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Tang Y, Qu S, Ning Z, Wu H. Immunopeptides: immunomodulatory strategies and prospects for ocular immunity applications. Front Immunol 2024; 15:1406762. [PMID: 39076973 PMCID: PMC11284077 DOI: 10.3389/fimmu.2024.1406762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Abstract
Immunopeptides have low toxicity, low immunogenicity and targeting, and broad application prospects in drug delivery and assembly, which are diverse in application strategies and drug combinations. Immunopeptides are particularly important for regulating ocular immune homeostasis, as the eye is an immune-privileged organ. Immunopeptides have advantages in adaptive immunity and innate immunity, treating eye immune-related diseases by regulating T cells, B cells, immune checkpoints, and cytokines. This article summarizes the application strategies of immunopeptides in innate immunity and adaptive immunity, including autoimmunity, infection, vaccine strategies, and tumors. Furthermore, it focuses on the mechanisms of immunopeptides in mediating ocular immunity (autoimmune diseases, inflammatory storms, and tumors). Moreover, it reviews immunopeptides' application strategies and the therapeutic potential of immunopeptides in the eye. We expect the immune peptide to get attention in treating eye diseases and to provide a direction for eye disease immune peptide research.
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Affiliation(s)
| | | | | | - Hong Wu
- Eye Center of Second Hospital of Jilin University, Changchun, China
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2
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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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3
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Werkl P, Rademacher J, Pleyer U. HLA-B27-positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management, and treatment. DIE OPHTHALMOLOGIE 2024; 121:12-22. [PMID: 38085287 DOI: 10.1007/s00347-023-01960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/03/2024]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
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Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz-LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Universitäts-Augenklinik, Charité, Campus Virchow Klinikum-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, 13355, Berlin, Germany.
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4
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Werkl P, Rademacher J, Pleyer U. [HLA-B27 positive anterior uveitis : Clinical aspects, diagnostics, interdisciplinary management and treatment]. DIE OPHTHALMOLOGIE 2023; 120:108-122. [PMID: 36633629 DOI: 10.1007/s00347-022-01793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 01/13/2023]
Abstract
Acute anterior uveitis (AAU) associated with human leukocyte antigen (HLA) B27 is the most common form of noninfectious intraocular inflammation and is considered to be a separate clinical entity. Young adults between the ages of 20 and 40 years are predominantly affected. The HLA-B27 positive AAU typically presents as a unilateral, fulminant disruption of the blood-aqueous humor barrier, which is accompanied by pronounced cellular infiltration and fibrinous exudation. Other characteristics are reduced intraocular pressure and a high tendency to relapse, which can also involve the partner eye. Patients with HLA-B27 positive AAU share a high risk for other genetically associated diseases, especially spondylarthritis, chronic inflammatory bowel diseases and psoriasis. As up to 40% of those affected have a systemic disease that has not yet been diagnosed, the ophthalmologist is of major importance for early detection.
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Affiliation(s)
- Peter Werkl
- Universitätsaugenklinik Graz - LKH-Universitätsklinikum Graz, Medizinische Universität Graz, Auenbruggerplatz 4, 8036, Graz, Österreich
| | - Judith Rademacher
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Deutschland.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Uwe Pleyer
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. .,Universitäts-Augenklinik, Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health, Berlin, Deutschland.
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5
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Sexual dimorphism in the prevalence, manifestation and outcomes of axial spondyloarthritis. Nat Rev Rheumatol 2022; 18:657-669. [DOI: 10.1038/s41584-022-00833-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/08/2022]
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6
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Kenyon M, Maguire S, Rueda Pujol A, O'Shea F, McManus R. The genetic backbone of ankylosing spondylitis: how knowledge of genetic susceptibility informs our understanding and management of disease. Rheumatol Int 2022; 42:2085-2095. [PMID: 35939079 PMCID: PMC9548471 DOI: 10.1007/s00296-022-05174-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
Abstract
Ankylosing spondylitis (AS) is a seronegative, chronic inflammatory arthritis with high genetic burden. A strong association with HLA-B27 has long been established, but to date its contribution to disease aetiology remains unresolved. Recent insights through genome wide studies reveal an increasing array of immunogenetic risk variants extraneous to the HLA complex in AS cohorts. These genetic traits build a complex profile of disease causality, highlighting several molecular pathways associated with the condition. This and other evidence strongly implicates T-cell-driven pathology, revolving around the T helper 17 cell subset as an important contributor to disease. This prominence of the T helper 17 cell subset has presented the opportunity for therapeutic intervention through inhibition of interleukins 17 and 23 which drive T helper 17 activity. While targeting of interleukin 17 has proven effective, this success has not been replicated with interleukin 23 inhibition in AS patients. Evidence points to significant genetic diversity between AS patients which may, in part, explain the observed refractoriness among a proportion of patients. In this review we discuss the impact of genetics on our understanding of AS and its relationship with closely linked pathologies. We further explore how genetics can be used in the development of therapeutics and as a tool to assist in the diagnosis and management of patients. This evidence indicates that genetic profiling should play a role in the clinician’s choice of therapy as part of a precision medicine strategy towards disease management.
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Affiliation(s)
- Marcus Kenyon
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland.
| | - Sinead Maguire
- Department of Rheumatology, St James' Hospital, Dublin, Ireland
| | - Anna Rueda Pujol
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Finbar O'Shea
- Department of Rheumatology, St James' Hospital, Dublin, Ireland
| | - Ross McManus
- Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
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Teo AYT, Betzler BK, Hua KLQ, Chen EJ, Gupta V, Agrawal R. Intermediate Uveitis: A Review. Ocul Immunol Inflamm 2022:1-20. [PMID: 35759636 DOI: 10.1080/09273948.2022.2070503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE This review aims to provide an update on the clinical presentation, etiologies, complications, and treatment options in intermediate uveitis (IU). METHODS Narrative literature review. RESULTS IU affects all age groups with no clear gender predominance and has varied etiologies including systemic illnesses and infectious diseases, or pars planitis. In some instances, IU may be the sole presentation of an underlying associated condition or disease. Management of IU and its complications include administration of corticosteroids, antimetabolites, T-cell inhibitors, and/or biologics, along with surgical interventions, with varying degrees of effectiveness across literature. In particular, increasing evidence of the safety and efficacy of immunomodulatory agents and biologics has seen greater adoption of these therapies in clinical practice. CONCLUSIONS IU is an anatomical description of uveitis, involving intraocular inflammation of the vitreous, peripheral retinal vasculature, and pars plana. Various treatment options for intermediate uveitis are currently used in practice.
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Affiliation(s)
| | | | - Keith Low Qie Hua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Singapore Eye Research Institute, Singapore.,Duke NUS Medical School, Singapore
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8
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Eder L. Spondyloarthritis Among Patients With Uveitis: Can We Improve Referral Pathways? J Rheumatol 2022; 49:659-660. [PMID: 35569829 DOI: 10.3899/jrheum.220263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Delays in diagnosis remain a major gap in the care of patients with axial spondyloarthritis (axSpA). Despite efforts to improve awareness among family physicians and nonrheumatologist specialists, the average duration from onset of symptoms to diagnosis of axSpA is approximately 8 years,1 which is one of the longest in rheumatology. Such delays in diagnosis are associated with late initiation of therapy and worse disease outcomes.
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Affiliation(s)
- Lihi Eder
- LE is supported by Canada Research Chair (Tier 2) in Inflammatory Rheumatic Diseases and Early Researcher Award from Ontario Ministry of Science, Research and Innovation. L. Eder, MD, PhD, Associate Professor of Medicine, University of Toronto and Women's College Hospital, Toronto, Ontario, Canada. LE received consultation fees and educational grants from Novartis, Pfizer, Eli Lilly, Janssen, AbbVie, and UCB. Address correspondence to Dr. L. Eder, 76 Grenville Street, Women's College Hospital, Toronto, ON M5S 1B2, Canada.
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9
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van Bentum RE, Verbraak FD, Wolf S, Ongkosuwito J, Boers M, Tan HS, van der Horst-Bruinsma IE. High prevalence of previously undiagnosed axial spondyloarthritis in patients referred with anterior uveitis and chronic back pain - the SpEYE study. J Rheumatol 2022; 49:680-687. [DOI: 10.3899/jrheum.210345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/22/2022]
Abstract
Objective To reduce the diagnostic delay in axial spondyloarthritis (axSpA), guidelines recommend to refer patients with acute anterior uveitis (AAU) and chronic back pain (CBP) to a rheumatologist. This observational study evaluated the prevalence of previously unrecognized axSpA in AAU patients with CBP in daily practice, referred by ophthalmologists who had received instructions to increase awareness. Methods All AAU patients referred with CBP (≥3 months, started <45 years of age), from five Ophthalmology clinics underwent rheumatologic assessment, including pelvic X-rays. Patients with previously diagnosed rheumatic disease and established other cause of AAU were excluded. The primary endpoint was a clinical axSpA diagnosis by the rheumatologist. Results Eighty-one patients fulfilled the referral criteria (52% male, 56% HLA-B27 positive, median age 41 years, median CBP duration 10 years). In total, 58% (n=47) had recurring AAU, of whom 87% already had CBP during previous AAU attacks. After assessment, 23% (n=19) of patients were clinically diagnosed with definite-axSpA (10/19 radiographic), 40% (n=32) were suspicious of axSpA and 37% (n=30) did not have axSpA. AxSpA was diagnosed more often in men (33% of the men versus 13% of women). Conclusion A high prevalence of axSpA was found in AAU patients referred because of CBP. There was substantial diagnostic delay in the majority of patients with recurring AAU, as many already had back pain during previous AAU flares. In AAU, screening for CBP and prompt referral has a high diagnostic yield, and should consistently be promoted among ophthalmologists.
