Bolletta Elena, Crescentini Filippo, Gentile Pietro, Citriniti Giorgia, Macchioni Pierluigi, Marchesoni Antonio, Simone Luca De, Gozzi Fabrizio, Salvarani Carlo, Cimino Luca
Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Italy.
Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Saudi J Ophthalmol. 2025 Jan 2;39(1):20-30. doi: 10.4103/sjopt.sjopt_240_24. eCollection 2025 Jan-Mar.
Anterior uveitis (AU) is characterized by the inflammation of the iris and ciliary body and is the most frequent extra-articular manifestation of spondyloarthritis (SpA). In SpA patients, AU is typically described as unilateral alternating acute AU (AAU). Moreover, as AAU can be the initial clinical manifestation of SpA, ophthalmologists could play a key role in the early diagnosis of SpA. The diagnostic delay in SpA is associated with poorer outcomes, including functional impairment, reduced response to treatment, and lower quality of life. A well-structured screening of patients with AAU could facilitate the early diagnosis. Consequently, the interdisciplinary collaboration between ophthalmologists and rheumatologists is fundamental to reduce the diagnostic delays. A correct and early diagnosis of SpA, together with early treatment initiation is important prognostic factors. These measures are associated with better treatment responses and may help retard the development of structural damage, particularly in the era of biological therapies, which have significantly improved the care of patients with SpA. Although various algorithms have been proposed to guide the selection of appropriate candidates for rheumatology referral, to date, there are no formal guidelines or universally recognized criteria for referral. This review aimed to summarize the epidemiological, pathogenetic, clinical, and therapeutic aspects of AU associated with SpA as well as the ophthalmology-rheumatology interdisciplinary approach.
前葡萄膜炎(AU)的特征是虹膜和睫状体发炎,是脊柱关节炎(SpA)最常见的关节外表现。在SpA患者中,AU通常被描述为单侧交替性急性前葡萄膜炎(AAU)。此外,由于AAU可能是SpA的初始临床表现,眼科医生在SpA的早期诊断中可能发挥关键作用。SpA的诊断延迟与较差的预后相关,包括功能损害、对治疗反应降低和生活质量下降。对AAU患者进行结构良好的筛查有助于早期诊断。因此,眼科医生和风湿病学家之间的跨学科合作对于减少诊断延迟至关重要。SpA的正确早期诊断以及早期开始治疗是重要的预后因素。这些措施与更好的治疗反应相关,可能有助于延缓结构损伤的发展,特别是在生物疗法时代,生物疗法显著改善了SpA患者的治疗。尽管已经提出了各种算法来指导选择合适的风湿病转诊候选人,但迄今为止,尚无正式的转诊指南或普遍认可的标准。本综述旨在总结与SpA相关的AU的流行病学、发病机制、临床和治疗方面,以及眼科-风湿病跨学科方法。