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Complicated uveitis in a spondyloarthritis patient: a case report

  • Afdal Rosihan Hasbi ,
  • Awali ,

Abstract

Background: Ophthalmic manifestations, like uveitis, might be one of the complications of spondyloarthritis. Many individuals experiencing acute uveitis are unaware that spondyloarthritis has already been present. The late diagnosis and treatment of uveitis can result in permanent vision impairment. This case report presents the diagnosis and management by a rheumatologist and ophthalmologist of a spondyloarthritis patient with complicated uveitis.

Case: On October 27, 2021, a 42-year-old male patient came to the rheumatology outpatient clinic of Dr. Soetomo General Hospital, Surabaya, Indonesia with intermittent low back pain for the past fourteen years, which worsened in the last eight months. The pain was accompanied by morning stiffness for about an hour after getting-up every day, gradually relieved by stretching. The lumbosacral x-ray revealed bilateral sacroiliitis. The patient also came to the ophthalmology outpatient clinic with sudden left eye pain and gradually blurred vision for the past two years. He was diagnosed with spondyloarthritis with bilateral uveitis, secondary glaucoma, and secondary cataract on both eyes. He was given methotrexate, sulfasalazine, sodium diclofenac, topical timolol 0.5%, topical atropine, acetazolamide, and methylprednisolone. The low back pain and impaired vision were improved after three months of treatment.

Conclusion: Uveitis should be suspected as a relatively common complication of spondyloarthritis. Early diagnosis and treatment of this uveitis might prevent permanent damage.

