Uveitis and Ankylosing Spondylitis (AS) are two medical conditions that share a significant connection, often presenting in the same patients. Understanding this relationship is crucial for early diagnosis and effective management of both conditions. Uveitis is an inflammation of the uvea, the middle layer of the eye, while ankylosing spondylitis is a type of chronic inflammatory arthritis that primarily affects the spine and sacroiliac joints. Let’s delve into the link between these two conditions, exploring causes, symptoms, treatments, and their implications for overall health.

Uveitis refers to inflammation of the uvea, which includes the iris, ciliary body, and choroid. It is a serious condition that can lead to vision loss if left untreated. Uveitis is categorized into different types based on the part of the uvea affected:

• Anterior Uveitis (Iritis): Inflammation of the iris, the most common type.
• Intermediate Uveitis: Affects the vitreous and peripheral retina.
• Posterior Uveitis: Involves inflammation of the retina and choroid.
• Panuveitis: Inflammation affecting all parts of the uvea.

The symptoms of uveitis include redness, eye pain, light sensitivity, blurred vision, and floaters. Though the exact cause of uveitis isn’t always clear, it is frequently associated with autoimmune diseases, particularly ankylosing spondylitis.

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that affects the spine and the joints connecting the spine to the pelvis, known as sacroiliac joints. AS typically begins in young adulthood and can lead to chronic pain and stiffness in the spine. Over time, the inflammation may cause the vertebrae to fuse, resulting in a rigid spine. AS belongs to a family of disorders known as spondyloarthropathies, which are closely related to autoimmune processes and inflammation.

Symptoms of AS include:

• Chronic lower back pain and stiffness, especially in the morning or after periods of inactivity.
• Reduced flexibility in the spine.
• Pain and swelling in other joints, such as the shoulders, hips, or knees.
• Fatigue due to chronic inflammation.

The root cause of AS is not entirely understood, but it is closely linked to genetic factors. The HLA-B27 gene is present in a majority of people with AS, making it a key marker for susceptibility.

The relationship between uveitis and ankylosing spondylitis is well-established. It is estimated that about 30-40% of people with ankylosing spondylitis will develop uveitis at some point in their lives, making it the most common extra-articular (beyond the joints) manifestation of the disease.

• Shared Genetic Factors: Both uveitis and AS are linked to the HLA-B27 gene. This gene is present in about 90% of patients with AS, and its presence is also associated with an increased risk of developing uveitis. People who carry the HLA-B27 gene have a much higher chance of experiencing recurrent episodes of uveitis, particularly anterior uveitis.
• Inflammatory Pathways: Both conditions involve autoimmune inflammation. In AS, the body’s immune system mistakenly attacks the joints and tissues of the spine, leading to chronic inflammation. Similarly, in uveitis, the immune system attacks the tissues of the eye, causing inflammation. The exact mechanism connecting these two conditions is still being studied, but it’s believed that similar inflammatory pathways, including cytokines and immune cell signaling, play a role.
• Co-Occurrence: In most cases, uveitis precedes or coincides with the onset of ankylosing spondylitis symptoms. A person with AS may experience uveitis before back pain begins or even be diagnosed with uveitis first, leading to a later diagnosis of AS. Conversely, an AS patient may experience recurrent bouts of uveitis over their lifetime.

Recognizing the link between uveitis and AS is essential for timely diagnosis and treatment. Since uveitis can be one of the first signs of AS, an eye examination is crucial for patients presenting with unexplained eye inflammation, especially when associated with back pain or stiffness.

• Screening and Diagnosis: Ophthalmologists play a key role in identifying uveitis and may refer patients for rheumatological evaluation if AS is suspected. Likewise, rheumatologists treating AS patients must remain vigilant for signs of uveitis, as it can develop or recur throughout the disease course.
• Impact on Quality of Life: The co-occurrence of these conditions can significantly affect a patient’s quality of life. Chronic pain from AS combined with recurrent episodes of eye inflammation can lead to physical discomfort, fatigue, and vision problems. This emphasizes the need for coordinated care between ophthalmologists and rheumatologists.

Managing uveitis in patients with ankylosing spondylitis involves a comprehensive approach targeting both conditions.

1. Uveitis Treatment:
   • Corticosteroid Eye Drops: These are often the first line of treatment to reduce inflammation in anterior uveitis.
   • Oral Steroids or Immunosuppressive Medications: In more severe or chronic cases, oral medications may be prescribed to manage inflammation.
   • Biologics: In cases of recurrent uveitis, biologic agents like TNF-alpha inhibitors (e.g., adalimumab, infliximab) have proven effective in controlling inflammation and reducing the frequency of uveitis attacks.
2. Ankylosing Spondylitis Treatment:
   • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): These are commonly prescribed to relieve pain and inflammation in AS.
   • Physical Therapy: Regular exercises and stretching can help maintain flexibility and reduce stiffness in the spine.
   • Biologics: TNF-alpha inhibitors and interleukin-17 (IL-17) inhibitors are key treatments for controlling systemic inflammation in AS, and they also help in reducing the risk of uveitis flare-ups.

The relationship between uveitis and ankylosing spondylitis underscores the complex interaction between the immune system and different parts of the body. Early recognition of uveitis in AS patients can help prevent complications like vision loss, while managing AS can reduce the frequency and severity of uveitis episodes. Collaboration between healthcare providers, timely diagnosis, and personalized treatment plans are crucial in improving outcomes for patients affected by both conditions.

World Eye Care Foundation’s eyecare.live brings you the latest information from various industry sources and experts in eye health and vision care. Please consult with your eye care provider for more general information and specific eye conditions. We do not provide any medical advice, suggestions or recommendations in any health conditions.