Patients with ankylosing spondylitis are more than seven times more likely to develop uveitis, reports a new study. Patients with juvenile idiopathic arthritis (JIA) are more than five times more likely to develop the ocular inflammatory condition.

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While an association between immune-mediated inflammatory diseases (IMIDs) and uveitis has long been presumed, the recent study is the first to quantify the risk in 12 different diseases. Researchers also found that patients with new-onset noninfectious uveitis had a higher risk of developing an IMID or already being diagnosed with one.

“We’ve known there’s a correlation between autoimmune diseases and uveitis, but now we better understand the magnitude of correlation,” says senior author Sumit Sharma, MD, a vitreoretinal surgeon at Cleveland Clinic Cole Eye Institute. “All 12 of the IMIDs we studied showed an increased risk of developing uveitis and vice versa, but for some specific IMIDs — including ankylosing spondylitis and JIA — the correlation was remarkable.”

Recognizing the link between IMIDs and uveitis is essential for enhancing early detection, refining treatment approaches and avoiding complications that could jeopardize vision, say the researchers.

EHR data helps quantify risk

The study was made possible thanks to electronic health record (EHR) data from more than 60 U.S. healthcare organizations in a global database.

“Uveitis is relatively rare in the general population, so it’s hard to quantify risk and draw meaningful conclusions based on data from a single institution,” explains Nitesh Mohan, a student at Cleveland Clinic Lerner College of Medicine who was lead author of the study. “Having access to a large EHR database allowed us to identify relationships that we weren’t able to study before.”

Risk by disease

The retrospective study published in the American Journal of Ophthalmology used 2006-2025 code data from more than 120 million patients to assess:

Risk of being diagnosed with uveitis within five years of being diagnosed with an IMID, compared to patients without an IMIDRisk of being diagnosed with an IMID within five years of being diagnosed with uveitis, compared to patients without uveitisOdds of having a preexisting IMID, comparing patients with and without uveitis

In all three analyses, the risk of having or developing comorbid IMID and uveitis was higher than in patients without either an IMID or uveitis, although the risk varied by IMID.

