Spondyloarthritis

Eye problems in SpA highlight need to work in collaboration: ophthalmologist


All intraocular inflammation is potentially vision-threatening, highlighting the need for ophthalmologists and rheumatologists to work together for their patients with spondyloarthritis.

Dr Diana Conrad, who runs a combined clinic for inflammatory eye disease at the Royal Brisbane and Women’s Hospital, told the APLAR-ARA meeting that acute anterior uveitis was characterised by a deep pain and photophobia.

She said a Spanish study of 798 patients with more than one episode of anterior uveitis found about half the patients (50.2%) had axial SpA and 17.5% had peripheral SpA according to ASAS criteria.

A smaller Irish study found more than 40% of patients with acute anterior uveitis had undiagnosed SpA.

The researchers also developed an algorithm including variables such as back pain before age 45years and HLA-B27 positivity to help identify undiagnosed SpA in uveitis patients.

They concluded closer collaboration between ophthalmologists and rheumatologists would lead to earlier intervention and better outcomes for SpA patients.

Dr Conrad said most patients could be managed with topical steroids such as Prednefrin Forte eye drops. Treatment must be continued until there was complete resolution, which could take 8-10 weeks.

The downsides of steroid treatment were the risks of cataracts or glaucoma.

Second episodes of uveitis were not uncommon, so patients should be encouraged to be prepared with a spare script and to carry eye drops when travelling, she added.

If topical steroids failed, other options included oral steroids, periocular steroid injections or intravitreal corticosteroid implants.

However the Multicenter Uveitis Steroid Treatment (MUST) study found that over a period of seven years, systemic steroid treatment resulted in better visual acuity than steroid implants.

Guidelines for non-corticosteroid systemic therapy were released last year.

Dr Conrad said complications of uveitis included cataracts, macular oedema, the development of cyclitic membrane, hypotony, phthisis and glaucoma.

She warned that the increasing scope of practice for optometrists could lead to inflammatory eye diseases being managed without any medical supervision.

And physicians could improve their level of patient care by working closer together.

“The problem is that we are probably all busy and just don’t pick up the phone often enough. We tend to rely on letters and then the communication isn’t perhaps as good as it could be,” she told the limbic.

Having ophthalmologists and rheumatologists working together in combined clinics could facilitate better collaboration and improved care, she suggested.

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