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HLA B27 Iritis - RNL 2021 Highlights

Mar 31, 2021 11:02 am

The Spondyloarthritis Advances pod presented during the RheumNow Live 2021 conference featured three speakers, including an excellent lecture by Dr. Robert Wang, ophthalmology, on HLA B27 iritis and practical tips for rheumatologists. 

I interviewed Dr. Wang and below are his five best pearls for HLA B27 iritis that you need to know for your clinical practice. 

  1. Remember, in patients referred for “iritis”, HLA-B27 is the most common cause. (Cited between 40-70% of cases).
  2. What is important is not to know if the patient is HLA-B27 positive but, if they have an associated SpA that, if treated, will also aid the eye.
  3. For the work up of “iritis” (anterior uveitis), don’t forget about infectious etiologies.  Fortunately they are rare, but (checking for) syphilis and TB should be sufficient.
  4. Cataracts and glaucoma are the complications we are trying to avoid. It's important to balance treatment based on avoiding these comorbidities.
  5. Remember that the prognosis of this group tends to be good and systemic treatment is rarely needed. (90% of patients maintain 20/40 vision or better.)  Most patients can do very well on steroids alone without complications. However, if the patient is developing sight threatening complications, then systemic therapy is warranted, even in the absence of systemic disease. 

While his lecture centered around HLA B27 iritis, he shared another very important and clinically relevant treatment pearl. Bisphosphonates can cause uveitis!  Be sure to review your patient's medication list, especially in those with normal labs and no evidence of systemic CTD. 

Dr. Wang's lecture will be available for viewing in mid-April on RheumNow.

References:
Martin TM; Rosenbaum JT. Identifying genes that cause disease: HLA-B27, the paradigm, the promise, the perplexity. Br J Ophthalmol, 1998; 82:12, 1354-5  

Nusenblatt RB, Whitcup SM, Palestine AG: Uveitis: Fundamentals and clinical practice . Mosby, 1996  

Power WJ, Rodriguez A, Pedroza-Seres M et al. Outcomes in anterior uveitis associated with the HLA-B27 haplotype. Ophthalmology 1998;105:1646-1651  

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