Acute anterior uveitis in SpA — SCE Rheumatology MCQ

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EasySpondyloarthropathiesAcute anterior uveitis in SpASCE Rheumatology

A 30-year-old man with axial spondyloarthritis reports a painful red left eye with photophobia and blurred vision. He has had two similar self-limiting episodes. He is HLA-B27 positive and takes naproxen. There is no discharge. What is the most important complication to screen for?

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Reveal the answer and explanation

Correct answer: D — Acute anterior uveitis

Explanation lettering: E = shown as A · D = shown as B · B = shown as D · A = shown as E

Acute anterior uveitis is best because painful photophobic red eye in HLA-B27 axial spondyloarthritis is acute anterior uveitis until proven otherwise. A is less suitable because keratoconus causes progressive visual distortion rather than acute red eye; C is less suitable because retinal detachment causes flashes and field loss without red photophobic eye; D is less suitable because optic neuritis causes painful visual loss but not anterior red eye; E is less suitable because dry eye causes irritation but not marked photophobia and ciliary pain. Clinical pearl: uveitis requires same-day ophthalmology assessment to prevent complications.

Reference: NICE NG65; ASAS-EULAR axial spondyloarthritis recommendations 2022