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Rademacher J, Müllner H, Diekhoff T, Haibel H, Igel S, Pohlmann D, Proft F, Protopopov M, Rios Rodriguez V, Torgutalp M, Pleyer U, Poddubnyy D. AB0826 Keep an Eye on the Back: Spondyloarthritis in Patients with Acute Anterior Uveitis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatients with acute anterior uveitis (AAU) have an increased risk for concomitant spondyloarthritis (SpA). Different referral strategies have been proposed to identify AAU patients with high probability of SpA, among them an Assessment of SpondyloArthritis international Society(ASAS)-based referral strategy focusing on patients with chronic back pain starting before the age of 45 years and the Dublin Uveitis Evaluation Tool (DUET) also including psoriasis, HLA-B27 and arthralgia (Poddubnyy et al., Haroon et al., both ARD 2015).ObjectivesTo analyse the prevalence of SpA in patients with AAU, to identify parameters associated with SpA presence, and to evaluate referral algorithms.MethodsPatients with non-infectious AAU underwent structured rheumatologic assessment including magnetic resonance imaging of sacroiliac joints allowing a definitive diagnosis/exclusion of concomitant SpA. Fisher’s exact test and Mann–Whitney U test were used to compare AAU patients with and without SpA. Furthermore, logistic regression analyses were performed. Sensitivity, specificity, positive predictive value, positive and negative likelihood ratios were analysed for referral strategies.ResultsThe 189 AAU patients with complete rheumatologic assessment and SIJ imaging were 40.8 years old, and 55% were males. SpA was diagnosed in 106 AAU patients (56%). The majority (93%) had predominantly axial SpA, 7 patients peripheral SpA. In 74 patients (70%), the SpA diagnosis was established for the first time. Pelvic X-rays were available for 88 (89%) of the axSpA patients, 66% of whom were classified as having radiographic axSpA.SpA was equally frequent in patients experiencing the first episode of AAU and in patients with recurrent disease. In our cohort, AAU patients with and without underlying SpA showed no differences in their ophthalmologic examination. In multivariable logistic regression analysis, psoriasis (OR 12.5 [95%CI 1.3-120.2]), HLA-B27 positivity (OR 6.3 [95%CI 2.4-16.4]), elevated CRP (OR 4.8 [95%CI 1.9-12.4]) and male sex (OR 2.1 [95%CI 1.1-4.2]) were associated with SpA presence.Table 1.Parameters associated with the presence of spondyloarthritis in patients with acute anterior uveitis.univariablemultivariableOR95%CIOR95%CIPsoriasis (ever)14.6(1.9; 112.4)12.5(1.3; 120.2)HLA-B27 positivity6.2(2.7; 14.6)6.3(2.4; 16.4)Elevated CRP (≥ 5 mg/l)4.1(1.8; 9.0)4.8(1.9; 12.4)Male sex2.2(1.2; 4.0)2.1(1.1; 4.2)Inflammatory back pain (ASAS definition)2.1(1.2; 3.9)1.9(0.9; 4.0)Any peripheral manifestation (ever)1.9(1.1; 3.5)1.9(0.9; 3.8)Age in years1.0(1.0; 1.0)1.0(1.0; 1.0)Univariable and multivariable logistic regression analyses. ASAS Assessment of SpondyloArthritis international Society; CRP C-reactive protein; OR odds ratio; CI confidence interval.The Dublin Uveitis Evaluation Tool showed higher specificity for SpA recognition than the ASAS referral tool (42% vs. 28%), which had slightly higher sensitivity (78% vs. 80%). However, both referral strategies would have missed more than 20% of SpA patients.ConclusionWe revealed a high prevalence of overall and previously undiagnosed SpA in AAU patients. Therefore, we propose rheumatologic evaluation for all AAU patients with musculoskeletal symptoms. Rheumatologists should consider that SpA in AAU patients might present “atypically” with back pain starting after 45 years and lasting shorter than 3 months.Figure 1.Performance of Referral Strategies in Patients with Acute Anterior Uveitis. Dublin Uveitis Evaluation Tool (DUET) and an ASAS-based referral tool (ASAS). + respective tool fulfilled, - not fulfilled. ASAS Assessment of SpondyloArthritis international Society; AxSpA axial spondyloarthritis, pSpA peripheral spondyloarthritis.AcknowledgementsThe authors would like to thank the rheumatologists S. Lüders, B. Muche and A.