Uveitis and Its Connection to Ankylosing Spondylitis

Iritis and ankylosing spondylitis?

Hello Doctor: I was diagnosed with ankylosing spondylitis at around 35 years old.
After a long period of treatment, I have not experienced pain since I turned 50.
Aside from some stiffness in my hip joints, I have no other discomfort, and my doctor has advised that I no longer need medication, just regular follow-ups.
I have not returned for check-ups in the past few years.
However, last week I experienced discomfort in my left eye and visited a general ophthalmology clinic, where I was informed that I have "iritis." I was prescribed steroid eye drops (to be applied every two hours) and a dilating agent (to be applied in the morning and evening).
After three days, I returned for a follow-up and was told there is still mild inflammation, and I was prescribed a medication called prednisolone (5 mg) for three days, with the eye drops to continue.
My questions are: 1.
Does this indicate that my ankylosing spondylitis has recurred? Should I return to the rheumatology clinic for follow-up? 2.
Is the ophthalmic treatment appropriate? 3.
How long does it typically take for iritis to heal?

Paul, 60~69 year old female. Ask Date: 2016/10/31

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
I will answer your inquiries briefly as follows: 1.
There may still be active connections between iritis and ankylosing spondylitis, so I recommend that you follow up with a rheumatologist.
2.
Iritis is generally treated with eye drops alone.
However, if inflammation persists after treatment, a short course of oral corticosteroids can be used to control it, in order to prevent synechiae and avoid complications such as increased intraocular pressure or glaucoma.
3.
The rate of improvement in iritis after treatment varies from person to person; some may improve quickly while others may take longer.
I suggest discussing this with your ophthalmologist.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2016/10/31

More Info

Uveitis, particularly iritis or anterior uveitis, is an inflammation of the uveal tract of the eye, which includes the iris, ciliary body, and choroid. It can be associated with various systemic conditions, including ankylosing spondylitis (AS), a type of inflammatory arthritis primarily affecting the spine and the sacroiliac joints. Understanding the connection between uveitis and ankylosing spondylitis is crucial for managing both conditions effectively.

1. Connection Between Uveitis and Ankylosing Spondylitis: Uveitis is known to occur in patients with ankylosing spondylitis due to the underlying autoimmune processes that characterize AS. The inflammation in AS can lead to extra-articular manifestations, including uveitis. In fact, studies have shown that approximately 25-40% of patients with AS may experience episodes of uveitis during their lifetime. The presence of HLA-B27 antigen is a significant risk factor for developing both AS and uveitis. Therefore, the occurrence of iritis in your case could indeed suggest a flare-up of your underlying condition, although it does not necessarily mean that your AS is worsening in terms of spinal or joint symptoms.

2. Need for Follow-Up with Rheumatology: Given your history of ankylosing spondylitis and the recent diagnosis of uveitis, it would be prudent to follow up with your rheumatologist or the immunology department. They can assess whether your AS requires any modification in management or if additional treatments are necessary to prevent further episodes of uveitis. Regular monitoring is essential, especially since uveitis can lead to complications such as glaucoma, cataracts, or even vision loss if not adequately treated.

3. Appropriateness of Eye Treatment: The treatment prescribed by your ophthalmologist, including corticosteroid eye drops (prednisolone) and mydriatic agents (dilating drops), is standard for managing uveitis. Corticosteroids help reduce inflammation, while mydriatics relieve pain and prevent synechiae (adhesions between the iris and lens). The frequency of administration (every two hours for the steroid drops) is typical for acute cases to achieve adequate control of inflammation. However, if your symptoms persist or worsen, further evaluation may be necessary, and adjustments to your treatment plan could be warranted.

4. Duration of Treatment and Recovery: The duration for which you will need to continue treatment for uveitis can vary significantly based on the severity of the inflammation and your response to therapy. Some patients may experience resolution of symptoms within a few days to weeks, while others may require prolonged treatment. Regular follow-up appointments with your ophthalmologist are essential to monitor the response to treatment and adjust the regimen as needed. It is also important to report any changes in vision or increased discomfort promptly.

In summary, while the occurrence of uveitis may indicate a connection to your ankylosing spondylitis, it is essential to manage it effectively with the help of both your ophthalmologist and rheumatologist. Regular follow-ups and adherence to the prescribed treatment regimen will be crucial in preventing complications and ensuring your overall well-being.

Similar Q&A

Understanding Uveitis: Causes, Treatment Duration, and Related Symptoms

Hello Doctor: I have been experiencing chronic lower back pain for about a year and a half. Recently, the pain has radiated to my back and neck, and I have been suffering from chronic headaches. This past week, the pain has extended to my eyes. After visiting an ophthalmologist, ...

Dr. Ke Meilan reply Ophthalmology
Hello, based on your description, it is clear that you do not have ankylosing spondylitis, but you do have iritis. Iritis is often associated with autoimmune diseases, and eye pain should also consider factors such as poor posture and high work stress. I recommend that you first ...

Understanding Iritis: Symptoms, Complications, and Necessary Tests

Hello, I recently discovered that I have iritis, which is due to an autoimmune system imbalance, and I was informed about the possibility of complications arising from it. I would like to understand more about this condition. Previously, I only consulted an ophthalmologist. Shoul...

Dr. Huang Bozhen reply Ophthalmology
Subject: Iritis. Description: For young males, it is recommended to obtain a pelvic and lumbar spine X-ray to facilitate early diagnosis of ankylosing spondylitis. Additionally, for recurrent iritis, it is advised to perform an HLA-B27 test; if positive, it may be associated with...

Understanding Rheumatoid Arthritis: Eye Symptoms and Immune System Links

Hello, Doctor. I started experiencing dryness and pain in my left eye last year. Last month, I suddenly developed scleral inflammation in my right eye. After seeking medical attention, my condition is currently stable. Recently, I underwent dry eye testing (using tear break-up ti...

Dr. Zeng Guosen reply Internal Medicine
Hello, dry eyes and scleritis can be manifestations of rheumatic diseases affecting the eyes. If the rheumatoid factor is positive, it is recommended to consult a rheumatologist for differential diagnosis, as rheumatic diseases do not always present initially with joint symptoms.

Understanding the Connection Between Rainbow Vision and Dry Eye Syndrome

Hello Dr. Feng: I have rainbow vision in my left eye and dry eye syndrome in both eyes. What is the relationship between the two conditions, and what should I be aware of? Thank you!

Dr. Feng Jiefan reply Ophthalmology
Hello: Rainbow eye should be interpreted as iritis. Essentially, iritis and dry eye syndrome are not directly related. However, if there are concurrent autoimmune diseases such as rheumatoid arthritis, the eyes may present symptoms of either iritis or dry eye syndrome. This means...