwent comprehensive rheumatologic assessment.
• Assessments included clinical examination, laboratory testing for HLA-B27, routine blood tests, musculoskeletal ultrasound of entheses, and MRI of the sacroiliac joints.
• The primary aim was the prevalence of newly diagnosed ax-SpA. Secondary aims included characterization of clinical features, imaging findings, and disease activity measures.

TAKEAWAY

• Overall, 43.2% of patients without prior rheumatic disease received a new diagnosis of ax-SpA.
• Patients with ax-SpA were more likely than those without ax-SpA to report chronic back pain (68.75% vs 19%; P = .004) and inflammatory back pain (56.2% vs 0%; P < .001).
• Sacroiliac MRI showed bone marrow edema more often in patients with vs without ax-SpA (62.5% vs 14.2%; P < .004). Structural damage (erosions) was also more common in patients with ax-SpA (75% vs 0%; P < .001).
• Mean disease activity scores were higher in patients with vs without ax-SpA (P < .05). HLA-B27 positivity was more frequent in patients with ax-SpA, although the difference was not statistically significant.

IN PRACTICE

"[The] study highlights NG-AAU as an important clinical window for identifying previously undiagnosed ax-SpA, particularly in patients with mild, atypical, or intermittent axial symptoms... an interdisciplinary approach involving close, structured collaboration between ophthalmologists and rheumatologists is essential to enable earlier diagnosis and reduce diagnostic delay," the authors of the study wrote.

SOURCE

The study was led by Alessandra Rai, Reggio Emilia Local Health Authority-IRCCS Advanced Technologies and Care Models in Oncology in Reggio Emilia, Italy. It was published online on August 1 in Therapeutic Advances in Musculoskeletal Disease.

LIMITATIONS

The cross-sectional design of the study prevented longitudinal follow-up and assessment of long-term disease progression. The study lacked a priori sample size calculation and had a relatively small sample size. All MRI scans were reviewed by a single rheumatologist.

DISCLOSURES

The authors did not receive any financial support for the study and declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.