-K. Weber for participating in the clinical data acquisition; and A. Langdon and L. Meinke for their support monitoring and coordinating this study. Furthermore, we are grateful to all participating ophthalmologists who included their patients in this study and to all patients. The study was supported by an unrestricted research grant from AbbVie. AbbVie had no role in the study design or in the collection, analysis, or interpretation of the data, the writing of the manuscript, or the decision to submit the manuscript for publication. Dr. Judith Rademacher and Dr. Dominika Pohlmann are participants in the BIH-Charité Clinician Scientist Program funded by the Charité –Universitätsmedizin Berlin and the Berlin Institute of Health.Disclosure of InterestsJudith Rademacher: None declared, Hanna Müllner: None declared, Torsten Diekhoff Speakers bureau: AbbVie, MSD, Novartis, Canon MS, Consultant of: Lilly, Hildrun Haibel Speakers bureau: AbbVie, MSD, Janssen, Roche, Pfizer, Sobi, Consultant of: Janssen, Sobi, Novartis, Sabrina Igel: None declared, Dominika Pohlmann Speakers bureau: Bayer, Consultant of: AbbVie, Celgene, Janssen, Novartis, UCB, Grant/research support from: Bayer, Allergan, Fabian Proft Speakers bureau: AMGEN, AbbVie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Celgene, Janssen, Novartis, UCB, Grant/research support from: UCB, Novartis, Lilly, Mikhail Protopopov Consultant of: Novartis, Valeria Rios Rodriguez Consultant of: AbbVie, Falk e.V., Murat Torgutalp: None declared, Uwe Pleyer Shareholder of: stock or stock options from Novartis, BionTec, Speakers bureau: AbbVie, Alimera, Novartis, Grant/research support from: AbbVie, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer and UCB, Consultant of: AbbVie, Biorad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer
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Helbig H, Grehn F, Lagrèze WA, Pleyer U, Seitz B. [Are "pachychoroid spectrum disorders" a topic for CME?]. Ophthalmologe 2021; 118:862-864. [PMID: 34351447 DOI: 10.1007/s00347-021-01380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/24/2022]
Affiliation(s)
- H Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - F Grehn
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - W A Lagrèze
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - U Pleyer
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes und Medizinische Fakultät, Universität des Saarlands, Homburg/Saar, Deutschland
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Rademacher J, Hempel C, Rios Rodriguez V, Proft F, Protopopov M, Torgutalp M, Haibel H, Pleyer U, Siegmund B, Poddubnyy D. POS0410 BIOMARKERS REFLECTING DISTURBED GUT BARRIER DIFFER IN PATIENTS WITH SPONDYLOARTHRITIS, CROHN’S DISEASE AND ACUTE ANTERIOR UVEITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Spondyloarthritides (SpA) are characterized by frequent extra-musculoskeletal manifestations (EMM) among them acute anterior uveitis (AAU) and Crohn’s disease (CD). Vice versa, about 50% of AAU and 20% of CD patients have concomitant SpA. SpA patients show gut dysbiosis together with frequent subclinical gut inflammation. Biomarkers reflecting disturbed gut barrier (intestinal-fatty acid binding protein (iFABP), lipopolysaccharide binding protein (LBP) and zonulin) were previously found to be elevated in patients with radiographic axial SpA (r-axSpA) (1).Objectives:To evaluate whether biomarkers reflecting leaky gut are altered in patients with AAU, CD and SpA compared to healthy controls and whether they differ between patients with EMM with and without concomitant SpA.Methods:A total of 100 patients from the German Spondyloarthritis Inception Cohort (GESPIC) were included – among them 20 patients with r-axSpA without EMM, 40 patients with CD and 40 patients with non-infectious AAU – out of which 19 and 20 patients, respectively, had concomitant SpA (11/8 and 20/0 axial/peripheral SpA, respectively). The GESPIC patients were compared to 20 age- and sex-matched healthy donors (HD). The following five serum biomarkers were analyzed with ELISA: calprotectin, iFABP, LBP, soluble CD14 (sCD14) and zonulin.Results:Patient characteristics are shown in Table 1. Serum levels of calprotectin, LBP, sCD14 and zonulin differed significantly between patients with r-axSpA, AAU and CD with and without concomitant SpA and HD (Figure 1). When comparing patients with EMM with and without underlying SpA, calprotectin serum levels were significantly elevated in CD patients with SpA (8.6µg/ml (SD 5.5µg/ml)) compared to CD patients without SpA (5.7µg/ml (SD 4.1µg/ml); Mann-Whitney U Test, p=0.031). Serum levels of the analyzed biomarkers did not differ between AAU patients with and without axSpA. Spearman rank correlation revealed a significant association between CRP and calprotectin (correlation coefficient r=0.230; p=0.012), LBP (r=0.596; p<0.0001), sCD14 (r=0.428; p<0.0001) and zonulin (r=0.221; p=0.016), respectively. Furthermore, LBP and zonulin serum levels correlated positively (r=0.208; p=0.023); as well as LBP and sCD14 levels (r=0.418; p<0.0001).Table 1.Patient characteristics. Mean values (standard deviation) or
