From the Rheumatology Department.
Ophthalmology Department, Complejo Asistencial Universitario de León, León, Spain.
J Clin Rheumatol. 2023 Apr 1;29(3):132-138. doi: 10.1097/RHU.0000000000001921. Epub 2023 Jan 9.
Evaluating the efficacy and refractoriness to treatment and determining factors associated with adverse outcomes in uveitis associated with spondylarthritis (SpA) are complicated by the lack of validated outcome measures.
The aims of this study were to develop an outcome score SpA-U in patients with uveitis associated with SpA and to determine factors associated with adverse outcomes in patients with uveitis under systemic treatment.
The outcome score SpA-U was defined by best-corrected visual acuity, anterior chamber inflammation, macular edema and inflammation of posterior chamber, global assessment, and refractoriness to treatment. Factors associated with adverse outcomes in uveitis were studied using linear regression. For categorical factors, marginal averages and their SEs are displayed together with linear regression coefficients with 95% confidence intervals. For continuous factors, averages and SDs are reported in addition to linear regression coefficients with 95% confidence interval. Two regression coefficients are reported for each variable: unadjusted and adjusted for age at diagnosis and sex.
One hundred ninety-seven uveitis outbreaks were included. Sixty-two uveitis outbreaks (31%) were classified as severe, 42 as moderate (21%), and 93 as mild (47%) based on the definition and construction of outcome score. The results of the linear regression model revealed that the uveitis activity was more severe in patients with smoking history ( β = 0.34), axial and peripheral involvement ( β = 0.43), Ankylosing Spondylitis Disease Activity Score >2.1 ( β = 0.45), positive HLA-B27 ( β = 0.29), female sex ( β = 0.19), patients with C-reactive protein elevation ( β = 0.002), and bilateral ocular involvement ( β = 0.32). At the same time, shorter disease evolution ( β = -0.02) was associated with less severe uveitis activity.
We have determined factors associated with adverse outcomes in patients with uveitis associated with SpA by developing an outcome score SpA-U that integrates ocular inflammatory activity, visual acuity, global assessment, and refractoriness to treatment.
评估与脊柱关节炎（SpA）相关的葡萄膜炎的疗效和治疗反应性，并确定与不良结局相关的因素，这在很大程度上受到缺乏经过验证的结局衡量指标的限制。
本研究旨在为与 SpA 相关的葡萄膜炎患者制定一种名为 SpA-U 的结局评分，并确定接受全身治疗的葡萄膜炎患者发生不良结局的相关因素。
通过最佳矫正视力、前房炎症、黄斑水肿和后房炎症、整体评估以及治疗反应性来定义 SpA-U 结局评分。使用线性回归来研究与葡萄膜炎不良结局相关的因素。对于分类变量，显示边缘平均值及其 SE 以及带有 95%置信区间的线性回归系数。对于连续变量，除了带有 95%置信区间的线性回归系数外，还报告平均值和标准差。为每个变量报告了两个回归系数：未调整的以及根据诊断时的年龄和性别调整后的。
共纳入 197 次葡萄膜炎发作。根据结局评分的定义和构建，62 次（31%）葡萄膜炎发作被归类为严重，42 次（21%）为中度，93 次（47%）为轻度。线性回归模型的结果显示，有吸烟史的患者（β=0.34）、存在中轴和外周关节累及的患者（β=0.43）、Ankylosing Spondylitis Disease Activity Score＞2.1（β=0.45）、HLA-B27 阳性的患者（β=0.29）、女性（β=0.19）、C 反应蛋白升高的患者（β=0.002）和双眼受累的患者（β=0.32）的葡萄膜炎活动度更严重。同时，疾病病程更短（β=-0.02）与葡萄膜炎活动度较轻相关。
我们通过制定一种整合眼部炎症活动、视力、整体评估和治疗反应性的 SpA-U 结局评分，确定了与 SpA 相关的葡萄膜炎患者不良结局的相关因素。