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10
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Pohlmann D, Rademacher J, Pleyer U. HLA-B27 assoziierte anteriore Uveitis: Herausforderung für
eine interdisziplinäre Zusammenarbeit. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1662-4086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungDie akute anteriore Uveitis (AAU) ist die häufigste Form intraokularer
Entzündungen, die v. a. Personen im erwerbsfähigen Alter
betrifft und mit erheblichen sozioökonomischen Auswirkungen verbunden
ist. Etwa die Hälfte der AAU-Patienten sind HLA-B27 positiv und teilen
ein hohes Risiko zu HLA-B27-assoziierten Erkrankungen, insbesondere zur
Spondyloarthritis (SpA). Sowohl die SpA als auch die AAU sind komplexe
entzündliche Erkrankungen, deren genaue Pathogenese unbekannt ist. Da
bei bis zu 40% der AAU-Patienten eine nicht diagnostizierte SpA
vorliegt, bietet die AAU die Möglichkeit einer frühzeitigen
Erkennung der zugrundeliegenden rheumatologischen Erkrankung. Die klinische
Präsentation der AAU bei SpA weist eine Reihe typischer Augenbefunde
auf, die diagnostisch wegweisend sind und auf eine systemische Grunderkrankung
hindeuten können. Daher ist eine abgestimmte
Überweisungsstrategie zur zügigen Diagnostik und Behandlung
notwendig. Dieser Beitrag fokussiert daher auf die interdisziplinäre
Zusammenarbeit und bietet gleichzeitig Hinweise für die
differentialdiagnostische Abklärung.
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Affiliation(s)
- Dominika Pohlmann
- Universitäts-Augenklinik, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt-Universität zu Berlin, and Berlin
Institute of Health, Department of Ophthalmology, Berlin, Germany
| | - Judith Rademacher
- Universitäts-Augenklinik, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt-Universität zu Berlin, and Berlin
Institute of Health, Division of Gastroenterology, Infectious Diseases and
Rheumatology, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health at Charité –
Universitätsmedizin Berlin, Berlin, Germany
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Gutteridge IF. 'Can you touch your toes?' spondyloarthropathies and acute anterior uveitis for primary eyecare practitioners. Clin Exp Optom 2021; 105:143-148. [PMID: 34538202 DOI: 10.1080/08164622.2021.1971933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The rheumatological diseases known as spondyloarthropathies (SpAs) are reviewed with respect to the current classifications of SpAs and from the perspective of ophthalmic practitioners. The focus is on the most common spondyloarthropathy, ankylosing spondylitis (AS), and the key symptoms, such as inflammatory back pain. The association with HLA-B27 and acute anterior uveitis (AAU) and the major clinical considerations for primary eye care practitioners are reviewed. An atypical case study illustrates difficulties in the detection and diagnosis of ankylosing spondylitis.
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Affiliation(s)
- Ian F Gutteridge
- Department of Optometry and Vision Sciences, The University of Melbourne Parkville, Parkville, Australia
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12
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Yaşar Bilge NŞ, Kalyoncu U, Atagündüz P, Dalkılıç E, Pehlivan Y, Küçükşahin O, Bes C, Akar S, Cinar M, Emmungil H, Ersözlü D, Ateş A, Mercan R, Kimyon G, Koca SS, Gonullu E, Yazisiz V, Tekgöz E, Alpay-Kanitez N, Erden A, Kiraz S, Coskun BN, Yağız B, İlgen U, Karadağ Ö, Kilic L, Ertenli İ, Kasifoglu T. Uveitis-related Factors in Patients With Spondyloarthritis: TReasure Real-Life Results. Am J Ophthalmol 2021; 228:58-64. [PMID: 33826929 DOI: 10.1016/j.ajo.2021.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE Spondyloarthritis (SpA) is a group of diseases with overlapping skeletal and extra-articular features. Acute anterior uveitis (AAU) is the most common extra-articular manifestation of SpA. The relation between AAU and SpA is well defined in the current literature. Our study aims to analyze the frequency and factors associated with AAU in different forms of SpA in a large nationwide cohort of Turkish SpA patients. DESIGN Retrospective cohort study. METHODS The data were obtained from the TReasure database, which compiles data from records of the web-based Rheumatoid Arthritis (RA) and SpA patients treated with biological disease-modifying anti-rheumatismal drugs from different regions of Turkey. The clinical characteristics of SpA and uveitis are recorded. RESULTS Data of the 4,297 SpA patients were included in the study. Overall, 475 of 4,297 patients (11.0%) had experienced 1 or more episodes of uveitis. SpA patients with older age (P < .001), a smoking history (P = .004), delayed diagnosis (P = .001), longer disease duration (P < .001), arthritis (P < .001), positive HLA-B27 (P < .001), a family history of SpA (P < .001), and radiographic damage (presence of sacroiliitis, syndesmophytes, bamboo spine, hip involvement) (P < .001 for all) more commonly had uveitis. On the other hand, uveitis was less prevalent in patients with psoriasis and psoriatic arthritis (P < .001 for both). CONCLUSION Uveitis may be the key feature leading to SpA diagnosis. Patients with radiographic damage and long disease duration have an increased risk for uveitis in both male and female SpA patients. Patients with uveitis should be referred to a rheumatologist for a thorough evaluation of SpA.
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Jeong H, Kim YG, Kim TH, Kim TJ, Park MC, Seo MR, Shin K, Oh JS, Lee SH, Lee YA, Lee EY, Baek HJ, Cha HS. Clinical characteristics of non-radiographic axial spondyloarthritis: Results of the Korean Nonradiographic Axial SPondyloArthritis (KONASPA) data. Int J Rheum Dis 2021; 24:1137-1147. [PMID: 34250745 DOI: 10.1111/1756-185x.14175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
AIM To evaluate clinical characteristics and natural history of non-radiographic axial spondyloarthritis (nr-axSpA) using KOrean Nonradiographic Axial SPondyloArthritis (KONASPA) data. METHODS Data were collected from 11 centers in South Korea. A total of 278 patients with nr-axSpA from January 2018 to July 2020 were included. Demographic data, clinical features, comorbidities, disease activity, medications, and laboratory results were collected. RESULTS Mean age at symptom onset was 28.2 ± 14.2 years. Of 278 patients, 152 (54.7%) were male. Mean Bath Ankylosing Spondylitis Disease Activity Index at diagnosis was 3.5 ± 2.1. Dyslipidemia was the most common comorbidity (8.4%), followed by hypertension (6.1%). Mean age at diagnosis of nr-axSpA was older in female patients than in male patients (31.8 ± 15.8 years vs 24.9 ± 12.0 years, P < 0.001). Enthesitis and uveitis were more frequently found in female patients than in male patients. Thirty-one (11.1%) participants with nr-axSpA progressed to ankylosing spondylitis. The median follow-up duration was 48 months. In multivariable Cox regression analysis, age at symptom onset (hazard ratio [HR] 0.93, 95% confidence interval (CI) 0.88-0.97, P = 0.006), body mass index (BMI) (HR 1.24, 95% CI 1.06-1.44, P = 0.005) and sacroiliitis grade (HR 1.86, 95% CI 1.19-2.92, P = 0.006) were associated with progression to ankylosing spondylitis. CONCLUSIONS Results of nationwide data revealed that women with nr-axSpA showed a late disease onset and more extra-articular manifestations than men. Young age at symptom onset, high BMI, and presence of radiographic sacroiliitis at diagnosis were risk factors for progression to AS.
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Affiliation(s)
- Hyemin Jeong
- Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, South Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Tae-Jong Kim
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Min-Chan Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Mi Ryoung Seo
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ji Seon Oh
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Hoon Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Yeon-Ah Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Han Joo Baek
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Hoon-Suk Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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14
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Triggering factors associated with a new episode of recurrent acute anterior uveitis. Sci Rep 2021; 11:12156. [PMID: 34108578 PMCID: PMC8190149 DOI: 10.1038/s41598-021-91701-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/31/2021] [Indexed: 01/27/2023] Open
Abstract
To identify triggering factors for the next inflammatory episode of recurrent acute anterior uveitis (RAAU), a 1:1 case-control study was conducted. We interviewed RAAU patients with recent acute anterior uveitis attack and quiescent controls for their information during a previous month using Srithanya Stress Test (ST-5) and questionnaires about potential triggering factors. Asymptomatic controls were matched for age (± 5 years), sex, and HLA-B27. There were 39 pairs of cases and controls. Patients who recently experienced a uveitis attack demonstrated higher mean ST-5 scores (3.7 ± 2.9 vs 0.7 ± 1.1) and shorter sleep time (6.3 ± 1.4 vs 7.4 ± 0.7 h per day) compared with their controls. In the multivariate conditional logistic regression analysis, ST-5 score ≥ 3 (OR 9.07, 95% CI 1.14-72.16, p = 0.037) and sleep time < 7 h per day (OR 12.12, 95% CI 1.37-107.17, p = 0.025) were more likely to trigger a uveitis attack in RAAU accounted for patients' age, sex, HLA- B27 positivity, and presence of concurrent anti-inflammatory drugs for co-existing diseases. Other suspected triggering factors were not found to have any significant association. In short, stress and inadequate sleep may lead to the future episode of acute anterior uveitis in RAAU. Both physical and emotional stress management should be advised to RAAU patients to minimize recurrences and further complications.