absolute numbers are shown.CD + SpACDr-axSpAAAU + axSpAAAUHDN192120202020Age39.1 (11.3)38.7 (14.4)38.4 (10.3)39.6 (12.0)39.2 (12.5)38.6 (12.9)Male (%)9 (47%)9 (43%)9 (45%)9 (45%)9 (45%)9 (45%)HLA-B27 positive (%)5 (26%)3 (14%)17 (85%)17 (85%)13 (65%)2 (10%)CRP in mg/l14.3 (25.6)18.0 (41.8)9.1 (11.3)6.7 (9.9)2.3 (3.4)0.6 (0.7)ASDAS2.8 (1.1)3.2 (0.6)2.2 (1.0)BASDAI4.1 (2.2)5.4 (1.2)3.2 (2.4)Figure 1.Biomarkers reflecting disturbed gut barrier show distinct signatures in patients with acute anterior uveitis, Crohn’s disease and axial Spondyloarthritis. Kruskal Wallis Test; p values shown. Dunn-Bonferroni Post-Hoc analyses, significant pairwise differences are marked; * p<0.05; **p<0.01; ***p<0.0001Conclusion:We found substantial differences in biomarkers reflecting disturbed gut barrier between with SpA, CD, AAU and healthy controls. The presence of SpA was associated with higher calprotectin serum levels in CD as compared to CD without SpA.References:[1]Ciccia F, et al. Dysbiosis and zonulin upregulation alter gut epithelial and vascular barriers in patients with ankylosing spondylitis. 2017.Acknowledgements:Dr. Judith Rademacher is participant in the BIH-Charité Clinician Scientist Program funded by the Charité –Universitätsmedizin Berlin and the Berlin Institute of Health.Disclosure of Interests:None declared
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Rios Rodriguez V, Essex M, Rademacher J, Proft F, Löber U, Marko L, Pleyer U, Siegmund B, Poddubnyy D, Forslund S. OP0031 SHARED AND DISTINCT GUT MICROBIOME SIGNATURES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS AND ITS RELATED IMMUNE-MEDIATED DISEASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Immune-mediated diseases such as spondyloarthritis (SpA) consistently coincide with dysbiosis of the gut microbiota and frequently present with additional inflammatory pathologies such as Crohn’s disease (CD) and acute anterior uveitis (AAU). Deep profiling of gut microbiota may reveal new pathways of how SpA and its related diseases are initiated and perpetuated.Objectives:To identify the presence of shared and specific gut microbiota signatures for SpA and its related diseases as a whole, as well as for the individual diseases, relative to healthy controls.Methods:Patients were recruited with a definite diagnosis of axial SpA, AAU or CD and were compared to controls (patients with back pain and previously ruled out SpA/CD/AAU diagnosis). All patients were naïve to or did not receive treatment with biological disease-modifying antirheumatic drugs for at least 3 months before enrollment of the study. Fecal samples were collected and microbiota composition was determined by 16S rRNA gene sequencing, followed by computational analysis referencing the SILVA138 database. Nonparametric Wilcoxon tests were used to calculate differential abundances between binary groups, and the Spearman correlation was used with continuous covariates. Nested linear models and likelihood ratio tests were used to assess confounding with respect to patient characteristics, HLA-B27 expression, inflammatory markers, and the presence of other immune-mediated diseases.Results:A total of 300 patients were recruited for the study: 111 axial SpA, 110 AAU, and 79 CD patients and were compared to 63 control individuals. Fifty-three of patients were males with an age (mean±SD) of 39.1±12.3 years. The prevalence of HLA-B27 was 63.0% by patients compared to 7.9% by control individuals. A multivariate PERMANOVA test between the groups was significant (p<0.001), revealing a difference in overall composition between the groups.At the phylum level, patients with axial SpA, AAU and CD contained higher abundances of