Resumen
- Introducción: A pesar de que la uveítis asociada a HLA-B27 es una de las etiologías más frecuentes de uveítis en todo el mundo, existen escasos estudios sobre el espectro clínico de esta enfermedad y las implicaciones de las estrategias terapéuticas utilizadas en la población latinoamericana, sin que se haya realizado ninguno en Colombia. Por lo tanto, este estudio tuvo como objetivo describir las características clínicas de una cohorte de pacientes con uveítis asociada a HLA-B27 positivo en Colombia y evaluar el impacto del tratamiento sistémico en la tasa de recurrencia. Métodos: Se revisaron retrospectivamente 490 historias clínicas de pacientes con uveítis, en busca de aquellos con uveítis asociada a HLA-B27 positivo durante ocho años en un centro de referencia en Bogotá, Colombia. Se utilizó estadística descriptiva para resumir las características demográficas y clínicas y se realizó una prueba de Chi-cuadrado, una prueba exacta de Fisher, una correlación de Spearman y una prueba de Mann-Whitney para evaluar las asociaciones entre las estrategias de tratamiento y la tasa de recurrencias.
- Introduction: Despite HLA-B27-associated uveitis is one of the most frequent etiologies of uveitis worldwide, there are scarce studies on the clinical spectrum of this disease and the implications of therapeutic strategies used in the Latin-American population, with none conducted in Colombia. Thus, this study aimed to describe the clinical characteristics of a cohort of patients with positive HLA-B27-associated uveitis in Colombia and evaluate the impact of systemic treatment on the recurrence rate. Methods: We retrospectively reviewed 490 clinical charts of patients with uveitis, searching for those with positive HLA-B27-associated uveitis over eight years in a referral center in Bogotá, Colombia. We used descriptive statistics to summarize demographic and clinical characteristics and conducted a Chi-square test, Fisher Exact test, Spearman correlation, and Mann–Whitney test to assess associations between treatment strategies and the recurrences rate. Results: We analyzed 39 patients (59% females) with positive HLA-B27-associated uveitis, with a median age at the first consultation of 44.5 years (Range: 2–80) and a mean follow-up time of 86.4 weeks (1.65 years). Most patients had unilateral uveitis (53.8%) and an anterior anatomical diagnosis (76.6%); two had anterior chamber fibrinous reaction, and only one had hypopyon. Most patients did not show associated systemic symptoms (66.7%). Topical corticosteroids, NSAIDs, methotrexate, mydriatics, and adalimumab were the most used treatments. The most common complications included cataracts, posterior synechiae, and macular edema. We identified that the rate of recurrences decreases over time (r = -0.6361, P = 0.002571), and this decrease seems to be associated with the initiation of disease-modifying antirheumatic drugs (DMARDs) in chronic and recurrent cases. Conclusion: The clinical spectrum of HLA-B27-associated uveitis in Colombian patients is distinct from other latitudes. Notably, we found a female predominance, older age at presentation, higher frequency of bilateral and vitreous involvement, and lower frequency of concomitant systemic diseases. Additionally, our results suggest that DMARDs such as methotrexate and biologic agents are good therapeutic options to avoid recurrences in chronic and recurrent cases.