Ankylosing spondylitis7.71 (5.84-10.19)15.61 (13.42-18.17)38.91 (31.21-48.51)Juvenile idiopathic arthritis5.13 (3.51-7.49)23.32 (17.52-31.04)82.58 (58.59-116.39)Systemic vasculitis4.61 (3.73-5.69)2.73 (2.42-3.08)7.21 (5.73-9.06)Sarcoidosis3.67 (3.02-4.47)9.99 (8.86-11.26)13.83 (12.17-15.71)Giant cell arteritis3.24 (2.58-4.07)2.39 (2.03-2.82)6.06 (4.24-8.66)ANCA-associated vasculitis3.18 (1.84-5.48)6.74 (4.93-9.22)7.72 (5.34-11.16)Scleroderma2.52 (1.64-3.87)2.12 (1.67-2.70)1.71 (1.28-2.29)Rheumatoid arthritis2.40 (2.19-2.64)2.57 (2.43-2.71)2.42 (2.26-2.58)Psoriasis2.11 (1.88-2.38)1.52 (1.42-1.62)1.82 (1.68-1.97)Systemic lupus erythematosus2.09 (1.77-2.46)2.40 (2.15-2.68)2.75 (2.47-3.07)Inflammatory bowel disease1.84 (1.62-2.09)1.78 (1.64-1.92)2.60 (2.40-2.81)Multiple sclerosis1.64 (1.36-1.97)3.14 (2.76-3.58)2.22 (1.99-2.48)Ankylosing spondylitisRisk of uveitis within 5 years of diagnosis (95% CI)7.71 (5.84-10.19)Risk of diagnosis within 5 years of uveitis (95% CI)15.61 (13.42-18.17)Odds of preexisting diagnosis in patients with uveitis (95% CI)38.91 (31.21-48.51)Juvenile idiopathic arthritisRisk of uveitis within 5 years of diagnosis (95% CI)5.13 (3.51-7.49)Risk of diagnosis within 5 years of uveitis (95% CI)23.32 (17.52-31.04)Odds of preexisting diagnosis in patients with uveitis (95% CI)82.58 (58.59-116.39)Systemic vasculitisRisk of uveitis within 5 years of diagnosis (95% CI)4.61 (3.73-5.69)Risk of diagnosis within 5 years of uveitis (95% CI)2.73 (2.42-3.08)Odds of preexisting diagnosis in patients with uveitis (95% CI)7.21 (5.73-9.06)SarcoidosisRisk of uveitis within 5 years of diagnosis (95% CI)3.67 (3.02-4.47)Risk of diagnosis within 5 years of uveitis (95% CI)9.99 (8.86-11.26)Odds of preexisting diagnosis in patients with uveitis (95% CI)13.83 (12.17-15.71)Giant cell arteritisRisk of uveitis within 5 years of diagnosis (95% CI)3.24 (2.58-4.07)Risk of diagnosis within 5 years of uveitis (95% CI)2.39 (2.03-2.82)Odds of preexisting diagnosis in patients with uveitis (95% CI)6.06 (4.24-8.66)ANCA-associated vasculitisRisk of uveitis within 5 years of diagnosis (95% CI)3.18 (1.84-5.48)Risk of diagnosis within 5 years of uveitis (95% CI)6.74 (4.93-9.22)Odds of preexisting diagnosis in patients with uveitis (95% CI)7.72 (5.34-11.16)SclerodermaRisk of uveitis within 5 years of diagnosis (95% CI)2.52 (1.64-3.87)Risk of diagnosis within 5 years of uveitis (95% CI)2.12 (1.67-2.70)Odds of preexisting diagnosis in patients with uveitis (95% CI)1.71 (1.28-2.29)Rheumatoid arthritisRisk of uveitis within 5 years of diagnosis (95% CI)2.40 (2.19-2.64)Risk of diagnosis within 5 years of uveitis (95% CI)2.57 (2.43-2.71)Odds of preexisting diagnosis in patients with uveitis (95% CI)2.42 (2.26-2.58)PsoriasisRisk of uveitis within 5 years of diagnosis (95% CI)2.11 (1.88-2.38)Risk of diagnosis within 5 years of uveitis (95% CI)1.52 (1.42-1.62)Odds of preexisting diagnosis in patients with uveitis (95% CI)1.82 (1.68-1.97)Systemic lupus erythematosusRisk of uveitis within 5 years of diagnosis (95% CI)2.09 (1.77-2.46)Risk of diagnosis within 5 years of uveitis (95% CI)2.40 (2.15-2.68)Odds of preexisting diagnosis in patients with uveitis (95% CI)2.75 (2.47-3.07)Inflammatory bowel diseaseRisk of uveitis within 5 years of diagnosis (95% CI)1.84 (1.62-2.09)Risk of diagnosis within 5 years of uveitis (95% CI)1.78 (1.64-1.92)Odds of preexisting diagnosis in patients with uveitis (95% CI)2.60 (2.40-2.81)Multiple sclerosisRisk of uveitis within 5 years of diagnosis (95% CI)1.64 (1.36-1.97)Risk of diagnosis within 5 years of uveitis (95% CI)3.14 (2.76-3.58)Odds of preexisting diagnosis in patients with uveitis (95% CI)2.22 (1.99-2.48)

ANCA = antineutrophil cytoplasmic antibody

“We found that ankylosing spondylitis and JIA were the two diseases most closely linked with uveitis,” Mohan says. “Other IMIDs are more closely associated with uveitis than we previously thought. Giant cell arteritis, for example, often has ophthalmic complications, but providers often don’t consider uveitis as one of them. Other diseases, like scleroderma, also typically don’t trigger concerns for uveitis.”

A separate study recently published by Dr. Sharma describes the spectrum of uveitis and retinal vasculitis in a series of patients with systemic sclerosis.

Screening specifics for ophthalmology and rheumatology

Ophthalmology and rheumatology specialists often work together on patient care. This study highlights just how closely they should be collaborating, say the authors.

“Patients who see a rheumatologist for autoimmune disease may be advised to watch for vision changes or eye symptoms, but it may be more helpful to specify what they’re looking for: flashes, floaters, eye pain and redness, for example,” advises Dr. Sharma. “They also should be alerted to see an ophthalmologist as soon as possible after those symptoms arise, before there’s lasting damage to their vision.”

The same is true for ophthalmologists evaluating a patient with intraocular inflammation or uveitis, he notes. Inquiring specifically about joint pain, skin rashes, fatigue, malaise and headaches can help identify patients who should be referred promptly to rheumatology for assessment of a potential IMID.

“Our study does not necessarily indicate that autoimmune diseases directly cause uveitis or vice versa,” adds Mohan. “However, there appears to be a close association, possibly due to shared pathophysiology like overactivation of the immune system or upregulation of pro-inflammatory cytokines, which can perpetuate both conditions.”