Proteobacteria, Bacteroidetes and Fusobacteria, and lower abundances of Firmicutes and Actinobacteria compared to the control group. At the genus level, patients (with axial SpA, AAU and CD) displayed a shared gut microbiome signature differing from that of control individuals. Patients samples were strongly depleted in Blautia compared to the control group. Many of the differentially abundant taxa also correlated with increased inflammation as measured by C-reactive protein (CRP), including a depletion of Fusicatenibacter, Lachnospiraceae FCS020 and Roseburia, as well as an enrichment of Lactobacillus and Veillonella. By looking at each separate disease phenotype, CD patients differed significantly from the control individuals with respect to many genera. These primarily consisted of depletions in Clostridiales (Roseburia, Coprococcus, Ruminococcaceae), and enrichments of pathogen-harboring genera such as Escherichia-Shigella and Fusobacterium. Axial SpA patients were uniquely enriched in Collinsella and Holdemanella and depleted in Cupriavidus; the enrichment of Lactobacillus and depletion of Blautia observed in all patient groups was also associated to the presence of axial SpA, though confounded by CRP. There were strong taxa associations to the presence of HLA-B27, including enrichment of Asteroleplasma, Coprococcus, Faecalibacterium, Rominococcaceae, Lachnospiraceae NK4A136 and Rikenellaceae.Conclusion:There is a robust shared taxonomic signature among related immune-mediated diseases, in addition to individual disease phenotype signatures. Patients frequently exhibited a strong depletion in Blautia and an enrichment in Lactobacillus as well as pathogen-harboring genera such as Escherichia-Shigella and Fusobacterium.Figure 1.Taxa associations within and between the groups resulting from comparing each with the control group and accounting for disease concomitance and patient characteristics (FDR ≤ 0.05). AAU, anterior acute uveitis; CD, Crohn’s disease; SpA, spondyloarthritis.Disclosure of Interests:None declared
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Holz FG, Heinz C, Wolf A, Hoerauf H, Pleyer U. [Intraocular inflammation with brolucizumab use : Patient management-diagnosis-therapy]. Ophthalmologe 2021; 118:248-256. [PMID: 33555415 PMCID: PMC7935813 DOI: 10.1007/s00347-021-01321-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
The anti-vascular endothelial growth factor (anti-VEGF) agent brolucizumab has been approved in the USA in October 2019 and in Europe in February 2020 for the treatment of neovascular age-related macular degeneration (nAMD). The approval was based on the randomized, double-blind phase III studies HAWK and HARRIER with a total of 1817 patients. Brolucizumab 6 mg (administered every 12 or 8 weeks depending on the activity of the disease) showed a non-inferior efficacy in terms of best-corrected visual acuity compared to aflibercept 2 mg (administered every 8 weeks). Initial reports on the use of brolucizumab after its approval in the USA indicated a safety signal of rare adverse events termed as retinal vasculitis and/or retinal vascular occlusion that may result in severe loss of vision. Typically, these events occurred in the presence of intraocular inflammation (IOI). A safety review committee (SRC) subsequently carried out an independent analysis of data from the pivotal studies. This article sets out the current state of knowledge and aims to provide users with orientation-from the authors' perspective-in treating brolucizumab-associated IOI. It appears mandatory to provide patients with information about possible symptoms of IOI. Even though the case reports and the SRC review of HAWK/HARRIER may not yet provide sufficient evidence for any final conclusions, it seems crucial to educate patients about signs and symptoms to ensure an early detection and diagnosis in cases of IOI. Once a patient is diagnosed with IOI, retinal vasculitis, and/or retinal vascular occlusive events, physicians should act promptly with an adequate and intensive anti-inflammatory treatment and brolucizumab treatment should be discontinued. It is important to note that these recommendations are primarily based on the authors' expert opinions and should be considered as guidance in managing these events rather than a formal protocol or guidelines.
