Uveitis Prevalence Markedly Higher in Crohn’s Disease Compared to Ulcerative Colitis

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A recent analysis investigating ocular manifestations related to inflammatory bowel disease (IBD) observed a higher prevalence of uveitis among patients with Crohn’s disease, compared to patients with ulcerative colitis (UC).¹

Encompassing data from ≥115,000 patients, the estimated prevalence of uveitis in the analysis was 2.38% among the total IBD cohort, with a prevalence of 3.27% among Crohn’s disease patients and 1.60% among patients with UC.

“It is clinically important to raise awareness of ocular screening in IBD patients, especially Crohn’s disease patients,” wrote the investigative team, led by Zhenzhen Liu and Lixia Luo, of the Zhongshan Ophthalmic Center at Sun Yat-Sen University. “General practitioners should improve their comprehensive understanding of the ocular manifestations of IBD to achieve timely detection and diagnosis.”

Approximately 6.8 million people globally are affected by IBD, with nearly half exhibiting ≥1 extraintestinal manifestation during disease progression.² Uveitis is considered the most prevalent ocular manifestation and often precedes the diagnosis of IBD. Elucidating the differences in the prevalence and characteristics of uveitis between Crohn’s disease and UC could aid in early diagnosis and management, leading to better patient outcomes.¹

Given the lack of overviews of the prevalence of uveitis across IBD, the investigative team systematically reviewed the differences in uveitis in IBD, to better define its epidemiology and clinical characteristics. The team reviewed published literature in PubMed and Embase from the introduction of the database to March 2022 using related keywords.

Two investigators independently selected studies matching inclusion criteria and extracted relevant data, including region, time frame, age, gender, number of IBD patients, and the prevalence of uveitis in IBD. For statistical analysis, either a fixed- or random-effects model was used to calculate the relevant risk ratio (RR), odds ratio (OR), and 95% confidence interval (95% CI), depending on the heterogeneity of included studies.

After initially identifying 2852 articles, investigators obtained 69 related articles. Based on inclusion and exclusion criteria, 54 articles were excluded, and 14 articles were included for analysis. The 14 studies included in the meta-analysis included 115,854 IBD patients and 2485 IBD patients with uveitis.

Based on the random-effects model, investigators found the frequency of uveitis in IBD to be 2.38% (95% CI, 1.60 - 3.17). Further analysis revealed the prevalence of uveitis in Crohn’s disease was 3.27% (95% CI, 2.15 - 4.39), while the prevalence among UC patients was 1.60% (95% CI, 0.93 - 2.27).

These results suggested a statistically significant difference in the prevalence of uveitis between Crohn’s disease and UC patients (RR, 1.76; 95% CI, 1.39 - 2.22; P <.05). A higher prevalence of uveitis was found in IBD patients in Europe (2.73%; 95% CI, 1.74 - 3.72), compared to patients in Asia (0.55%; 95% CI, 0.015 - 1.24), with similar findings for both disease cohorts. A random-effects model revealed a higher incidence of uveitis among patients with Crohn’s disease in Europe (RR, 1.75; 95% CI, 1.37 - 2.24), but not in Asia (RR, 1.88; 95% CI, 0.79 - 4.50; P = .16).

Liu and colleagues indicated the available literature showed a 25% – 89% probability of uveitis diagnosis occurring earlier than IBD diagnosis, as uveitis typically appeared as the earliest detected extraintestinal manifestation. As patients with Crohn’s disease often experience delayed diagnosis, the team noted the presence of extraintestinal manifestation-related symptoms should increase suspicion of IBD.

“Due to the late diagnosis of Crohn’s disease, the high likelihood of uveitis, and the fact that uveitis may act as the first extraintestinal manifestation, the prognosis of concomitant uveitis is poor, so earlier ophthalmologic screening and consultation in IBD patients would be necessary, especially for CD patients,” investigators wrote.

References

1. Lin H, Zhang J, Liang C, et al. Differences in the prevalence of uveitis between Crohn's disease and ulcerative colitis: A systematic review and meta-analysis [published online ahead of print, 2023 Oct 13]. Acta Ophthalmol. 2023;10.1111/aos.15793. doi:10.1111/aos.15793
2. GC Collaborators. (2020) The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. The Lancet Gastroenterology & Hepatology, 5(1), 17–30.