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Van Bentum RE, Van den Berg JM, Wolf SE, Van der Bijl J, Tan HS, Verbraak FD, van der Horst‐Bruinsma IE. Multidisciplinary management of auto-immune ocular diseases in adult patients by ophthalmologists and rheumatologists. Acta Ophthalmol 2021; 99:e164-e170. [PMID: 32749781 PMCID: PMC7984222 DOI: 10.1111/aos.14548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 12/27/2022]
Abstract
Purpose Management of chronic vision threatening auto‐immune ocular diseases (AIOD, e.g. uveitis, scleritis) can be challenging. Guidelines recommend a multidisciplinary approach (MDA) with ophthalmologists and rheumatologists, to enhance the recognition of systemic diseases and guide the use of immunosuppressives. However, the indications and results of such an approach have not yet been studied. Methods A monocentre, retrospective chart review of all patients treated in a MDA between ophthalmologists and rheumatologists, in a Dutch tertiary center. The collaboration was twofold: a combined multidisciplinary team meeting every 2 weeks, and an ophthalmology‐dedicated rheumatology outpatient clinic. Primary endpoints of this descriptive study were as follows: indications for MDA, new diagnoses of systemic auto‐immune diseases and changes in systemic immunosuppression and prednisone dosages. Results In total, 157 adults (mean age 46 years, 57% female, median disease duration 19 months) were included, mainly with uveitis (74%) and scleritis (12%). Multidisciplinary approach (MDA)‐indications included diagnostic workup (32%), treatment support (44%), diagnostic‐and‐treatment support (10%) and side effects (8%). A systemic disease was newly diagnosed in eight and already present in 34 patients. At baseline, 54 patients used oral prednisone at >7.5 mg/day. Non‐corticoid immunosuppressives, mostly methotrexate, were started in 41% of the patients. During follow‐up, systemic prednisone was lowered to ≤7.5 mg/day in 68% of the patients. Conclusion This evaluation of an MDA‐programme in the management of AIOD demonstrated its added value. Mainly, it addressed the high demand for support in managing systemic immunosuppression, resulting in significant corticosteroid tapering. In addition, it resulted in the recognition of underlying systemic diseases.
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Affiliation(s)
- Rianne Elise Van Bentum
- Departments of Rheumatology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
| | - Jesse M. Van den Berg
- Departments of Rheumatology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
- Departments of Ophthalmology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
| | - Sanne E. Wolf
- Departments of Ophthalmology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
- Department of Ophthalmology Bergman Clinics Location Zaandam the Netherlands
| | - Joyce Van der Bijl
- Departments of Rheumatology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
| | - H. Stevie Tan
- Departments of Ophthalmology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
| | - Frank D. Verbraak
- Departments of Ophthalmology Amsterdam University Medical CenterLocation VU Medical Center Amsterdam the Netherlands
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16
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Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology (Oxford) 2021; 59:iv38-iv46. [PMID: 33053194 PMCID: PMC7566372 DOI: 10.1093/rheumatology/keaa543] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/24/2020] [Indexed: 02/07/2023] Open
Abstract
Mounting evidence reveals evident sex differences in physiology, disease presentation and response to medication in axial SpA (axSpA). Unfortunately these data are often neglected in clinical practice and research. In this review, myths that still exist on diagnosis, disease manifestation and drug effectiveness were argued against data of the most recent literature. The aim is to increase awareness of sex differences in the clinical aspects of axSpA.
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Affiliation(s)
- Tamara Rusman
- Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Rianne E van Bentum
- Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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Redeker I, Siegmund B, Ghoreschi K, Pleyer U, Callhoff J, Hoffmann F, Marschall U, Haibel H, Sieper J, Zink A, Poddubnyy D. The impact of extra-musculoskeletal manifestations on disease activity, functional status, and treatment patterns in patients with axial spondyloarthritis: results from a nationwide population-based study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20972610. [PMID: 33281952 PMCID: PMC7682214 DOI: 10.1177/1759720x20972610] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/20/2020] [Indexed: 01/07/2023] Open
Abstract
Objective The aim of this study was to investigate the association of extra-musculoskeletal manifestations (EMMs) with disease activity, functional status, and treatment patterns in a large population-based cohort of patients with axial spondyloarthritis (axSpA). Methods A stratified random sample of patients with axSpA, drawn from health insurance data, received a survey on disease-related characteristics including history (ever presence) of the following EMMs: inflammatory bowel disease (IBD), psoriasis (PSO), and anterior uveitis (AU). Survey data were linked to health insurance data, gathering additional information on current occurrence (within one year) of EMMs and drug prescriptions. Separate multivariable linear regression models were calculated to determine the association of EMMs with disease activity (Bath Ankylosing Spondylitis Disease Activity Index), and functional status (Bath Ankylosing Spondylitis Functional Index) after adjustment for relevant parameters, including treatment. Results A total of 1729 patients with axSpA were included in the analyses (response: 47%; mean age: 56 years; 46% female) of whom 6% (9%) had current (ever) IBD, 10% (15%) had current (ever) PSO, and 9% (27%) had current (ever) AU. Ever presence of IBD and history of PSO were significantly associated with higher level of disease activity. Ever presence of PSO was also associated with higher level of functional impairment, whereas current AU was significantly associated with lower disease activity. Patients with current IBD or PSO received more frequently biological and conventional synthetic disease-modifying anti-rheumatic drugs as well as systemic steroids. AU was associated with a higher use of conventional synthetic disease-modifying anti-rheumatic drugs only. Conclusion Disease activity is higher in patients with axSpA with history of IBD or history of PSO. Functional impairment is also higher in patients with axSpA with history of PSO. The presence of different EMMs was associated with different treatment patterns in axSpA.
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Affiliation(s)
- Imke Redeker
- Epidemiology Unit, German Rheumatism Research Centre, Charitéplatz 1, Berlin, 10117, Germany
| | - Britta Siegmund
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Callhoff
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Ursula Marschall
- BARMER Institute for Health Systems Research, BARMER Statutory Health Insurance, Wuppertal, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Denis Poddubnyy
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
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18
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Hien DL, Pham BH, Nguyen QD. How Do We Manage HLA-B27-associated Ocular Inflammation Refractory or Intolerant to Conventional Immunomodulatory Therapy? J Ophthalmic Vis Res 2020; 15:442-445. [PMID: 33133433 PMCID: PMC7591831 DOI: 10.18502/jovr.v15i4.7777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is an Editorial and does not have an abstract.
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Affiliation(s)
- Doan Luong Hien
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Pham Ngoc Thach University of Medicine, Saigon, Vietnam
| | - Brandon Huy Pham
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
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19
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Kasper M, Walscheid K, Laffer B, Bauer D, Busch M, Loser K, Vogl T, Langmann T, Ganser G, Rath T, Heiligenhaus A. Phenotype of Innate Immune Cells in Uveitis Associated with Axial Spondyloarthritis- and Juvenile Idiopathic Arthritis-associated Uveitis. Ocul Immunol Inflamm 2020; 29:1080-1089. [PMID: 32160102 DOI: 10.1080/09273948.2020.1715449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: To analyze circulating immune cells in patients with anterior uveitis (AU) associated to axial spondyloarthritis (SpA), or juvenile idiopathic arthritis (JIA).Methods: Venous blood samples were collected from healthy controls (n = 16), and either SpA (n = 19) or JIA (n = 23) patients with associated anterior uveitis (AU) during active flare, or after ≥3 months of inactivity. Frequencies of CD56+, MHC-I+, and S100A9+ monocytes, CCR7+ dendritic cells, CD56+dim natural killer (NK) cells and CD3+CD56bright T-cells were analyzed via flow cytometry. Serum S100A8/A9 levels were determined via ELISA.Results: SpA patients showed a reduced frequency of CD56+dim NK cells during uveitis activity, a constitutively activated monocyte phenotype, and elevated S100A8/A9 serum levels. In contrast, JIAU patients showed elevated frequencies of CD56+ monocytes and CCR7+ DC.Conclusion: Phenotype of peripheral immune cells differ between patients, probably contributing to different courses of acute onset AU in SpA and insidious onset AU in JIAU patients.Abbreviations: AU: anterior uveitis, AR: arthritis, JIA: juvenile idiopathic arthritis, SpA: axial spondyloarthritis.
