Year : 1979 | Volume
: 27 | Issue : 4 | Page : 24--25
Uveitis and sero-negative spondy arthedes
Medical College, Madras, India
C P Gupta
Professor of Ophthalmology, Medical College, Madras
|How to cite this article:|
Gupta C P. Uveitis and sero-negative spondy arthedes.Indian J Ophthalmol 1979;27:24-25
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Gupta C P. Uveitis and sero-negative spondy arthedes. Indian J Ophthalmol [serial online] 1979 [cited 2020 Sep 22 ];27:24-25
Available from: http://www.ijo.in/text.asp?1979/27/4/24/32563
The association of uveitis and some types of spondy arthedes (SA) like rheumatoid arthritis (RA), ankylosing spondylitis (AS) etc. is well known. Perkins established a diagnosis of AS in 18% and Rieter's disease in 28% of 896 patients with acute anterior-uveitis.
Rheumotologists now divide spondy arthedes in two types based on sheep cell agglutination test like the rose waller test. In rheumatoid arthritis the rose waller test is positive while in ankylosing spondylitis, Rieter's disease and psoaritic arthritis the sheep cell agglutination test is negative. In the former group episcleritis, scleretis and scleromalacia perforans are common, while in the latter group uveitis is common. Other sero-negative S.A. are ulcerative colitis, Crohn's disease, Whipple's disease and Behcet's syndrome.
The characteristics of the sero-negative spondy arthedes (S.N.S.A.) are:
(a) Tendency to affect sacro-iliac joints
(b) Tendency to affect spine
(c) Other peripheral joints may or may not be affected
(d) X-ray of SI joints show sacro-ileitis usually unilateral, later bilateral, Spine: syndesmophytes are present. These may be continuous or skip certain vertebrae. ESR is raised and serum proteins are usually normal.
(e) Absence of rheumatoid nodules.
There may be mixed group showing clinical signs of rheumatoid and positive sheep cell haemagglutination tests.
In the present study, we have tried to correlate the incidence and type of uveitis in sero-negative spondy arthedes.
Material and methods
Patients attending my service at the Government Ophthalmic Hospital were taken for the study. A detailed history was taken regarding previous attacks and other systemic diseases and previous treatments. A detailed examination of the e)e was made including vision, slit lamp examination of the anterior segment and of the fundus. From rheumatic care centre of Government General Hospital, cases who had sero-negative spondy arthedes were referred for eye examinations. Our cases of uveitis were referred to rheumatic care Centre. There a detailed history was taken especially regarding joint pains, back ache, burning micturition diarrhoes and skin changes. This was followed by a clinical examination of the joints.
The following investigations were done, Urine albumin, sugar TLC., DLC., ESR, blood sugar, rosewaller test, blood VDRL, X-ray of SI joints, spine and any affected joint were taken.
The criteria for diagnosis of spondy arthedes:
(a) Clinical Examination
Low backache, pain relating to spine- Tenderness over SI joints, restriction of spinal movement and chest expansion.
There were a total of 28 cases of uveitis. Of these 19 were men and 9 were women. All the cases with proved SA were men. The maximum cases were in 2029 years age group [Table 1].
Of the 28 cases, only 5 (1.4%) had S.N.S.A. Of these, 3 cases had ankylosing spondylitis and 2 incomplete Rieter's. Of the 5 cases with S.N.S.A. 4 Lad acute anterior-uveitis and one healed choroiditis. In the 4 cases with acute anterior-uveitis, the uveitis was unilateral and it was their first attack.
12 cases with proved S.N.S.A. were received from rheumatic care centre, Government General Hospital. Of the 12 cases with S.N.S.A. only one case (8.3%) had evidence of healed anterior uveitis i.e. fine K.P's. posterior synechia. This case did not have any eye symptoms.
1. Cases of S.N.S.A. with uveitis are preponderantly men.
2. Usual age group, when eye is affected was 20-29 years.
3. Acute anterior-uveitis is the commonest type of uveitis associated with S.N.S.A. Indeed from our small group, it is evident that at least in Madras, uveitis is associated with a S.N.S.A. only in a very small percentage of cases in contrast to the reports from the west, where the association of uveitis with S.N.S.A. is about 6%-46%. I am aware that the number of cases in this study are small, however, I hope this will kindle your interest in the association of acute anterior-uveitis and S.N.S.A.
I am grateful to Dr. Premraj and Dr. Anandkanan of the Government General Hospital for examining our cases. I am grateful to Prof. E.T. Selvam, superintendent, Government Ophthalmic Hospital for permission to use the hospital records.