HLA-B27 and Clinical Features of Acute Anterior Uveitis in Cuba

Clinical characterization of patients with HLA-B27-associated uveitis and evaluation of the impact of systemic treatment on the recurrence rate: a cross-sectional study

INTRODUCTION

Despite HLA-B27-associated uveitis is one of the most frequent etiologies of uveitis worldwide, there are scarce studies on the clinical spectrum of this disease and the implications of therapeutic strategies used in the Latin-American population, with none conducted in Colombia. Thus, this study aimed to describe the clinical characteristics of a cohort of patients with positive HLA-B27-associated uveitis in Colombia and evaluate the impact of systemic treatment on the recurrence rate.

METHODS

We retrospectively reviewed 490 clinical charts of patients with uveitis, searching for those with positive HLA-B27-associated uveitis over eight years in a referral center in Bogotá, Colombia. We used descriptive statistics to summarize demographic and clinical characteristics and conducted a Chi-square test, Fisher Exact test, Spearman correlation, and Mann-Whitney test to assess associations between treatment strategies and the recurrences rate.

RESULTS

We analyzed 39 patients (59% females) with positive HLA-B27-associated uveitis, with a median age at the first consultation of 44.5 years (Range: 2-80) and a mean follow-up time of 86.4 weeks (1.65 years). Most patients had unilateral uveitis (53.8%) and an anterior anatomical diagnosis (76.6%); two had anterior chamber fibrinous reaction, and only one had hypopyon. Most patients did not show associated systemic symptoms (66.7%). Topical corticosteroids, NSAIDs, methotrexate, mydriatics, and adalimumab were the most used treatments. The most common complications included cataracts, posterior synechiae, and macular edema. We identified that the rate of recurrences decreases over time (r = -0.6361, P = 0.002571), and this decrease seems to be associated with the initiation of disease-modifying antirheumatic drugs (DMARDs) in chronic and recurrent cases.

CONCLUSION

The clinical spectrum of HLA-B27-associated uveitis in Colombian patients is distinct from other latitudes. Notably, we found a female predominance, older age at presentation, higher frequency of bilateral and vitreous involvement, and lower frequency of concomitant systemic diseases. Additionally, our results suggest that DMARDs such as methotrexate and biologic agents are good therapeutic options to avoid recurrences in chronic and recurrent cases.

Ocular manifestations of HLA B 27 associated uveitis: a study of 255 cases from a tertiary eye care centre from South India

PURPOSE

To describe the clinical profile of HLA B-27-associated uveitis in Indian population.

METHOD

We conducted a retrospective review of medical records of 431 eyes of 255 consecutive patients with HLA B-27-associated uveitis, presented to our institute between 2012 and 2017.

RESULT

The study observed a male preponderance (75.7%) and the mean age of patients was 35.6 ± 13.3 years. A total of 412 (95.3%) eyes had anterior uveitis, 17(3.9%) eyes had anterior and intermediate uveitis and 3 eyes (0.7%) had intermediate uveitis. Retinal vasculitis was detected in four eyes (0.9%). A total of 176 patients (69%) in the study had evidence of systemic disease and 85% patients developed recurrences. In addition to the treatment with topical and oral steroid, immunosuppressive was required in 39.6% patients and 4% patients received biological therapy. The majority of the eyes (78.4%) had a good visual outcome, while 61 (14.2%) eyes had moderate visual impairment and 32 (7.4%) eyes had severe visual impairment at the time of final follow-up.

CONCLUSION

HLA-B27-associated uveitis can be associated with higher number of posterior segment involvement than it is estimated and aggressive therapy in moderate-to-severe uveitis can prevent severe visual impairment in these patients.

The Effect of Anterior Uveitis and Previously Undiagnosed Spondyloarthritis: Results from the DUET Cohort

OBJECTIVE

Anterior uveitis (AU) is an intraocular inflammatory condition closely linked to spondyloarthritis (SpA). Clinical disease variables may often underestimate the true effect of the disease on patient's quality of life. This study examines AU and associated undiagnosed SpA using established quality-of-life tools to inform clinicians of the effect of these diseases.

