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Micheal O'Rourke, Muhammad Haroon, Pathma Ramasamy, Oliver FitzGerald, Conor Murphy; The Dublin Uveitis Evaluation Tool (DUET) - an algorithm for earlier diagnosis of spondyloarthropathies by ophthalmologists in acute anterior uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5300.
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The incidence of spondyloarthropathy (SpA) is 1%. Early diagnosis is crucial as morbidity in SpA is related to duration of the disease. Advanced disease is typified by joint fusion in the axial skeleton but even early disease can impact greatly on quality of life. The acutely painful red eye in anterior uveitis (AU) will prompt a patient to seek medical attention more readily than lower back pain of insidious onset. The first aim of this study was to establish the incidence of previously undiagnosed SpA in patients presenting with AU. The second aim was to formalize a referral algorithm for early referral to a rheumatologist with the aim of earlier diagnosis and treatment.
104 consecutive patients with non-infectious AU were recruited prospectively. Other causes of AU and a known history of SpA were excluded. All patients were subsequently screened by a rheumatologist for the presence or absence of SpA. A detailed clinical history was undertaken and the most significant features which may identify patients with SpA were identified to generate a predictive algorithm. This algorithm was subsequently validated in a further cohort of 80 patients.
A new diagnosis of SpA was made in 42 patients. Of these, over 60% had previously attended their family doctor for backache and the average duration of backache was 9.36 years prior to diagnosis. HLA-B27 positivity and backache were the most statistically relevant features with an odds ratio of 27 and 21 respectively. An algorithm consisting of the most significant confounding clinic features of these patients advised that any patient with AAU and back pain of onset under 45 years of age with duration greater than 3 months should have HLA-B27 checked. If this is positive then the patient should be referred. In addition to this, any patient presenting with AAU with a personal history of psoriasis, even in the absence of back pain should also be referred. This algorithm has sensitivity of 95% and specificity of 98%. Validation of this algorithm in a second cohort had comparable sensitivity and specificity.
Close collaboration between ophthalmologists and rheumatologists utilizing our algorithm will result in earlier treatment intervention to improve disease outcome in SpA.
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