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Affiliation(s)
- Maren Kasper
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Karoline Walscheid
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
| | - Björn Laffer
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
| | - Dirk Bauer
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Martin Busch
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Karin Loser
- Department of Dermatology, Experimental Dermatology and Immunobiology of the Skin University of Münster, Münster, Germany
| | - Thomas Vogl
- Department of Immunology, University of Münster, Münster, Germany
| | - Thomas Langmann
- Experimental Immunology of the Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Gerd Ganser
- Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Thomas Rath
- Department of Nephrology, Immunology and Osteology of St. Franziskus Hospital, Münster, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
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Massa H, Pipis SY, Adewoyin T, Vergados A, Patra S, Panos GD. Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges. Clin Ophthalmol 2019; 13:1761-1777. [PMID: 31571815 PMCID: PMC6750710 DOI: 10.2147/opth.s180580] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022] Open
Abstract
Macular edema (ME) is the most common sight-threatening complication in uveitis. The diagnostic and therapeutic management of the uveitic macular edema (UME) might be challenging due to the complex diagnostic workup and the difficulties physicians face to find the underlying cause, and due to its usually recurrent nature and the fact that it can be refractory to conventional treatment. Some of the mild cases can be treated with topical steroids, which can be combined with non-steroid anti-inflammatory drugs. However, immunomodulators such as methotrexate, tacrolimus, azathioprine, cyclosporine and mycophenolate mofetil together with anti-tumor necrosis factor-α (anti-TNF alpha) monoclonal antibodies such as adalimumab and infliximab, may be required to control the inflammation and the associated ME in refractory cases, or when an underlying disease is present. This review of the literature will focus mostly on the non-infectious UME.
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Affiliation(s)
- Horace Massa
- Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
| | - Spyros Y Pipis
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Temilade Adewoyin
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Athanasios Vergados
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Sudeshna Patra
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Georgios D Panos
- Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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21
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Accorinti M, Okada AA, Smith JR, Gilardi M. Epidemiology of Macular Edema in Uveitis. Ocul Immunol Inflamm 2019; 27:169-180. [DOI: 10.1080/09273948.2019.1576910] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | - Annabelle A. Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Justine R. Smith
- Flinders University College of Medicine & Public Health, Adelaide, Australia
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22
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Abstract
Acute anterior uveitis (AAU) is the most frequent uveitis subtype. It is often associated with HLA-B27 and with inflammatory rheumatic diseases, in particular with spondyloarthritis (SpA), which itself is strongly associated with HLA-B27. About 40-60% of patients with AAU have an associated spondyloarthritis, and 20-40% of patients with spondyloarthritis also have uveitis. The incidence of AAU in patients with SpA clearly correlates with disease duration. The AAU has an acute onset, usually affects only one eye at a time, and shows a tendency for recurrence. Early therapy of AAU with topical steroids is relevant for good visual outcomes. Minimum duration of therapy of flares of AAU is 6-8 weeks in order to prevent early recurrency. The rate of local complications correlates with the rate of AAU flares and the visual outcome is often good. Refractory uveitis and frequent recurrencies of AAU may be treated with conventional disease-modifying antirheumatic drugs (DMARDs, such as sulfasalazine and methotrexate) and biologicals (e.g. TNF-alpha inhibitors). Any first episode of AAU diagnosed by an ophthalmologist should prompt referral to rheumatology for suspected SpA, particularly if rheumatic symptoms are present.
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23
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van Bentum RE, Heslinga SC, Nurmohamed MT, Gerards AH, Griep EN, Koehorst CB, Kok MR, Schilder AM, Verhoef M, van der Horst-Bruinsma IE. Reduced Occurrence Rate of Acute Anterior Uveitis in Ankylosing Spondylitis Treated with Golimumab — The GO-EASY Study. J Rheumatol 2018; 46:153-159. [DOI: 10.3899/jrheum.180312] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 01/24/2023]
Abstract
Objective.Acute anterior uveitis (AAU) is common in ankylosing spondylitis (AS). Golimumab (GOL), a tumor necrosis factor-α inhibitor (TNFi), has proven to be effective in the treatment of AS. To date, the effect of GOL on the incidence of AAU in AS is unknown. The objective was to study the AAU occurrence rate in patients with AS during GOL treatment and secondarily, the efficacy of GOL in daily clinical practice.Methods.The study was a multicenter prospective study in a real-world setting in patients with AS who were treated with GOL for 12 months. The occurrence of AAU was assessed in the year before the initial TNFi treatment and during GOL treatment and calculated for the period at risk for a new AAU. Measures for disease activity [Ankylosing Spondylitis Disease Activity Score (ASDAS)] and treatment response [Assessment of Spondyloarthritis international Society (ASAS20 score)] were collected.Results.In total, 93 patients (65% male, 55% TNFi-naive, 27% history of AAU) were included, with a median disease duration of 7 years and ASDAS score of 3.1. During GOL treatment, the AAU occurrence rate was reduced from 11.1 to 2.2 per 100 patient-years (rate-ratio 0.20, 95% CI 0.04–0.91). After 3 months of treatment, 41% of the patients experienced a clinically important improvement of the ASDAS score (p < 0.001) and 36% an ASDAS20 response (p < 0.001). At month 12, 49% had achieved an ASAS20 response (p < 0.001).Conclusion.In AS, the AAU occurrence rate and disease activity decreased significantly during GOL treatment. Therefore, GOL can be considered a good choice in patients with AS who need a TNFi, especially in cases of recurrent AAU. (EudraCT number: 2012-002458-21)
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24
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Zu Hoerste MM, Walscheid K, Tappeiner C, Zurek-Imhoff B, Heinz C, Heiligenhaus A. The effect of methotrexate and sulfasalazine on the course of HLA-B27-positive anterior uveitis: results from a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 2018; 256:1985-1992. [PMID: 30069748 DOI: 10.1007/s00417-018-4082-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/05/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To investigate the effect of methotrexate (MTX) or sulfasalazine (SSZ) on the course of HLA-B27-positive, remitting acute anterior uveitis (AAU). METHODS Forty-six patients with HLA-B27-positive AAU with or without associated systemic rheumatic disease either receiving MTX (n = 20), SSZ (n = 13), or no systemic immunomodulating treatment (Ctrl; n = 13) were studied retrospectively. Best-corrected visual acuity (BCVA), AAU relapse rate, and occurrence of uveitis-related ocular complications were analyzed at baseline (BL) and at 12-month follow-up (FU). RESULTS Groups did not differ regarding age, gender, and presence of associated systemic diseases. BCVA at baseline was significantly worse in patients receiving MTX (logMAR 0.39 ± 0.4) than in those treated with SSZ (0.17 ± 0.2; P = 0.05) or in controls (Ctrl; 0.14 ± 0.2; P = 0.009). At the 12-month endpoint, MTX treatment was associated with significantly improved BCVA (0.18 ± 0.4 logMAR; P = 0.004). In contrast, BCVA did not significantly change in patients treated with SSZ (0.17 ± 0.3 logMAR) or in the controls (0.11 ± 0.2 logMAR). The annual uveitis relapse rate significantly decreased with MTX (BL 3.6 ± 2.4 relapses to FU 0.7 ± 0.8; P = 0.0001) and SSZ (BL 3.6 ± 1.9 to FU 1.8 ± 2.4, P < 0.01), but not in the controls (BL 1.9 ± 1.4 vs 1.9 ± 1.7 FU). The complication rate was slightly reduced with MTX (BL 1.75 ± 1.2 complications present versus FU 1.3 ± 1.2, P = 0.09) but not with SSZ (BL 0.9 ± 0.8 to FU 1.3 ± 1.4; P = 0.4) or in the controls (BL and FU 1.0 ± 0.95; P = 0.7). CONCLUSIONS MTX and SSZ reduced the uveitis relapse rate in HLA-B27-positive AAU patients, with MTX showing a beneficial effect on AAU-related macular edema.
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Affiliation(s)
- Melissa Meyer Zu Hoerste
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany
| | - Karoline Walscheid
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany.
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beatrix Zurek-Imhoff
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany
| | - Carsten Heinz
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany.,University of Duisburg-Essen, Duisburg, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany.,University of Duisburg-Essen, Duisburg, Germany
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Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE. Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky. Curr Rheumatol Rep 2018; 20:35. [PMID: 29754330 PMCID: PMC5949138 DOI: 10.1007/s11926-018-0744-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Ankylosing spondylitis (AS) was historically seen as a predominantly male disease. However, more recent data showed a more homogenous sex prevalence. Unfortunately, in many studies in axial spondyloarthritis (axSpA), the number of women included is low and the analyses are often not stratified for gender distribution. The purpose of this review is to aggregate the existing data on gender differences in axSpA in order to increase the awareness that female axSpA patients are still under-recognized. RECENT FINDINGS Several studies considering gender differences revealed that female axSpA patients had different disease manifestations due to different immunological, hormonal, and genetic responses. For instance, allelic frequencies of the AHNK-gene and tissue non-specific alkaline phosphatase (TNAP) haplotypes differed between men and women with ankylosing spondylitis (AS). In addition, different levels of tumor necrosis factor (TNF), interleukins IL-6, IL-17, and IL-18, were found between the two sexes. Furthermore, female patients show a higher diagnostic delay compared to males. Several studies indicate a higher frequency of extra-articular manifestations (EAM) in female axSpA patients, such as enthesitis, psoriasis, and inflammatory bowel disease (IBD), whereas acute anterior uveitis is more prevalent in male patients. Male AS patients more frequently show a higher Bath Ankylosing Spondylitis Radiology Index (BASRI) scores and modified Stoke Ankylosing Spondylitis Spine Scores (mSASSS) than females, which indicates that males have higher radiological damage and radiographic progression. However, disease activity (BASDAI) and quality of life (AsQol) scores are significantly higher in women, and more importantly, they have significantly lower response rates to treatment with TNF inhibitors (TNFi) and a significantly lower drug adherence. Despite the fact that men with axial SpA have a worse radiologic prognosis, women have a high disease burden, in part because they have a longer delay in diagnosis, higher disease activity, and significantly less responsiveness to treatment with TNFi.
