TOPLINE:

An analysis of a nationwide electronic health record database revealed strong bidirectional associations between uveitis and immune-mediated inflammatory diseases. The presence of immune-mediated inflammatory diseases — particularly ankylosing spondylitis and juvenile idiopathic arthritis — was associated with an increased risk for incident uveitis, and patients with uveitis were more likely to have had, or subsequently develop, an immune-mediated inflammatory disease.

METHODOLOGY:

• Researchers conducted a retrospective cohort and case-control study using data from electronic health records to evaluate the association between immune-mediated inflammatory diseases and uveitis.
• The analysis used three complementary strategies: a cohort study assessing the 5-year risk for incident uveitis after the diagnosis of an immune-mediated inflammatory disease, a case-control study comparing the prevalence of a prior immune-mediated inflammatory disease in individuals with or without uveitis, and a reverse cohort study evaluating the 5-year risk for incident immune-mediated inflammatory diseases after the diagnosis of uveitis.
• Patients were diagnosed with noninfectious uveitis and/or one of 12 immune-mediated inflammatory diseases: rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, scleroderma, inflammatory bowel disease, multiple sclerosis, ankylosing spondylitis, psoriasis, juvenile idiopathic arthritis, giant cell arteritis, antineutrophil cytoplasmic antibody-associated vasculitis, and other systemic vasculitis.
• Control individuals had no prior diagnosis of uveitis or any immune-mediated inflammatory disease.
• The first and third analyses reported risk ratios (RRs) for incident diagnoses of uveitis and immune-mediated inflammatory diseases, respectively; the second analysis reported odds ratios (ORs) for a prior diagnosis of an immune-mediated inflammatory disease.

TAKEAWAY:

• All 12 immune-mediated inflammatory diseases were associated with a significantly increased 5-year risk for new-onset uveitis — highest for ankylosing spondylitis (RR, 7.71; P < .0001), followed by juvenile idiopathic arthritis (RR, 5.13; P < .0001) and systemic vasculitis (RR, 4.61; P < .0001).
• Among patients with uveitis, the highest odds of a prior diagnosis of immune-mediated inflammatory diseases were found for juvenile idiopathic arthritis (OR, 82.58; P < .0001) and ankylosing spondylitis (OR, 38.91; P < .0001).
• Patients with uveitis had an increased 5-year risk of developing immune-mediated inflammatory diseases, particularly juvenile idiopathic arthritis (RR, 23.32; P < .0001) and ankylosing spondylitis (RR, 15.61; P < .0001).

IN PRACTICE:

“Adult patients should receive urgent referral to an ophthalmologist with new onset of symptoms to identify active uveitis to allow for early intervention and prevent vision loss,” the researchers reported.

“Given the significant risks observed, targeted screening strategies and timely intervention may improve patient outcomes by mitigating ocular and systemic complications,” they added.

SOURCE:

The study was led by Nitesh Mohan, of the Cole Eye Institute at Cleveland Clinic in Cleveland. It was published online on January 9, 2025, in the American Journal of Ophthalmology.

LIMITATIONS:

The analysis depended on use of diagnosis codes by physicians. Unmeasured confounders such as environmental factors and family history could not be accounted for. Although the study evaluated risk within a 5-year window, many patients with autoimmune and inflammatory diseases may have had the condition for years before receiving an official diagnosis. 

DISCLOSURES:

The study received support from the Clinical and Translational Science Collaborative of Cleveland, funded by the National Institutes of Health, National Center for Advancing Translational Science, and Clinical and Translational Science Award grant. Several authors disclosed receiving consulting fees and research support from various pharmaceutical companies.

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