Introduction: Uveitis associated with seronegative spondyloarthropathies (SSAs) represents a complex inflammatory condition characterized by intraocular inflammation in individuals with seronegative arthritis. This article provides a comprehensive exploration of uveitis in the context of SSAs, encompassing its epidemiology, pathogenesis, clinical features, diagnostic approaches, treatment strategies, and associated challenges.

Epidemiology: Uveitis is a well-recognized extra-articular manifestation of SSAs, occurring in approximately 20-30% of patients with conditions such as ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), and inflammatory bowel disease-associated arthritis (IBD-A). The prevalence of uveitis varies among different subtypes of SSAs, with AS being the most commonly associated condition.

Pathogenesis: The pathogenesis of uveitis in SSAs is multifactorial and involves interactions between genetic predisposition, dysregulated immune responses, and environmental triggers. Genetic factors such as HLA-B27 positivity are strongly associated with the development of both spondyloarthropathies and uveitis. Immune-mediated mechanisms, including aberrant T-cell activation and cytokine dysregulation, contribute to intraocular inflammation and tissue damage.

Clinical Features: Uveitis in SSAs typically presents as acute or recurrent episodes of intraocular inflammation, predominantly affecting the anterior segment of the eye. Common clinical features include:

• Anterior chamber inflammation characterized by anterior chamber cells and flare, posterior synechiae, and keratic precipitates.
• Bilateral involvement in a significant proportion of cases, particularly in AS-associated uveitis.
• Association with systemic manifestations of SSAs such as arthritis, enthesitis, and extra-articular manifestations.

Diagnostic Approaches: Diagnosis of uveitis in SSAs relies on a combination of:

• Ophthalmic examination, including slit-lamp biomicroscopy and dilated fundus examination, to assess intraocular inflammation and associated complications.
• Ancillary tests such as optical coherence tomography (OCT), fluorescein angiography (FA), and ultrasonography to evaluate retinal and choroidal involvement.
• Systemic evaluation for underlying spondyloarthropathy and associated systemic manifestations by a rheumatologist.

Treatment Strategies: Management of uveitis in SSAs aims to achieve and maintain disease remission while minimizing ocular complications and preserving vision. Treatment modalities include:

• Topical corticosteroids as first-line therapy for anterior uveitis, with periocular or intraocular corticosteroid injections reserved for more severe cases.
• Systemic immunomodulatory agents such as methotrexate, sulfasalazine, or tumor necrosis factor (TNF) inhibitors for refractory or sight-threatening uveitis.
• Close ophthalmic monitoring and collaboration with rheumatologists for optimal disease management.

Associated Challenges: Uveitis in SSAs presents several challenges, including:

• Risk of vision loss and ocular complications despite aggressive treatment.
• Variable response to immunosuppressive therapy and the need for individualized treatment approaches.
• Importance of multidisciplinary collaboration between ophthalmologists and rheumatologists to optimize patient care and outcomes.

Reference Sites:

1. Spondylitis Association of America (SAA) – https://www.spondylitis.org/
2. American Uveitis Society (AUS) – https://uveitissociety.org/
3. European League Against Rheumatism (EULAR) – [Link to relevant research articles and resources]

By providing a comprehensive overview of uveitis in the context of SSAs, this article aims to enhance understanding among healthcare professionals and improve the management and outcomes of affected individuals. Continued research efforts are essential for advancing our knowledge of the pathogenesis and optimal treatment strategies for this challenging condition.