Ankylosing spondylitis (AS) and related forms of spondyloarthritis (SpA) are associated with some extra-articular features, and the most common symptomatic association is with acute
anterior uveitis (AAU). Thus, approximately 40 % of patients with AS will experience a sudden onset of a unilateral
anterior uveitis sometime during the course of their disease. Patients with AAU, especially those who are
HLA-B27 positive, should be questioned about inflammatory
low back pain and also evaluated for other clinical features of SpA. Since a prolonged delay in diagnosis is common among SpA patients and occurrence of AAU may be the reason for their first interaction with medical care, occurrence of AAU presents a unique opportunity for identifying such undiagnosed SpA patients. Therefore, a novel evidence-based algorithm called Dublin
Uveitis Evaluation Tool (DUET) has been proposed to guide ophthalmologists and primary care physicians to refer appropriate AAU patients to rheumatologists. In a large two-phase study, approximately 40 % of patients presenting with idiopathic AAU were noted to have undiagnosed SpA, and DUET algorithm was noted to have excellent sensitivity (96 %) and specificity (97 %). It has a positive likelihood ratio (LR) 41.5 and negative LR 0.03. In most instances, the eye
inflammation responds well to
corticosteroid and
mydriatic eye drops and without the need for additional
therapy. Use of oral
corticosteroids is reserved for patients, especially with associated chronic
inflammatory bowel disease or
psoriatic arthritis presenting with bilateral, chronic, anterior, and/or
intermediate uveitis, and this treatment is rarely needed for more than a couple of weeks. A very small percentage may be more refractory to such treatment and require potential novel
therapies, including the use of
tumor necrosis factor blockers.