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Affiliation(s)
- T Rusman
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
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Frequency of HLA-B5, HLA-B51 and HLA-B27 in patients with idiopathic uveitis and Behçet's disease: a case-control study. Reumatologia 2018; 56:67-72. [PMID: 29853720 PMCID: PMC5974627 DOI: 10.5114/reum.2018.75516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/11/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives Idiopathic uveitis is the most common form of uveitis in most countries. Uveitis affects about 40–80% of patients with Behçet’s disease (BD). Class I, HLA-B5, and its subclass B51 allele have the strongest association with BD, but its role in idiopathic uveitis is unclear. The aim of this study was to determine the frequency of HLA-B5, HLA-B51 and HLA-B27 in patients with idiopathic uveitis, BD and the control group. Material and methods Forty-eight patients with idiopathic uveitis, 62 patients with BD, and 49 control subjects were compared. The presence of HLA-B5, HLA-B51 and HLA-B27 was checked by reviewing the charts of patients with idiopathic uveitis and Behçet’s disease referred to the rheumatologic center of Shiraz University of Medical Sciences. The control group consisted of a sex-matched normal control population, among which HLA typing was done. Results HLA-B5 was significantly higher in patients with idiopathic uveitis and BD compared to the control group (p = 0.029 and 0.0001). It was significantly higher in patients with BD compared to those with idiopathic uveitis (p = 0.001). The difference of HLA-B51 between the groups was not statistically significant although it was higher in the BD group than the controls. The presence of HLA-B51 was significantly associated with ocular involvement in the BD group (p = 0.013). HLA-B27 was the least common type of HLA in all groups. Conclusions HLA-B5 was the most common, compared to HLA-B51 and HLA-27, in patients with idiopathic uveitis and BD. There was an association between HLA-B51 positivity and ocular involvement in patients with BD. It seems that the pattern of HLA in our patients with idiopathic uveitis was different from that observed in some other studies.
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Potential predictors for frequent relapse in human leukocyte antigen-B27-associated uveitis. Graefes Arch Clin Exp Ophthalmol 2018; 256:1543-1549. [PMID: 29705838 DOI: 10.1007/s00417-018-4002-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To identify potential predictors for frequent relapse in a cohort of patients with human leukocyte antigen (HLA)-B27-associated uveitis in a tertiary referral center at the initial visit. METHODS This retrospective cohort study comprised 130 patients diagnosed with HLA-B27-associated uveitis. Subjects were divided into two groups according to the frequency of uveitis attacks (number/year): frequent relapse (FR) (who relapsed more than twice a year, 38) and infrequent relapse (IR) group (who relapsed twice or less than twice a year, 92). RESULTS The FR group presented more often with hypopyon or posterior synechiae at the initial presentation. Interestingly, posterior segment involvements including vitritis, vasculitis, or cystoid macular edema were not significantly different between the groups. In terms of laboratory findings, the erythrocyte sedimentation rate (ESR) was higher in the FR group. Multivariate Cox hazards analysis showed male sex, the presence of hypopyon, and ESR to be potential predictive factors for frequent relapse. CONCLUSION We found that male sex, hypopyon at presentation, and high ESR are potential predictors for frequent relapse in HLA-B27-associated uveitis. Identifying patients at higher risk of relapse could provide important information for patients, allowing patients to understand their condition and increase their acceptance of strict management.
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Crowell EL, Pfeiffer ML, Kamdar AA, Koenig MK, Wittenberg SE, Supsupin EP, Adesina OOO. Idiopathic Central Nervous System Inflammatory Disease in the Setting of HLA-B27 Uveitis. Ocul Immunol Inflamm 2018; 27:912-917. [PMID: 29652210 DOI: 10.1080/09273948.2018.1449865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: The purpose of the article is to describe a novel case of idiopathic central nervous system inflammatory disease with bilateral human leukocyte antigen (HLA)-B27-positive anterior uveitis. Methods/Results: A 15-year-old African American boy with bilateral HLA-B27-positive anterior uveitis controlled with topical and oral steroids for 8 months acutely developed headaches, left eyelid ptosis, and binocular diplopia. Imaging showed lesions in the right midbrain, superior colliculus, cerebellar peduncles, and cerebellar vermis and leptomeningeal enhancement along the vermian foliae. Cerebral spinal fluid tests showed mild lymphohistiocytic pleocytosis with negative cytology; inflammatory and infectious workup were negative. He received intravenous methylprednisolone without initial symptomatic improvement; repeat magnetic resonance imaging (MRI) showed reduced lesion burden. Oral steroids were continued; his symptoms resolved in 1 month. Repeat MRI 2 months after presentation showed almost complete lesion resolution. Conclusions: Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) was diagnosed. HLA-B27 positivity may represent a novel association with CLIPPERS.
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Affiliation(s)
- Eric L Crowell
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center in Houston (UTHealth) , Houston , Texas , USA.,Robert Cizik Eye Clinic , Houston , Texas , USA
| | - Margaret L Pfeiffer
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center in Houston (UTHealth) , Houston , Texas , USA.,Robert Cizik Eye Clinic , Houston , Texas , USA
| | - Ankur A Kamdar
- Department of Pediatrics, McGovern Medical School at UTHealth , Houston , Texas , USA
| | - Mary K Koenig
- Division of Child and Adolescent Neurology, Department of Pediatrics, McGovern Medical School at UTHealth , Houston , Texas , USA
| | | | - Emilio P Supsupin
- Department of Diagnostic and Interventional Imaging, McGovern Medical School at UTHealth , Houston , Texas , USA
| | - Ore-Ofe O Adesina
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center in Houston (UTHealth) , Houston , Texas , USA.,Robert Cizik Eye Clinic , Houston , Texas , USA.,Department of Neurology, McGovern Medical School at UTHealth , Houston , Texas , USA
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Sungur G, Yakin M, Uzman S, Balta O, Orman G, Ornek F. Clinical Features and Prognosis of Uveitis in a Turkish Patient Population with Ankylosing Spondylitis: Incidence and Management of Ocular Complications. Ocul Immunol Inflamm 2018; 27:551-559. [DOI: 10.1080/09273948.2018.1431290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Gulten Sungur
- Department of Ophthalmology, Ankara Training and Research Hospital, Altindag, Turkey
| | - Mehmet Yakin
- Department of Ophthalmology, Ankara Training and Research Hospital, Altindag, Turkey
| | - Selma Uzman
- Department of Ophthalmology, Ankara Training and Research Hospital, Altindag, Turkey
| | - Ozgur Balta
- Ophthalmology Clinic, Dr. Nafiz Korez Hospital, Sincan, Turkey
| | - Gozde Orman
- Department of Ophthalmology, Ankara Training and Research Hospital, Altindag, Turkey
| | - Firdevs Ornek
- Department of Ophthalmology, Ankara Training and Research Hospital, Altindag, Turkey
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Oliveira TL, Maksymowych WP, Lambert RGW, Muccioli C, Fernandes ARC, Pinheiro MM. Sacroiliac Joint Magnetic Resonance Imaging in Asymptomatic Patients with Recurrent Acute Anterior Uveitis: A Proof-of-concept Study. J Rheumatol 2017; 44:1833-1840. [PMID: 29093157 DOI: 10.3899/jrheum.170036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our aim was to quantify bone marrow edema (BME) and/or structural lesions in the sacroiliac joints (SIJ) of patients with recurrent acute anterior uveitis (rAAU) with or without back pain, to evaluate the frequency of axial (axSpA) and peripheral spondyloarthritis (pSpA) and to establish which criterion for magnetic resonance imaging (MRI) positivity best reflected the global assessment of SIJ MRI. METHODS A total of 50 patients with rAAU without prior rheumatologic diagnosis were included in our cross-sectional study, and these patients were compared to 21 healthy volunteers. SIJ MRI scans were read by 2 rheumatologists according to the Spondyloarthritis Research Consortium of Canada (SPARCC/MORPHO) protocol. Discrepant cases were adjudicated by a radiologist. RESULTS Patients with rAAU were diagnosed with axSpA (Group 1, n = 20, 40%) and nonspecific back pain (Group 2, n = 6, 12%), or as being asymptomatic (Group 3, n = 24, 48%). Group 3 results showed 9 patients (37.5%) had SIJ MRI and/or were radiography-positive for axSpA (5 MRI and radiograph, 1 MRI, 3 radiograph). SIJ MRI scans that were compatible with SpA in groups 1 (n = 12) and 3 (n = 6) were similar in acute and structural lesions that were analyzed according to SPARCC/MORPHO. The best sensitivity/specificity criterion for defining a positive global MRI assessment was a BME score ≥ 3 (88%/94%). CONCLUSION This is the first study evaluating SIJ MRI in patients with rAAU without back symptoms, showing positive findings for sacroiliitis. Moreover, a BME score ≥ 3 had better performance to define an SIJ MRI as positive for axSpA.
