Acute anterior uveitis and undiagnosed spondyloarthritis: usefulness of Berlin criteria

Inflammatory back pain, the main symptom in spondyloarthritis, is defined by the presence of two or more positive responses among the four items of Berlin Criteria. This study assesses the value of these criteria in detecting previously undiagnosed spondyloarthritis after an episode of acute anterior uveitis. Records of patients addressed for etiological diagnosis after an acute anterior uveitis (April 2006 to November 2013) were retrospectively analysed. Patient characteristics, the presence of back pain, Berlin Criteria, the final diagnosis, and the ASAS classification criteria for spondyloarthritis were collected and analysed. The study included 102 patients (59.8 % women). The mean age was 44.5 years. Uveitis cases were mainly unilateral (73.5 %) and recurrent (58.8 %). Twenty-one patients had some type of spondyloarthritis, 20 fulfilling retrospectively the ASAS criteria. Back pain with at least two positive items from Berlin Criteria was 61.9 % sensitive and 97.5 % specific in diagnosing spondyloarthritis. Considering only one positive item increased the sensitivity (90.5 %) but decreased the specificity (91.4 %). Acute anterior uveitis may be the key symptom that reveals a formerly undiagnosed spondyloarthritis. A referral to a rheumatologist should be considered in presence of back pain, even without fulfilment of the classical definition with Berlin Criteria.