TOPLINE

Among patients with spondyloarthritis (SpA), when uveitis occurred, it was most often in an anterior location and with an acute recurrent course, and the pattern differed according to whether SpA manifested peripherally or axially.

METHODOLOGY

• Researchers conducted a retrospective observational study at Hospital Universitario La Paz in Madrid, Spain, to characterize uveitis across different types of SpA, involving 163 patients with noninfectious uveitis and SpA (mean age at onset, 42.5 years; 53% male individuals) evaluated from 2012 to 2024.
• Patients were categorized according to five SpA subtypes: those with radiographic axial SpA (r-axSpA; 49%), nonradiographic axial SpA (nr-axSpA; 21%), peripheral SpA (pSpA; 4.3%), inflammatory bowel disease (IBD)-associated SpA (13%), or psoriatic arthritis (PsA; 12%); the median follow-up duration was 61.7 months.
• Investigators evaluated treatments encompassing topical therapies; corticosteroids; conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) such as methotrexate, sulfasalazine, cyclosporine, and mycophenolate; and biologic therapies such as adalimumab, infliximab, certolizumab pegol, and golimumab. They also assessed treatment duration and causes of discontinuation (inefficacy, improvement, or adverse events).
• For comparative analysis, patients were regrouped into axial SpA (r-axSpA and nr-axSpA) and peripheral SpA (pSpA, IBD-associated SpA, and PsA) groups.

TAKEAWAY

• The common patterns noted in the overall cohort were an anterior location of uveitis (97%), an acute recurrent course (79%), and alternating laterality (47.4%). Keratic precipitates were observed in 40% of patients, vitritis in 12%, cystoid macular edema in 12%, and papillitis in 4% during the follow-up period.
• Intermediate uveitis, posterior uveitis, and panuveitis occurred exclusively in patients with peripheral SpA, and the frequencies of chronic and acute nonrecurrent courses and bilateral presentation were higher in patients with peripheral SpA than in those with axial SpA (P < .001 and P < .05, respectively).
• Mean age at uveitis onset was higher in patients with r-axSpA (46 years) or PsA (45 years) than in those with nr-axSpA (36.2 years), pSpA (31.3 years), or IBD-associated SpA (40 years); cystoid macular edema and glaucoma frequencies were higher in patients with PsA (20% and 15%, respectively) and were not observed in those with pSpA.
• Overall, 28.2% of patients required csDMARDs, and 17.8% required biologic therapy. Variables predicting a greater need for systemic therapy included chronic course (P < .01) and bilateral uveitis (P < .05); more immunosuppressive therapy was needed by those with a higher mean maximum number of annual episodes, a younger age at onset, and the presence of peripheral joint involvement in their articular process.

IN PRACTICE

“Understanding and distinguishing the ocular inflammatory processes associated with SpA may have important therapeutic and prognostic implications,” the authors of the study wrote. “These results may help clinicians identify patients at higher risk of complex ocular involvement who may benefit from closer ophthalmologic monitoring and earlier consideration of systemic therapy, thereby supporting a more individualized, phenotype-driven approach to the management of uveitis in patients with spondyloarthritis.”

SOURCE

The study was led by Elena Miguélez Sánchez, Ramon y Cajal University Hospital, Madrid, Spain. It was published online on June 25, 2026, in Clinical Rheumatology.

LIMITATIONS

The study was retrospective in nature, and sample sizes in some subgroups were small. Patient follow-up duration was variable.

DISCLOSURES

The study did not receive any specific funding. The authors disclosed having no relevant financial or nonfinancial interests.

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