A new large-scale study published in the American Journal of Ophthalmology suggests the connection is not only real, but clinically meaningful. Using a nationwide electronic health record (EHR) database of over 120 million patients, the Cleveland-based team set out to quantify the bidirectional association between uveitis and 12 IMIDs – and the results make a compelling case for more reciprocal screening between ophthalmology and rheumatology.
The investigators analysed data from the TriNetX US Collaborative Network (2006–2025) and applied three complementary analytic strategies:
a cohort analysis assessing uveitis risk after IMID diagnosis,
a case–control analysis examining prior IMID diagnoses in uveitis patients, and
a reverse cohort analysis assessing future IMID development after uveitis.
Across all 12 systemic inflammatory conditions, patients showed a significantly higher risk of developing uveitis within five years of IMID diagnosis. The strongest associations were seen in:
● Ankylosing spondylitis: RR 7.71
● Juvenile idiopathic arthritis (JIA): RR 5.13
● Systemic vasculitis: RR 4.61
Even conditions with lower relative risks still showed a statistically significant increase, including multiple sclerosis (RR 1.64) and inflammatory bowel disease (RR 1.84).
Crucially, the relationship between uveitis and inflammatory disease was not one-way. In a matched analysis of 238,697 uveitis patients versus controls, uveitis was associated with dramatically higher odds of a prior IMID diagnosis. And looking forward, patients with uveitis had an increased risk of developing a new IMID within five years.
For ophthalmologists, the message is clear: uveitis may be an early marker of systemic autoimmunity, not simply a local inflammatory event. As such, greater interdisciplinary collaboration is needed between ophthalmologists, rheumatologists, and other specialists involved in treating these patients. In an era of increasingly targeted immunomodulatory therapy, the study adds weight to a simple but powerful clinical principle: the eye may be the first place systemic inflammation shows itself – and we should act accordingly.
