Spondyloarthritis with uveitis: eye inflammation in axial spondyloarthritis

Axial spondyloarthritis is a long-term inflammatory condition that mainly involves the spine and the joints at the base of the spine. The NHS describes ankylosing spondylitis as a type of axial spondyloarthritis in which changes to the spine can be seen on an X-ray, and notes a similar condition, non-radiographic axial spondyloarthritis, where those changes cannot be seen on an X-ray but can sometimes be seen on an MRI scan.

Although back pain and stiffness are the best-known features, inflammation is not always limited to the spine. The NHS says it is common for people with ankylosing spondylitis to also have other conditions, including iritis, which it also calls acute anterior uveitis, where the front part of the eye becomes red and swollen. NASS explains that uveitis is an eye condition caused by inflammation in the front part of the eye between the cornea, the clear window at the front, and the lens.

This page is about that overlap. It is not a substitute for guidance on axial spondyloarthritis itself, which is covered in the ankylosing spondylitis guide, or for the wider guide to uveitis from all causes.

NASS lists the signs of uveitis in axial spondyloarthritis as pain in the eye, sensitivity to light that is worse in bright light, redness and soreness of the eye, and blurred vision. The NHS gives a similar list for uveitis generally: eye pain that may feel worse when reading, red or watery eyes, reduced or blurred vision, sensitivity to light, and flashes, floaters or dark spots.

The NHS adds that uveitis usually affects one eye but can affect both, and that symptoms can develop in hours and days or more gradually over weeks and months. It also says that sometimes uveitis does not cause any symptoms, which is one reason regular eye care matters once an eye problem has been diagnosed.

• Eye pain, sometimes worse when reading or in bright light.

• A red, sore or watery eye.

• Blurred or reduced vision.

• Sensitivity to light.

• Flashes, floaters or dark spots.

The NHS advises asking for an urgent GP appointment or getting help from NHS 111 if you have pain in your eyes, sensitivity to light, changes in your vision such as flashing or blurring, or very red eyes in one or both eyes. If you cannot see, which means a loss of vision, the NHS says to go to A&E or call 999.

NASS gives a practical route for people with axial spondyloarthritis: ask your GP to make an urgent referral to the local ophthalmology team, or go to your local hospital A&E department, which will contact the ophthalmologist to arrange an urgent review. Because other eye problems can look similar, the NHS lists glaucoma, conjunctivitis, keratitis, scleritis and eye injury as conditions that can cause similar symptoms, so a red painful eye should be examined rather than assumed to be an infection.

NASS says uveitis in axial spondyloarthritis is usually treated with a combination of eye drops. Steroid drops, such as dexamethasone and prednisolone, reduce inflammation. Dilating drops widen the pupil, which reduces the risk of the iris sticking to the lens and helps break any attachments that have already formed.

The NHS explains that, depending on the cause and severity, people are usually prescribed a combination of medicines to get rid of any infection, reduce inflammation and relax the eye and reduce pain. If uveitis is very severe or keeps coming back, the NHS says other treatments may be offered, including medicines that reduce the activity of the immune system (immunosuppressants), tumour necrosis factor (TNF) inhibitors, light treatment, temporarily freezing part of the eye (cryotherapy), or surgery on part of the eye.

After treatment starts, the NHS says you will be seen again by an ophthalmologist to see how treatment is working, check for side effects and check for complications such as vision loss.

The NHS notes that some of the medicines used for axial spondyloarthritis are also used for severe or recurrent uveitis. It describes anti-TNF medicines as treatments given by injection that reduce inflammation in the joints and are offered when painkillers, exercise and stretching do not control symptoms. For anyone whose eye attacks keep returning, it is reasonable to make sure the rheumatologist and the eye team both know about each condition, so that treatment choices take both into account.

It is also worth telling every clinician you see that you have axial spondyloarthritis. NASS notes that uveitis is likely to recur and that each attack may differ in severity, even in the same person, so a quick route back to eye services is valuable.

In the NHS, urgent eye assessment usually runs through the GP, NHS 111 or an eye casualty or A&E department, and the ophthalmology team arranges follow-up. Joint care sits with a rheumatology team. Some people also see an ophthalmologist privately for a faster appointment, but the main priority with a painful red eye is speed of assessment rather than the setting. Where you are seen should not delay getting help if symptoms are severe.