Prevalence and incidence of uveitis in patients with spondyloarthritis: the impact of the biologics era. Data from the international ASAS-COMOSPA study

Objectives: Uveitis is a common extra-musculoskeletal manifestation in SpA. The aim of this study was to analyze the prevalence of uveitis in SpA patients, and its association with geographical areas, and to determine whether its incidence differed between before and after the biologics era. Methods: ASAS-COMOSPA is a retrospective study that includes patients fulfilling Assessment in SpondyloArthritis International Society (ASAS) SpA classification criteria from 22 countries. The overall prevalence of uveitis was calculated, and factors associated with the onset of a first episode of uveitis were evaluated using a Cox regression. A Log-Rank test was performed to compare the new onset of uveitis in the non-biologics era (SpA onset before 2000) vs biologics era (SpA onset after 2000). Results: A total of 3984 patients were included. The likelihood of presenting a first uveitis episode increased over time, from a prevalence of 10.5% (95% CI 9.5-11.4%) at the time of the SpA diagnosis to 46.6% (41.6-51.5%) after 30 years since the SpA diagnosis. HLA-B27 positivity, family history of uveitis, peripheral enthesitis, and IBD were associated with higher risk of uveitis. Patients with SpA disease onset after the year 2000 showed a lower prevalence of uveitis compared with those with disease onset before the year 2000 (8.2% vs 25.5%, P <0.01), as well as a lower incidence (2.8 per 100 person-years vs 6.1 per 100 person-years, respectively). Conclusion: In our study, the risk of having suffered from at least one episode of uveitis ranged from 10% at the time of the diagnosis of axial SpA to 47% after 30 years of disease duration. Patients with disease onset after biologic therapy introduction showed a significantly lower prevalence and incidence of first episodes of uveitis.