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Affiliation(s)
- Thauana L Oliveira
- From Division of Rheumatology, Department of Ophthalmology, and Department of Radiology and Diagnostic Imaging, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil; Department of Medicine, and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada. .,T.L. Oliveira, MD, MSc, Division of Rheumatology, UNIFESP/EPM; W.P. Maksymowych, MD, PhD, Department of Medicine, University of Alberta; R.G. Lambert, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; C. Muccioli, MD, PhD, Department of Ophthalmology, UNIFESP/EPM; A.R. Fernandes, MD, PhD, Department of Radiology and Diagnostic Imaging, UNIFESP/EPM; M.M. Pinheiro, MD, PhD, Division of Rheumatology, UNIFESP/EPM.
| | - Walter P Maksymowych
- From Division of Rheumatology, Department of Ophthalmology, and Department of Radiology and Diagnostic Imaging, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil; Department of Medicine, and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,T.L. Oliveira, MD, MSc, Division of Rheumatology, UNIFESP/EPM; W.P. Maksymowych, MD, PhD, Department of Medicine, University of Alberta; R.G. Lambert, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; C. Muccioli, MD, PhD, Department of Ophthalmology, UNIFESP/EPM; A.R. Fernandes, MD, PhD, Department of Radiology and Diagnostic Imaging, UNIFESP/EPM; M.M. Pinheiro, MD, PhD, Division of Rheumatology, UNIFESP/EPM
| | - Robert G W Lambert
- From Division of Rheumatology, Department of Ophthalmology, and Department of Radiology and Diagnostic Imaging, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil; Department of Medicine, and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,T.L. Oliveira, MD, MSc, Division of Rheumatology, UNIFESP/EPM; W.P. Maksymowych, MD, PhD, Department of Medicine, University of Alberta; R.G. Lambert, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; C. Muccioli, MD, PhD, Department of Ophthalmology, UNIFESP/EPM; A.R. Fernandes, MD, PhD, Department of Radiology and Diagnostic Imaging, UNIFESP/EPM; M.M. Pinheiro, MD, PhD, Division of Rheumatology, UNIFESP/EPM
| | - Cristina Muccioli
- From Division of Rheumatology, Department of Ophthalmology, and Department of Radiology and Diagnostic Imaging, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil; Department of Medicine, and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,T.L. Oliveira, MD, MSc, Division of Rheumatology, UNIFESP/EPM; W.P. Maksymowych, MD, PhD, Department of Medicine, University of Alberta; R.G. Lambert, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; C. Muccioli, MD, PhD, Department of Ophthalmology, UNIFESP/EPM; A.R. Fernandes, MD, PhD, Department of Radiology and Diagnostic Imaging, UNIFESP/EPM; M.M. Pinheiro, MD, PhD, Division of Rheumatology, UNIFESP/EPM
| | - Artur R C Fernandes
- From Division of Rheumatology, Department of Ophthalmology, and Department of Radiology and Diagnostic Imaging, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil; Department of Medicine, and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,T.L. Oliveira, MD, MSc, Division of Rheumatology, UNIFESP/EPM; W.P. Maksymowych, MD, PhD, Department of Medicine, University of Alberta; R.G. Lambert, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; C. Muccioli, MD, PhD, Department of Ophthalmology, UNIFESP/EPM; A.R. Fernandes, MD, PhD, Department of Radiology and Diagnostic Imaging, UNIFESP/EPM; M.M. Pinheiro, MD, PhD, Division of Rheumatology, UNIFESP/EPM
| | - Marcelo M Pinheiro
- From Division of Rheumatology, Department of Ophthalmology, and Department of Radiology and Diagnostic Imaging, Federal University of São Paulo (UNIFESP/EPM), São Paulo, Brazil; Department of Medicine, and Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.,T.L. Oliveira, MD, MSc, Division of Rheumatology, UNIFESP/EPM; W.P. Maksymowych, MD, PhD, Department of Medicine, University of Alberta; R.G. Lambert, MD, PhD, Department of Radiology and Diagnostic Imaging, University of Alberta; C. Muccioli, MD, PhD, Department of Ophthalmology, UNIFESP/EPM; A.R. Fernandes, MD, PhD, Department of Radiology and Diagnostic Imaging, UNIFESP/EPM; M.M. Pinheiro, MD, PhD, Division of Rheumatology, UNIFESP/EPM
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Acute Anterior Uveitis as a Risk Factor of Ankylosing Spondylitis-A National Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010107. [PMID: 28124984 PMCID: PMC5295357 DOI: 10.3390/ijerph14010107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 01/31/2023]
Abstract
Introduction: In clinical settings, acute anterior uveitis (AAU) could be the first presentation of ankylosing spondylitis (AS). Based on this hypothesis, we investigate whether AAU is a risk factor in developing AS later by using National Health Insurance Research Database (NHIRD) in Taiwan. Materials and Methods: This cohort comparison study used longitudinal Taiwanese NHIRD to probe the relative risk odds of AAU for AS development, and consisted of all patients diagnosed with AAU (n = 5621) (ICD-9-CM codes 364.00). The relative risks of AS between AAU patients and controls were compared by estimating the crude hazard ratio with logistic regression. Kaplan–Meier analysis was used to calculate the cumulative incidence rates of developing AS, and a log-rank test was used to analyze the differences between the survival curves. Separate Cox proportional hazard regressions were performed to compute the AS-free rate after adjusting for possible confounding factors such as age and sex. Results: The crude hazard ratio was 2.667 for the AAU group, and the adjusted hazard ratio was 2.705 for the AAU group. The observation time of the AS-free group was shorter for AAU patients compared with the control group (1507 versus 1578 days). Moreover, in the AAU patients, the younger age onset of AAU (less than 30 years old here) would lead to an earlier diagnosis of AS later with a median of 1445.5 (742–2241) versus 1544 (819–2289) days of survival for the group of age onset of AAU greater than 30 years old. The difference is statistically significant (p < 0.05). Conclusions: AAU was a risk factor for AS. To identify AAU as an extra-articular manifestation is crucial for early diagnosis and treatment of AS and containing functional loss accordingly.
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Alfawaz AM, Holland GN, Yu F, Margolis MS, Giaconi JA, Aldave AJ. Corneal Endothelium in Patients with Anterior Uveitis. Ophthalmology 2016; 123:1637-1645. [DOI: 10.1016/j.ophtha.2016.04.036] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/04/2016] [Accepted: 04/18/2016] [Indexed: 12/14/2022] Open
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Pathanapitoon K, Dodds EM, Cunningham ET, Rothova A. Clinical Spectrum of HLA-B27-associated Ocular Inflammation. Ocul Immunol Inflamm 2016; 25:569-576. [DOI: 10.1080/09273948.2016.1185527] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Emilio M. Dodds
- Consultores Oftalmológicos, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Emmett T. Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
- West Coast Retina Medical Group, San Francisco, California, USA
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
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D’Ambrosio EM, La Cava M, Tortorella P, Gharbiya M, Campanella M, Iannetti L. Clinical Features and Complications of the HLA-B27-associated Acute Anterior Uveitis: A Metanalysis. Semin Ophthalmol 2016; 32:689-701. [DOI: 10.3109/08820538.2016.1170158] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Maurizio La Cava
- Department of Ophthalmology, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Tortorella
- Department of Ophthalmology, “Sapienza” University of Rome, Rome, Italy
| | - Magda Gharbiya
- Department of Ophthalmology, “Sapienza” University of Rome, Rome, Italy
| | - Michelangelo Campanella
- RVC Department of Comparative Biomedical Sciences and UCL Consortium for Mitochondrial Research, University of London, London, UK
| | - Ludovico Iannetti
- Department of Ophthalmology, “Sapienza” University of Rome, Rome, Italy
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Verhagen FH, Brouwer AH, Kuiper JJW, Ossewaarde-van Norel J, Ten Dam-van Loon NH, de Boer JH. Potential Predictors of Poor Visual Outcome in Human Leukocyte Antigen-B27-Associated Uveitis. Am J Ophthalmol 2016; 165:179-87. [PMID: 26940162 DOI: 10.1016/j.ajo.2016.02.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/19/2016] [Accepted: 02/19/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify potential predictors of permanent vision loss in patients with human leukocyte antigen (HLA)-B27-associated uveitis in a tertiary referral center. DESIGN Retrospective case-control study. METHODS The charts of 212 patients (338 eyes) with HLA-B27-associated uveitis that visited the University Medical Center Utrecht with a follow-up of at least 6 months were retrospectively studied. Clinical features at presentation and during follow-up were compared to final visual outcome in quiescent state. Eyes with (sub-) normal vision (>20/50) were compared with visually impaired (≤20/50) and blind (≤5/50, or a visual field of <10 degrees) eyes, using survival analysis. A multivariate Cox proportional hazards analysis was performed to analyze potential predictors for permanent vision loss. RESULTS Median follow-up was 10.4 years (range, 0.5-44.7 years). During follow-up 226 eyes (66%) experienced vision loss up to 20/50, but most recovered. Twenty patients (9%) became permanently visually impaired or blind in at least 1 eye because of uveitis, after a median of 9.7 years (range, 0-20.9 years). The main cause was secondary glaucoma or related to glaucoma surgery (12/22 eyes, 55%). Survival analysis showed, after adjustment for age and sex, an ocular pressure of >21 mm Hg, hypotony, and panuveitis to be potential predictors at presentation, and the development of secondary glaucoma or hypotony to be predictors of blindness or visual impairment during follow-up. CONCLUSIONS The long-term visual prognosis of HLA-B27-associated uveitis is relatively good, but the true incidence of permanent vision loss is probably still underestimated. Our findings highlight the importance of proper control of intraocular pressure.
