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Anterior Uveitis — SCE Rheumatology MCQ

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EasySpondyloarthropathyAnterior UveitisSCE Rheumatology

A 38-year-old man with MRI-confirmed bilateral sacroiliitis and HLA-B27 positivity has recurrent episodes of a painful, photophobic red eye. Which pattern of uveitis is most characteristic of this association?

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Correct answer: D — Acute recurrent anterior uveitis, usually unilateral and potentially alternating between eyes

HLA-B27-associated uveitis classically causes acute, symptomatic, non-granulomatous anterior uveitis affecting one eye at a time. Attacks recur after periods of remission and may involve the opposite eye on subsequent occasions, producing an alternating unilateral pattern. This is strongly associated with axial spondyloarthritis. Chronic simultaneous bilateral anterior uveitis is more characteristic of conditions such as juvenile idiopathic arthritis and is not the usual HLA-B27 phenotype. Although posterior segment inflammation can occasionally accompany severe disease, isolated posterior uveitis, intermediate uveitis and panuveitis are not the characteristic patterns. Therefore, option D is the single best answer.

Reference: D'Ambrosio EM et al. Clinical Features and Complications of the HLA-B27-associated Acute Anterior Uveitis: A Metanalysis. Seminars in Ophthalmology. 2017;32(6):689–701. https://pubmed.ncbi.nlm.nih.gov/27404944/