Insights into uveitis in association with spondyloarthritis from a large patient survey.

BACKGROUND: Uveitis is reported to be the most common extra-articular feature in spondyloarthritis (SpA). OBJECTIVE: The objective of this study was to investigate the relationship between uveitis and SpA in a cohort identified from a survey. METHODS: Eight hundred sixty-three respondents completed a survey conducted by the Spondylitis Association of America. Data on baseline demographics, quality of life, medication use, and joint involvement were compared in SpA patients with and without uveitis. Logistic regression analysis was used to identify characteristics associated with the presence of uveitis. RESULTS: Of the 863 respondents, 168 (19.5%) reported a diagnosis of uveitis. Baseline demographics including sex, age, and ethnicity were similar between the uveitis and no-uveitis groups. The presence of uveitis had a significant positive association with the use of the biologic drug infliximab (adjusted odds ratio [ORadj] = 1.66, P = 0.044), "lower jaw" involvement (ORadj = 1.60, P = 0.015), heel involvement (ORadj = 1.51, P = 0.023), and a diagnosis of arthritis associated with inflammatory bowel disease (ORadj = 1.92, P = 0.005). It had a significant negative association with the use of the biologic drug etanercept (ORadj = 0.49, P = 0.011) or a coexisting diagnosis of diabetes (ORadj = 0.02, P = 0.020). CONCLUSIONS: The relationship of uveitis to medication presumably reflects the choice of a specific tumor necrosis factor inhibitor in the setting of a history of uveitis. One prior study has also correlated heel pain and uveitis, thus supporting the validity of the association and suggesting potentially a common pathogenesis. Because diabetes has been proposed as a risk factor for uveitis, the negative association is surprising and may distinguish the pathogenesis of uveitis in association with SpA from other forms of uveitis.

Development and validation of a case ascertainment tool for ankylosing spondylitis.

OBJECTIVE: Ankylosing spondylitis (AS) diagnosis is often delayed. The availability of effective biologic agents for treating AS has increased the importance of early diagnosis. We tested questions derived from a comprehensive literature review and an advisory board in a case-control study designed to identify patients with AS from among patients with chronic back pain (CBP). METHODS: Question items were cognitively tested among patients with AS, and then in case-control studies for validation and creation of a scoring algorithm and question item reduction. AS cases were recruited from a known database, and CBP subjects (controls) were recruited from clinics, employers, and from the SpineUniverse Web site. We used individual question items in a multivariate framework to discriminate between people with and without AS. RESULTS: Forty-three questions yielded 24 items for analyses; 12 of these were entered into a multivariate regression model. Individual items yielded odds ratios ranging from 0.07 to 30.31. Question items with a significant positive relationship to AS included male sex, neck or hip pain/stiffness, longer pain duration, decreased pain/stiffness with daily physical activity, pain relief within 48 hours of nonsteroidal antiinflammatory drugs, and diagnosis of iritis. The tool demonstrated a sensitivity of 67.4 and a specificity of 94.6. The tool was developed from clinically and radiologically diagnosed AS cases and therefore is designed to distinguish AS cases among CBP subjects. In addition, approximately 54% of the AS cases in the study were treated with biologic agents, which may impact questionnaire responses. CONCLUSION: This tool can identify undiagnosed patients with AS and, potentially, those at an earlier stage in their disease course.

Visual assessment of the spine bruckel instrument, a novel status tool to reflect appearance of the spine in patients with ankylosing spondylitis.

OBJECTIVE: The Visual Assessment of the Spine Bruckel Instrument (VASBI) is a new status tool developed by the Spondylitis Association of America and the University of Toronto to reflect spinal appearance in patients with ankylosing spondylitis (AS). Our objective was to validate the VASBI according to the Outcome Measures in Rheumatoid Arthritis Clinical Trials filter (truth, discrimination, and feasibility). METHODS: Three hundred patients with AS were asked to rate their degree of perceived spinal deformity using the VASBI. To evaluate construct validity, VASBI scores were compared with functional outcome, spinal mobility, and radiographic spinal damage. Test-retest reliability was evaluated using kappa statistic (kappa). RESULTS: Patient VASBI demonstrated strong correlation with spinal mobility (r = 0.543) and moderate correlation with functional impairment (r = 0.490) and structural damage (r = 0.309). Reliability for VASBI was very good (kappa = 0.973, p < 0.001). CONCLUSION: The VASBI is a novel tool with practical applications in a busy clinical setting as it simplifies assessment of AS spinal deformity. Our study demonstrates that the VASBI has good feasibility, construct validity, and reliability.