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Affiliation(s)
- Fleurieke H Verhagen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Anna H Brouwer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jonas J W Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands; Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
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The Risk of Intraocular Pressure Elevation in Pediatric Noninfectious Uveitis. Ophthalmology 2015; 122:1987-2001. [PMID: 26233626 DOI: 10.1016/j.ophtha.2015.06.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/12/2015] [Accepted: 06/20/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To characterize the risk and risk factors for intraocular pressure (IOP) elevation in pediatric noninfectious uveitis. DESIGN Multicenter retrospective cohort study. PARTICIPANTS Nine hundred sixteen children (1593 eyes) younger than 18 years at presentation with noninfectious uveitis followed up between January 1978 and December 2007 at 5 academic uveitis centers in the United States. METHODS Medical records review by trained, certified experts. MAIN OUTCOME MEASURES Prevalence and incidence of IOP of 21 mmHg or more and 30 mmHg or more and incidence of a rise in IOP by 10 mmHg or more. To avoid underascertainment, outcomes were counted as present when IOP-lowering therapies were in use. RESULTS Initially, 251 (15.8%) and 46 eyes (2.9%) had IOP ≥21 mmHg and ≥30 mmHg, respectively. Factors significantly associated with presenting IOP elevation included age of 6 to 12 years (versus other pediatric ages), prior cataract surgery, pars plana vitrectomy, duration of uveitis ≥6 months, contralateral IOP elevation, presenting visual acuity worse than 20/40, and topical corticosteroid use (in a dose-response relationship). The median follow-up was 1.25 years (interquartile range, 0.4-3.66). The estimated incidence of any observed IOP elevation to ≥21 mmHg, to ≥30 mmHg, and increase in IOP by ≥10 mmHg was 33.4%, 14.8%, and 24.4%, respectively, within 2 years. Factors associated with IOP elevation included pars plana vitrectomy, contralateral IOP elevation (adjusted hazard ratio [aHR], up to 9.54; P < 0.001), and the use of topical (aHR, up to 8.77 that followed a dose-response relationship; P < 0.001), periocular (aHR, up to 7.96; P < 0.001), and intraocular (aHR, up to 19.7; P < 0.001) corticosteroids. CONCLUSIONS Intraocular pressure elevation affects a large minority of children with noninfectious uveitis. Statistically significant risk factors include IOP elevation or use of IOP-lowering treatment in the contralateral eye and local corticosteroid use that demonstrated a dose-and route of administration-dependent relationship. In contrast, use of immunosuppressive drug therapy did not increase such risk. Pediatric eyes with noninfectious uveitis should be followed up closely for IOP elevation, especially when strong risk factors such as the use of local corticosteroids and contralateral IOP elevation are present.
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Heiligenhaus A, Minden K, Föll D, Pleyer U. Uveitis in juvenile idiopathic arthritis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:92-100, i. [PMID: 25721436 PMCID: PMC4349966 DOI: 10.3238/arztebl.2015.0092] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/30/2014] [Accepted: 10/30/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common systemic disease causing uveitis in childhood, with a prevalence of 10 per 100 000 persons. JIA often takes a severe inflammatory course, and its complications often endanger vision. METHODS This review is based on pertinent articles retrieved by a selective literature search up to 18 August 2014 and on the current interdisciplinary S2k guideline on the diagnostic evaluation and anti-inflammatory treatment of juvenile idiopathic uveitis. RESULTS Uveitis arises in roughly 1 in 10 patients with JIA. Regular eye check-ups should be performed starting as soon as JIA is diagnosed. 75-80% of patients are girls; antinuclear antibodies are found in 70-90%. The risk to vision is higher if JIA begins in the preschool years. As for treatment, only a single, small-scale randomized controlled trial (RCT) and a small number of prospective trials have been published to date. Topical corticosteroids should be given as the initial treatment. Systemic immunosuppression is needed if irritation persists despite topical corticosteroids, if new complications arise, or if the topical steroids have to be given in excessively high doses or have unacceptable side effects. If the therapeutic effect remains inadequate, conventional and biological immune modulators can be given as add-on (escalation) therapy. Treatment lowers the risk of uveitis and its complications and thereby improves the prognosis for good visual function. CONCLUSION Severely affected patients should be treated in competence centers to optimize their long-term outcome. Multidisciplinary, individualized treatment is needed because of the chronic course of active inflammation and the ensuing high risk of complications that can endanger vision. Future improvements in therapy will be aided by prospective, population-based registries and by basic research on biomarkers for the prediction of disease onset, prognosis, tissue damage, and therapeutic response.
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Affiliation(s)
- Arnd Heiligenhaus
- Department of Ophthalmology, St. Franziskus Hospital, Uveitis Center, University of Duisburg-Essen
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin (DRFZ), University Medicine, Berlin
| | - Dirk Föll
- Department of Pediatric Rheumatology and Immunology, University Children’s Hospital Münster
| | - Uwe Pleyer
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin
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Abstract
Uveitides can be due to non-infectious and infectious etiologies. It has been observed that there is a gender difference with a greater preponderance of non-infectious uveitis in women than in men. This review will describe both non-infectious and infectious uveitides and describes some of the current autoimmune mechanisms thought to be underlying the gender difference. It will specifically look at non-infectious uveitides with systemic involvement including juvenile idiopathic arthritis, spondyloarthopathies, sarcoidosis, Behçet’s disease, and Vogt-Koyanagi-Harada disease and at uveitides without systemic involvement including sympathetic ophthalmia, birdshot chorioretinitis, and the white dot syndromes. Infectious uveitides like acute retinal necrosis, progressive outer retinal necrosis, and cytomegalovirus mediated uveitis will be mentioned. Different uveitides with female- or male- predominance are presented and discussed.
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Sen HN, Davis J, Ucar D, Fox A, Chan CC, Goldstein DA. Gender disparities in ocular inflammatory disorders. Curr Eye Res 2014; 40:146-61. [PMID: 24987987 DOI: 10.3109/02713683.2014.932388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ocular inflammatory disorders disproportionately affect women, and the majority of affected women are of childbearing age. The role of sex or reproductive hormones has been proposed in many other inflammatory or autoimmune disorders, and findings from non-ocular autoimmune diseases suggest a complex interaction between sex hormones, genetic factors and the immune system. However, despite the age and sex bias, factors that influence this disparity are complicated and unclear. This review aims to evaluate the gender disparities in prevalence, incidence and severity of the most common infectious and non-infectious ocular inflammatory disorders.
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Affiliation(s)
- Hatice Nida Sen
- National Eye Institute, National Institutes of Health , Bethesda, MD , USA
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40
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Jiménez-Balderas FJ, García-Jaimes J, Ríos R, Zonana-Nacach A, Tapia-Romero R, Villanueva N, Méndez-Samperio P, de-la-Rosa-Arana JL. Isolation of IgG antibodies to Toxocara in ankylosing spondylitis patients with acute anterior uveitis. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:207-12. [PMID: 24882953 PMCID: PMC4038725 DOI: 10.3341/kjo.2014.28.3.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 10/07/2013] [Indexed: 11/23/2022] Open
Abstract
Purpose Since few reports had been published on the prevalence of toxocariasis in ankylosing spondylitis (AS) patients with acute non-granulomatous anterior uveitis (ANGAU), the aim of this work was to determine the presence of antibodies against Toxocara canis in AS patients with ANGAU. Methods Thirty-six patients (14 female and 22 male) with AS were enrolled in the study. The history of ANGAU was accepted only if diagnosed by an ophthalmologist. The detection of IgG antibodies to T. canis was determined by enzyme-linked immunosorbent assay. In addition, antibodies to Ascaris lumbricoides were also tested to verify non-specific reactions. Results The prevalence of ANGAU in the AS patients was 58% (21 / 36), and 38% (8 / 21) of the patients with ANGAU were positive for antibodies to Toxocara, while 7% (1 / 15) of AS patients without ANGAU were positive for T. canis (p = 0.038, two tails; mid-p exact). No antibodies were detected to A. lumbricoides antigens in the serum samples of patients with AS. Conclusions These data suggest that the seroprevalence of antibodies to T. canis is high in Mexican patients with AS-associated uveitis, suggesting a chronic asymptomatic toxocariosis, which could be associated with the pathogenesis of ANGAU; however, further larger-scale studies are needed to confirm this observation.
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Affiliation(s)
| | - Janete García-Jaimes
- Rheumatology Department, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Rita Ríos
- Ophthalmology Department, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Abraham Zonana-Nacach
- Rheumatology Department, Regional General Hospital 20, Mexican Institute of Social Security, Tijuana Baja California, Mexico
| | - Raquel Tapia-Romero
- National Institute of Diagnostic and Epidemiological Reference, Ministry of Health, Mexico City, Mexico
| | - Nayeli Villanueva
- National Institute of Diagnostic and Epidemiological Reference, Ministry of Health, Mexico City, Mexico
| | - Patricia Méndez-Samperio
- Immunology Department, National School of Biological Sciences, National Politecnic Institute, Mexico City, Mexico
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Smith WM. Gender and spondyloarthropathy-associated uveitis. J Ophthalmol 2013; 2013:928264. [PMID: 24455197 PMCID: PMC3881526 DOI: 10.1155/2013/928264] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/11/2013] [Indexed: 11/23/2022] Open
Abstract
Spondyloarthropathies encompass a group of inflammatory diseases with arthritis and other features such as enthesitis and dermatologic and gastrointestinal involvement. Up to 37% of spondyloarthropathy patients may develop uveitis which is typically bilateral asynchronous acute anterior uveitis. Spondyloarthropathies with and without uveitis are more prevalent among males; the reasons for gender imbalance are unclear. This review will focus on gender differences in the prevalence, incidence, clinical manifestations, and prognosis of uveitis associated with spondyloarthropathies.
