← Questions/BEYOND THE SPINE
My eyes keep flaring. Is that connected?
The short answer
Acute anterior uveitis, a painful red eye with light sensitivity, is the most common extra-joint manifestation of AS and shares its HLA-B27 biology; new research traces both to the same population of T cells. It needs same-day eye care each time. When choosing a biologic partly to protect the eyes, a head-to-head trial found adalimumab and under-the-skin infliximab equally good at preventing flares.
3 papers behind this answer, best first
Clicking through to a study? How to read a paper is the ten-minute version.
Comparison of the Risk of Acute Anterior Uveitis Flare Between Adalimumab and Subcutaneous Infliximab in Patients with Radiographic Axial Spondyloarthritis and Prior Acute Anterior Uveitis: A Randomized Controlled Trial.
BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy
In a head-to-head trial of 56 people with radiographic axial spondyloarthritis and recent eye inflammation, adalimumab (Humira) and under-the-skin infliximab (Remicade) each saw one uveitis flare over 48 weeks. For someone choosing a TNF blocker partly to protect their eyes, both options look equally good on this evidence.
Refinement of the Pathogenic T Cell Receptor Motif Suggests Type 17 CD8+ T Cells Initiate HLA-B*27-associated Autoimmunity.
bioRxiv : the preprint server for biology
A specific family of killer T cells that recognise HLA-B27 was found in people with axial spondyloarthritis, uveitis and psoriatic arthritis but not healthy controls, and these cells appear to switch into an IL-17-producing mode in the gut. It is a direct line from the HLA-B27 gene, through the gut, to the inflammation that IL-17 drugs block, in one set of cells.
Why Do Some Therapies Work While Others Fail? Mechanisms of Response and Emerging Treatments in axial Spondyloarthritis: 2026 SPARTAN Annual Meeting Proceedings.
Current rheumatology reports
This 2026 review explains why some drugs work in axial spondyloarthritis and others do not: HLA-B27 can present fragments that expand a specific population of T cells making TNF and IL-17, while IL-23 matters less once inflammation is established, which fits the failure of IL-23 blockers. It names the next targets, including an interferon signature seen in people who fail TNF and IL-17 drugs and a macrophage factor called MIF.
Plain-language guides on this from patient organisations
Reviewed sources written for patients. They cover the “what do I do” part that research papers can’t.
- NASS: Uveitis guide (PDF) ↗
National Axial Spondyloarthritis Society (UK)