SAT0346 EARLY RECOGNITION OF AXIAL SPONDYLOARTHRITIS IN PATIENTS WITH ACUTE ANTERIOR UVEITIS: COMPARISON OF TWO REFERRAL STRATEGIES
Authors: Judith Rademacher, Hildrun Haibel, Susanne Lüders, Burkhard Muche, Fabian Proft, Mikhail Protopopov, Valeria Rios Rodriguez, Laura Spiller, Sabrina Sron, Anne Katrin Weber, Uwe Pleyer, Denis Poddubnyy
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Diagnostic delay in axial spondyloarthritis (axSpA) remains with 5 to 9 years very high. Extraarticular manifestations like acute anterior uveitis might occur as first manifestations. Up to 40% of patients with acute anterior uveitis have an undiagnosed SpA. Recently, the Dublin Uveitis Evaluation tool (DUET) was proposed as a SpA screening instrument for ophthalmologists [1]. At the same time, the ASAS referral tool [2] can also be used on the level of ophthalmologists. <h3>Objectives</h3> The objective of the study was to compare the performance of the DUET and the ASAS referral tools for recognition of SpA in patients with acute anterior uveitis. <h3>Methods</h3> A total of 100 consecutive patients with acute anterior uveitis of an ophthalmology clinic were included, 87 had completed a standardized rheumatological examination (including MRI of sacroiliac joints) allowing for a definite conclusion on the presence/absence of SpA. The sensitivity, the specificity and the positive predictive value of both referral tools were calculated. <h3>Results</h3> Out of the 87 patients with acute anterior uveitis 54 (62%) were diagnosed with SpA (51 with axSpA, one with peripheral SpA, one with reactive arthritis and one with psoriatic arthritis), in 36 cases the diagnosis was made for the first time. The performance of both referral tools is presented in table. The ASAS referral tool showed higher sensitivity (that was especially evident in the previously undiagnosed population) but somehow lower specificity compared to the DUET. The positive predictive value was comparable for both tools indicating that approximately 2 patients with uveitis should be referred in order to diagnose one case of SpA. In our study, MRI scans were performed on all patients including those without back pain. We thereby diagnosed axial spondyloarthritis in 5 patients, even though they did not fulfill the ASAS classification criteria as they never reported back pain (1 patients) or their back pain did not start prior to the age of 45 years (4 patients). <h3>Conclusion</h3> We revealed a high prevalence of undiagnosed SpA in patients with acute anterior uveitis. As anticipated, the more complex DUET including also psoriasis and HLA-B27 positivity showed higher specificity for recognition than the ASAS referral tool. However, the ASAS tool has a higher sensitivity (especially in undiagnosed population) and a better feasibility (purely clinical tool, does not include HLA-B27 testing and evaluation of psoriasis by an ophthalmologist). <h3>References</h3> [1] Haroon M, et al. Ann Rheum Dis2015;74:1990-5. [2] Poddubnyy D, et al. Ann Rheum Dis2015;74:1483-7. <h3>Acknowledgement</h3> The study was supported by an unrestricted research grant from Abbvie. <h3>Disclosure of Interests</h3> Judith Rademacher: None declared, Hildrun Haibel: None declared, Susanne Lüders: None declared, Burkhard Muche Speakers bureau: Yes less than 10.000, Fabian Proft Grant/research support from: Novartis, Consultant for: yes but less than 10.000, Paid instructor for: yes but less than 10.000, Speakers bureau: yes but less than 10.000, Mikhail Protopopov: None declared, Valeria Rios Rodriguez: None declared, Laura Spiller: None declared, Sabrina Sron: None declared, Anne Katrin Weber: None declared, Uwe Pleyer: None declared, Denis Poddubnyy Grant/research support from: AbbVie, Merck Sharp &amp; Dohme, Novartis, Consultant for: AbbVie, Bristol-Myers Squibb, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, UCB Pharma, Speakers bureau: AbbVie, Bristol-Myers Squibb, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, UCB Pharma