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Affiliation(s)
- Wendy M. Smith
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Qi J, Li Q, Lin Z, Liao Z, Wei Q, Cao S, Rong J, Hu Z, Yang M, Zhang Y, Lv Q, Huang J, Pan Y, Wu Y, Jin O, Li T, Gu J. Higher risk of uveitis and dactylitis and older age of onset among ankylosing spondylitis patients withHLA-B*2705than patients withHLA-B*2704in the Chinese population. ACTA ACUST UNITED AC 2013; 82:380-6. [PMID: 24498994 DOI: 10.1111/tan.12254] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 10/08/2013] [Accepted: 10/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J. Qi
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Q. Li
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Z. Lin
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Z. Liao
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Q. Wei
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - S. Cao
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - J. Rong
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Z. Hu
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - M. Yang
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Y. Zhang
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Q. Lv
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - J. Huang
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Y. Pan
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - Y. Wu
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - O. Jin
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - T. Li
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
| | - J. Gu
- Department of Rheumatology; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou China
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Kulbrock M, Distl O, Ohnesorge B. A Review of Candidate Genes for Development of Equine Recurrent Uveitis. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Bawazeer AM, Joharjy HI. The association of human leukocyte antigen B27 with anterior uveitis in patients from the western region of Saudi Arabia: a retrospective study. Clin Ophthalmol 2013; 7:2107-11. [PMID: 24204112 PMCID: PMC3817032 DOI: 10.2147/opth.s53518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The association of human leukocyte antigen B27 (HLA-B27) with anterior uveitis is well known. The prevalence of HLA-B27 and its relation to anterior uveitis is related to race and geographic location. The association is strongest in Western countries and weakest in Eastern countries. Data regarding this association from Middle Eastern countries are limited. Thus, we undertook the study reported here to evaluate the association of HLA-B27 with anterior uveitis in patients in a tertiary center in the western region of the Saudi Arabia. Methods The study involved a retrospective analysis of the records of patients with anterior uveitis, referred to the uveitis clinic in Magrabi Eye and Ear Hospital, Jeddah, Saudi Arabia, from 1999 to 2010. The cost-effectiveness of HLA-B27 testing was analyzed. Results Among the 587 cases of uveitis, 335 (57.1%; mean age 37.56±12.82 years; 203 male and 132 female) cases were of anterior uveitis. All patients with anterior uveitis were investigated for HLA-B27 positivity. Idiopathic anterior uveitis was the most common (80%), followed by Fuchs heterochromic cyclitis (7.45%) and ankylosing spondylitis (3.8%). Only two patients were HLA-B27 positive. The cost-effectiveness of HLA-B27 testing was found to be 165,000 Saudi riyals (44,594 US dollars) per positive case. Conclusion HLA-B27-related uveitis appears to be very rare in our part of the world. Idiopathic uveitis is the most common type of anterior uveitis. The cost-effectiveness of HLA-B27 testing is low for patients with anterior uveitis in the western region of Saudi Arabia.
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Affiliation(s)
- Ahmed M Bawazeer
- Uveitis Services, Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia ; Magrabi Eye and Ear Hospital, Jeddah, Saudi Arabia
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Braakenburg AM, Rothova A. The clinical characteristics of retinal vasculitis in HLA-B27-positive patients. Ocul Immunol Inflamm 2013; 22:197-202. [DOI: 10.3109/09273948.2013.835429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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van der Veer EG, Keunen JE, Rothova A. Severe HLA B27-associated Uveitis Complicated by Hypotony, Serous Retinal Detachment, and Ciliochoroidal Effusion. Ocul Immunol Inflamm 2013; 22:23-6. [DOI: 10.3109/09273948.2013.828081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wexler A, Sand T, Elsås TB. Bilateral macular thickening in mild unilateral anterior uveitis: is HLA-B27 involved? BMC Ophthalmol 2012; 12:30. [PMID: 22839430 PMCID: PMC3479004 DOI: 10.1186/1471-2415-12-30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 07/18/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Macular thickening (MT) without clinically recognized macular edema has been described in anterior uveitis (AU). Although fellow-eyes of patients have been used as controls in several studies, little is known about macular thickness in these eyes. We studied the rate and extent of MT in both AU-affected and quiescent fellow-eyes of phakic AU patients with good visual acuity (VA). We also assessed macular thickness related to HLA-B27 presence and to recurrence, since these issues have been almost unexplored by previous optical coherence tomography (OCT) studies. METHODS Patients with AU were prospectively included and macular thickness was measured with OCT initially and on follow up. Macular thickness in patients' affected eyes (n = 30) as well as in their quiet fellow-eyes (n = 28) was compared with eyes of age- and gender matched controls. Inter-ocular differences in macular thickness between AU affected eyes and their fellow-eyes were assessed in patients (n = 28), also in a subgroup with visual acuity ≥ 0.8 (n = 23) by one-sample Student's t-tests. Inter-ocular differences were also assessed related to HLA-B27 presence and related to the status of current AU episode (initial or relapse). RESULTS Subclinical MT is present in both quiet fellow-eyes and AU-affected eyes of patients. MT was found in most cases of AU, even in phakic eyes with good VA. There was a larger increase in macular thickness in HLA-B27-positive than in HLA-B27-negative patients. No differences in macular thickness were found between patients with their first AU episode and patients with recurrent episodes. CONCLUSIONS MT probably reflects systemic immune-mediated response to the inflammatory disorder in AU, and it is possible that HLA-B27-related factors are involved in the pathogenesis of AU. These observations are in line with and extend the current understanding of the mechanisms behind MT in AU.
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Affiliation(s)
- Alexandra Wexler
- Department of Ophthalmology, St. Olavs University Hospital, Trondheim, Norway.
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Chan CC, Inrig T, Molloy CB, Stone MA, Derzko-Dzulynsky L. Prevalence of inflammatory back pain in a cohort of patients with anterior uveitis. Am J Ophthalmol 2012; 153:1025-30.e1. [PMID: 22321801 DOI: 10.1016/j.ajo.2011.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine the prevalence of inflammatory back pain in an anterior uveitis cohort. DESIGN Retrospective cohort study. METHODS Patients with anterior uveitis were recruited from the clinic of an ophthalmologist to complete a survey between March and December 2008. Patients were classified with inflammatory back pain if they had ≥2 positive responses to 4 validated inflammatory back pain questions: presence of morning stiffness >30 minutes in duration; improvement in back pain with exercise but not with rest; awakening from back pain during the second half of the night only; and presence of alternating buttock pain. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The impact of disease on quality of life was measured using the EuroQOL (EQ-5D) questionnaire. Twenty-five patients underwent further rheumatologic examination. RESULTS One hundred forty-one of 167 patients (84.4%) completed the survey. Sixty-six of 141 patients (46.8%) were classified to have inflammatory back pain. Mean BASDAI (4.2, SD 2.41) and EQ-5D scores (0.73, SD 0.21) were lower than patients with no inflammatory back pain (0.82, SD 0.16, P = .0048). In the subgroup that underwent rheumatologic assessment, a classification of inflammatory back pain was 92% sensitive and 67% specific for a diagnosis of inflammatory back pain. CONCLUSIONS The prevalence of inflammatory back pain in a cohort of anterior uveitis patients was found to be 46.8%. Patients with inflammatory back pain had worse quality of life than those without. Ophthalmologists may use these questions on back pain to select patients classified to have inflammatory back pain to refer for early rheumatologic assessment.
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Systemic associations of anterior uveitis in a tertiary care ophthalmic centre in south India. Int Ophthalmol 2012; 32:417-21. [DOI: 10.1007/s10792-012-9580-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 04/21/2012] [Indexed: 10/28/2022]
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Sen HN, Drye LT, Goldstein DA, Larson TA, Merrill PT, Pavan PR, Sheppard JD, Burke A, Srivastava SK, Jabs DA. Hypotony in patients with uveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial. Ocul Immunol Inflamm 2012; 20:104-12. [PMID: 22409563 PMCID: PMC3610172 DOI: 10.3109/09273948.2011.647228] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the prevalence of hypotony in patients with severe forms of uveitis. METHODS The Multicenter Uveitis Steroid Treatment (MUST) Trial, a randomized study, enrolled 255 patients. Patients with hypotony at the baseline visit were identified. RESULTS Twenty (8.3%) of 240 patients with sufficient data had hypotony. Hypotony was more common in patients with uveitis ≥5 years duration (odds ratio [OR] = 5.0; p < .01), and in eyes with a history of ocular surgery (vitrectomy vs. none, OR = 3.1; p = .03). Hypotony was less in patients with older age of uveitis onset (>51 years vs. <51 years, OR = 0.1; p = .02), in Caucasian patients (OR = 0.1; p < .01) compared to African American patients. Hypotonous eyes were more likely to have visual impairment (OR = 22.9; p < .01). CONCLUSIONS Hypotony is an important complication of uveitis and more commonly affects African-American patients, those with uveitis onset at a younger age, and those with longer disease duration. It is associated with visual impairment.
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Affiliation(s)
- H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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