References

  1. Dougados M, Baeten D. Spondyloarthritis. Lancet. 2011;377(9783):2127–37. Available from: http://dx.doi.org/10.1016/s0140-6736(11)60071-8
  2. Rathinam SR, Namperumalsamy P. Global variation and pattern changes in epidemiology of uveitis. Indian J Ophthalmol. 2007;55(3):173. Available from: http://dx.doi.org/10.4103/0301-4738.31936
  3. Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009;68(Suppl 2):ii1–44. Available from: http://dx.doi.org/10.1136/ard.2008.104018
  4. Hayward RJ, Machado PM. Classification Criteria in Axial Spondyloarthritis. Rheum Dis Clin North Am. 2020;46(2):259–74. Available from: http://dx.doi.org/10.1016/j.rdc.2020.01.008
  5. Sykes MP, Hamilton L, Jones C, Gaffney K. Prevalence of axial spondyloarthritis in patients with acute anterior uveitis: a cross-sectional study utilizing MRI. RMD open. 2018;4(1):e000553–e000553. Available from: https://pubmed.ncbi.nlm.nih.gov/29531779
  6. Ali A, Samson CM. Seronegative spondyloarthropathies and the eye. Curr Opin Ophthalmol. 2007;18(6):476–80. Available from: http://dx.doi.org/10.1097/icu.0b013e3282f0fda2
  7. Tiara T, Fidiana F. Obstructive sleep apnea and chronic pain as risk factors of cognitive impairment in elderly population: A study from Indonesia. Narra J. 2021;1(3). Available from: http://dx.doi.org/10.52225/narra.v1i3.62
  8. Nazir A, Sutiono AB. Breathing and Light- to Vigorous-Intensity Aerobic Exercises Improved Respiratory Functions and Functional Capacity of COVID-19 Survivor with Morbid Obesity. J Respirasi. 2023;9(2):124–9. Available from: http://dx.doi.org/10.20473/jr.v9-i.2.2023.124-129
  9. Yanti B, Hadi S, Harrika F, Shehzad A. Giant bronchopleural fistula and empyema in a tuberculosis patient with diabetes mellitus: Vista from a high tuberculosis burden country in Southeast Asia. Narra J. 2022;2(2). Available from: http://dx.doi.org/10.52225/narra.v2i2.81
  10. Yulistiawati F. A case report of a woman with SLE and lupus enteritis as the first manifestation of active systemic lupus erythematosus. Bali Medical Journal. 2023;12(2):1321-237.
  11. Rahma AI, Awalia. Perioperative management of patient with late rheumatoid arthritis and post-bone tuberculosis with genu contracture undergoing tenotomy. Bali Med J. 2022;11(2):913–7. Available from: http://dx.doi.org/10.15562/bmj.v11i2.3443
  12. Prananjaya BA, Aini S, Loo JL, Ikhsan DS, Suryani PR, Rashid AS. Vaginismus: An Approach from biology to psychological aspect. J Psikiatri Surabaya. 2023;12(1):65–70. Available from: http://dx.doi.org/10.20473/jps.v12i1.44205
  13. de Winter JJ, van Mens LJ, van der Heijde D, Landewé R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther. 2016;18(1):196. Available from: https://pubmed.ncbi.nlm.nih.gov/27586785
  14. Stolwijk C, van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis. 2013;74(1):65–73. Available from: http://dx.doi.org/10.1136/annrheumdis-2013-203582
  15. Rosenbaum JT. Extra-articular manifestations: uveitis [Internet]. Oxford Medicine Online. Oxford University Press; 2016. Available from: http://dx.doi.org/10.1093/med/9780198734444.003.0016
  16. Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis. 2007;67(7):955–9. Available from: http://dx.doi.org/10.1136/ard.2007.075754
  17. Webers C, Essers I, Ramiro S, Stolwijk C, Landewé R, van der Heijde D, et al. Gender-attributable differences in outcome of ankylosing spondylitis: long-term results from the Outcome in Ankylosing Spondylitis International Study. Rheumatology. 2015;kev340. Available from: http://dx.doi.org/10.1093/rheumatology/kev340
  18. Rademacher J, Poddubnyy D, Pleyer U. Uveitis in spondyloarthritis. Ther Adv Musculoskelet Dis. 2020;12:1759720X20951733-1759720X20951733. Available from: https://pubmed.ncbi.nlm.nih.gov/32963592
  19. Sieper J, Poddubnyy D. Axial spondyloarthritis. Lancet. 2017;390(10089):73–84. Available from: http://dx.doi.org/10.1016/s0140-6736(16)31591-4
  20. Wakefield D, Carr G, McCluskey P. Ankylosing Spondyloarthropathy [Internet]. Intraocular Inflammation. Springer Berlin Heidelberg; 2016. p. 693–701. Available from: http://dx.doi.org/10.1007/978-3-540-75387-2_54
  21. Sepriano A, Regel A, van der Heijde D, Braun J, Baraliakos X, Landewé R, et al. Efficacy and safety of biological and targeted-synthetic DMARDs: a systematic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD open. 2017;3(1):e000396–e000396. Available from: https://pubmed.ncbi.nlm.nih.gov/28176964
  22. Dewi S, Nurudhin A, Paramaiswari A, Wibowo RMSAK, Werdiningsih Y, Darma S, et al. Indonesian Rheumatologist Association (IRA) Recommendations for Diagnosis and Management of Peripheral Spondyloarthritis 2021. Indones J Rheumatol. 2021;13(1):459–75. Available from: http://dx.doi.org/10.37275/ijr.v13i1.175
  23. Rosenbaum JT, Bodaghi B, Couto C, Zierhut M, Acharya N, Pavesio C, et al. New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Semin Arthritis Rheum. 2019;49(3):438–45. Available from: http://dx.doi.org/10.1016/j.semarthrit.2019.06.004
  24. Braun J, Zochling J, Baraliakos X, Alten R, Burmester G, Grasedyck K, et al. Efficacy of sulfasalazine in patients with inflammatory back pain due to undifferentiated spondyloarthritis and early ankylosing spondylitis: a multicentre randomized controlled trial. Ann Rheum Dis. 2006/04/10. 2006;65(9):1147–53. Available from: https://pubmed.ncbi.nlm.nih.gov/16606646
  25. Benitez-Del-Castillo JM, Garcia-Sanchez J, Iradier T, Bañares A. Sulfasalazine in the prevention of anterior uveitis associated with ankylosing spondylitis. Eye. 2000;14(3):340–3. Available from: http://dx.doi.org/10.1038/eye.2000.84
  26. Muñoz-Fernández S, Hidalgo V, Bonilla G, Fernández J, Schlincker A, Larqué AB, et al. OP0055 Sulfasalazine improves the number of flares of acute anterior uveitis over one year [Internet]. Speaker abstracts 2001. BMJ Publishing Group Ltd and European League Against Rheumatism; 2001. Available from: http://dx.doi.org/10.1136/annrheumdis-2001.347

How to Cite

Hasbi, A. R., & Awali. (2023). Complicated uveitis in a spondyloarthritis patient: a case report. Bali Medical Journal, 12(3), 2758–2761. https://doi.org/10.15562/bmj.v12i3.4699

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