METHODS

The Dublin Uveitis Evaluation Tool (DUET) algorithm was developed and validated in a cohort of consecutive patients with AU who were all screened by a rheumatologist for the presence of SpA. This same cohort completed vision-related [Vision Core Measure 1 (VCM1)] and general health [Medical Outcomes Study Short Form-36 (SF-36)] questionnaires when AU was active and resolved.

RESULTS

VCM1 scores improved with AU resolution. VCM1 did not correlate with vision at baseline, but did on resolution of inflammation. Physical SF-36 scores were reduced during AU episodes and improved on resolution remaining below those of population norms. Subanalysis revealed that SpA scores were more affected than the idiopathic AU group.

CONCLUSION

AU affects physical aspects of quality of life more than is appreciated by clinical variables, especially in those with pre-existing, undiagnosed SpA. This study is unique in examining the effect of SpA on patients prior to diagnosis. These results highlight the role of the ophthalmologist in identifying patients with SpA who present with AU using the DUET algorithm.

Lack of Association between Genetic Polymorphisms of JAK-STAT Signaling Pathway Genes and Acute Anterior Uveitis in Han Chinese

Purpose. This study aimed to investigate the association between single nucleotide polymorphisms (SNPs) of JAK-STAT signaling pathway genes and acute anterior uveitis (AAU) with or without ankylosing spondylitis (AS) in the Han Chinese population. Methods. Eleven SNPs of the JAK1, JAK2, STAT1, IRF1, and NOS2 genes were analyzed in 443 AAU patients with AS, 486 AAU patients without AS, and 714 healthy controls. Genotyping was performed by PCR-RFLP assay or TaqMan® probe assay. The Chi-squared (χ²) test and multivariate logistic regression analysis were used to compare the distributions of alleles and genotypes between patients and controls. P values were adjusted using Bonferroni correction. Results. We did not observe significant differences in the genotype and allele frequencies of any SNP between AAU patients with or without AS and healthy controls. Stratification analyses by gender and HLA-B27 status showed a boundary significant association between two SNPs (rs10975003 and rs10758669) in JAK2 and AAU (P = 0.052 and P = 0.053, resp.). Conclusions. Our results indicated that genetic polymorphisms of the JAK-STAT signaling pathway genes may not be associated with AAU in the Han Chinese population.

Association of CD59 and CFH polymorphisms with acute anterior uveitis in Chinese population

PurposeCD59 complement regulator and complement factor H (CFH) have important roles in complement activation pathways, which are known to affect the development of uveitis. The present study was performed to investigate whether an association exists between CD59 and CFH genetic polymorphisms and acute anterior uveitis (AAU).MethodsA total of 600 individuals (300 patients diagnosed with AAU and 300 healthy controls) were recruited for this case-control study. Five single-nucleotide polymorphisms (SNPs) in CD59 (rs831626, rs12272807, rs831625, rs11585, and rs12576440) and CFH-rs1065489 were genotyped using Sequenom MassARRAY technology. Allele and genotype frequencies were statistically compared between patients and controls using χ² test. Analyses were stratified for gender, human leukocyte antigen (HLA)-B27, and ankylosing spondylitis (AS) status.ResultsNo significant association was found between any of the six polymorphisms and AAU. In HLA-B27-negative AAU patients, the frequencies of the G allele and GG homozygosity were lower in CD59-rs831626 when compared with controls (P=0.032). There were also significant decreases in the frequencies of T allele and TT homozygosity in CFH-rs1065489 in AAU patients with AS compared with controls (P=0.002). Furthermore, the frequencies of the T allele and TT homozygosity in CFH-rs1065489 were lower in the AAU male patients with AS compared with controls (P=0.015).ConclusionOur results revealed that SNPs CD59-rs831626 and CFH-rs1065489 were associated with the susceptibility of AAU. The influence on AAU could be gender specific and dependent on the HLA-B27 and AS status. No positive results were found in the overall group.

Gender disparities in ocular inflammatory disorders

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.