The Eyes May Be Windows on the Spine

June 20, 2014

A new tool could help ophthalmologists who see uveitis collaborate in the early diagnosis of spondyloarthritis.

Haroon M, O'Rourke M, Ramasamy P et al. A novel evidence-based detection of undiagnosed spondyloarthritis in patients presenting with acute anterior uveitis: the DUET (Dublin Uveitis Evaluation Tool).Ann Rheum Dis. (2014) Jun 13. doi: 10.1136/annrheumdis-2014-205358. [Epub ahead of print]

A new easy-to-use tool could help ophthalmologists be on the alert for spondyloarthritis (SpA), which has the longest delay in diagnosis of any inflammatory joint disease -- often more than six years.

Approximately 40% of patients with a common form of uveitis, idiopathic acute anterior uveitis (AAU), also have SpA. So spotting eye inflammation may also reveal early SpA and avoid these delays, say Irish researchers.

Noting the lack of guidelines for referring AAU patients to rheumatologists, they developed an easy-to-use algorithm for ophthalmologists to aid the early diagnosis of SpA: The Dublin Uveitis Evaluation Tool (DUET).

It takes advantage of the fact that SpA and AAU share a common human leukocyte antigenic link, HLA-B27. Half of HLA-B27-positive AAU patients have underlying SpA, and half of SpA patients have AAU.

The researchers tested and validated the DUET tool among two groups of consecutive AAU patients (most of them men in their 40s) seen in the emergency department at the Royal Victoria Eye and Ear Hospital in Dublin and identified as having SpA.

The new tool looks for suspected SpA and tests for HLA-B27 as well as psoriasis among AAU patients with back or joint pain. If patients reporting pain who are HLA-B27 positive and/or have psoriasis would be referred to a rheumatologist.

The DUET algorithm proved more than 90% sensitive and specific in both an initial group of 101 AAU patients and a 72-patient validation cohort. Most patients had previously sought medical help for back pain, but the link between the eyes and the spine had not been recognized.

The researchers say their study makes a strong case for collaboration between ophthalmologists and rheumatologists and for such evidence-based guidelines to make it more likely that patients will be referred for care in the same manner, regardless of where and by whom they are seen.