Exploring the Association Between Autoimmune and Inflammatory Diseases and Uveitis.

OBJECTIVE To evaluate the association between immune-mediated inflammatory diseases (IMIDs) and uveitis DESIGN: Retrospective cohort and case-control study using electronic health record data.

SUBJECTS, PARTICIPANTS, AND/OR CONTROLS Patients diagnosed with uveitis and/or one of 12 IMIDs: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), sarcoidosis, scleroderma, inflammatory bowel disease (IBD), multiple sclerosis (MS), ankylosing spondylitis, psoriasis, juvenile idiopathic arthritis (JIA), and giant cell arteritis (GCA), anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis, and other systemic vasculitis. Controls were patients without prior uveitis diagnosis or any IMIDs.

METHODS We calculated the risk of developing uveitis in patients with each IMID, the odds of prior IMID diagnoses among patients with uveitis, and the risk of developing an IMID following a uveitis diagnosis.

MAIN OUTCOME MEASURES Relative risk (RR) and odds ratio (OR) estimates with 95% confidence intervals (CIs) for associations between IMIDs and uveitis.

RESULTS Patients with all 12 IMIDs had a significantly increased risk of developing uveitis. Highest risks were observed in ankylosing spondylitis (RR=7.71, 95% CI: 5.84-10.19), JIA (RR=5.13, 95% CI: 3.51-7.49), and systemic vasculitis (RR=4.61, 95% CI: 3.73 to 5.69). Increased risk was also found in sarcoidosis (RR=3.67, 95% CI: 3.02 to 4.47), GCA (RR=3.24, 95% CI: 2.58-4.07), and ANCA vasculitis (RR=3.18, 95% CI: 1.84-5.48). In addition, in patients with uveitis, both the odds of a prior IMID diagnosis and the risk of a future IMID diagnosis were significantly increased for all 12 IMIDs.

CONCLUSIONS IMIDs are strongly associated with uveitis, with significant bidirectional risk. Patients with uveitis should be monitored for potential IMID development, and those with IMIDs should undergo ophthalmologic evaluation when appropriate.