The incidence, risk factor, and time to develop rheumatologic diseases after isolated inflammatory eye diseases: a 12-year cohort study

The incidence, risk factors, and time to diagnosis of rheumatologic disease (RD) in patients with isolated inflammatory eye diseases (IED) were investigated.

A 12-year bidirectional cohort study was conducted in IED patients who were tested for antinuclear antibody (ANA) and rheumatoid factor (RF). Patients with prior RD were excluded. Impacts of relevant symptoms, signs, and laboratory investigations were analyzed.

Seventy-five patients presented with IED including scleritis, anterior uveitis (AU), retinal vasculitis (RV), keratopathy, and optic neuritis (OP). AU, RV, keratopathy, and OP were associated with RD development. The incidence of RD was 36% during 12 years. RD developed most frequently in AU (55.5%) and RV (22.2%). The longest duration for RD development was 5.5 years. Prevalence of positive ANA and RF were 57.3% and 13.3%, respectively. The three most common RDs developed after IEDs were spondyloarthropathy (44.4%), systemic lupus erythematosus (SLE) (18.5%), and Sjogren’s syndrome (pSS) (11.1%). The risk factors of RD from univariate analysis were age below 35 years old at onset of IED [relative risk (RR) 3.45; 95% CI (1.13–10.55), p =0.026], positive pertinent findings from history [RR 2.125; 95% CI (1.39–3.25), p<0.001], and physical examination [RR 3.23; 95% CI (1.84–5.66), p<0.001]. Multivariable logistic regression showed that bilateral eye involvement of IED was the significant risk of RD [RR 4.33; 95% CI (1.57–11.96), p=0.004]. IED patients with bilateral eye involvement had shorter time to develop RD (p=0.018). Positive ANA was the predictor for SLE and pSS in RV or OP patients [RR 2.00; 95% CI (1.14–3.52), p=0.04].

IED with bilateral eye involvement was the risk of RD development. Positive ANA was the predictor of RD in RV and OP patients, but not for the other IEDs. Follow-up period of at least 5 years was required to identify RD.