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Affiliation(s)
- F G Holz
- Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland.
| | - C Heinz
- Augenzentrum am St. Franziskus-Hospital Münster, Münster, Deutschland
- Klinik für Augenheilkunde, Universität Duisburg-Essen, Essen, Deutschland
| | - A Wolf
- Klinik für Augenheilkunde am Universitätsklinikum Ulm, Ulm, Deutschland
| | - H Hoerauf
- Augenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - U Pleyer
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Abstract
Multiple sclerosis (MS) is a chronic inflammatory disorder of the brain and the spinal cord occurring mostly in young adults and is associated with temporary or permanent neurological deficits. An association between uveitis and MS has been recognized for a long time. Current data indicate an approximately 10 times higher prevalence of uveitis in patients with MS compared to the general population. In particular, MS is associated with intermediate uveitis and typically with concomitant retinal vasculitis. The treatment of uveitis should not only take the severity of intraocular inflammation into account but a coordination of the active agents must also consider the neurological manifestations. Since uveitis and MS are pathogenetically based on an immune-mediated genesis, immunomodulatory treatment approaches are dominant but it is important to bear in mind that tumor necrosis factor(TNF)-alpha blocking agents may worsen MS.
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Affiliation(s)
- N Stübiger
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - K Ruprecht
- Klinik und Hochschulambulanz für Neurologie, Klinisches und experimentelles Forschungszentrum für Multiple Sklerose, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - U Pleyer
- Universitäts-Augenklinik, Charité, Uveitis Zentrum Campus Virchow Klinikum - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Hedin CRH, Vavricka SR, Stagg AJ, Schoepfer A, Raine T, Puig L, Pleyer U, Navarini A, van der Meulen-de Jong AE, Maul J, Katsanos K, Kagramanova A, Greuter T, González-Lama Y, van Gaalen F, Ellul P, Burisch J, Bettenworth D, Becker MD, Bamias G, Rieder F. The Pathogenesis of Extraintestinal Manifestations: Implications for IBD Research, Diagnosis, and Therapy. J Crohns Colitis 2019; 13:541-554. [PMID: 30445584 DOI: 10.1093/ecco-jcc/jjy191] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article reports on the sixth scientific workshop of the European Crohn's and Colitis Organisation [ECCO] on the pathogenesis of extraintestinal manifestations [EIMs] in inflammatory bowel disease [IBD]. This paper has been drafted by 15 ECCO members and 6 external experts [in rheumatology, dermatology, ophthalmology, and immunology] from 10 European countries and the USA. Within the workshop, contributors formed subgroups to address specific areas. Following a comprehensive literature search, the supporting text was finalized under the leadership of the heads of the working groups before being integrated by the group consensus leaders.
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Affiliation(s)
- C R H Hedin
- Gastroenterology unit, Patient Area Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - S R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - A J Stagg
- Centre for Immunobiology, Bart's and The London Medical School, Queen Mary University of London, London, UK
| | - A Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - T Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - U Pleyer
- University Eye Clinic, Uveitis Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - J Maul
- Gastroenterologie am Bayerischen Platz, Berlin, Germany.,Department of Medicine (Gastroenterology, Infectious Diseases, Rheumatology), Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University of Ioannina School of Medical Sciences, Ioannina, Greece
| | - A Kagramanova
- IBD Department, The Loginov Moscow Clinical Scientific Centre, Moscow, Russia
| | - T Greuter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Gastroenterology Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Y González-Lama
- IBD Unit, Gastroenterology and Hepatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - F van Gaalen
- Department of Rheumatology, Leiden University Medical Center [LUMC], Leiden, Netherlands
| | - P Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - J Burisch
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Abdominal Center K, Medical Section, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - D Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - M D Becker
- Department of Ophthalmology, Triemli Hospital, Zurich, Switzerland & Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - G Bamias
- National and Kapodistrian University of Athens, GI Unit, 3rd Academic Department of Internal Medicine, Sotiria Hospital, Athens, Greece
| | - F Rieder
- Department of Gastroenterology, Hepatology and Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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9
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10
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Heiligenhaus A, Minden K, Tappeiner C, Baus H, Bertram B, Deuter C, Foeldvari I, Föll D, Frosch M, Ganser G, Gaubitz M, Günther A, Heinz C, Horneff G, Huemer C, Kopp I, Lommatzsch C, Lutz T, Michels H, Neß T, Neudorf U, Pleyer U, Schneider M, Schulze-Koops H, Thurau S, Zierhut M, Lehmann HW. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin Arthritis Rheum 2018; 49:43-55. [PMID: 30595409 DOI: 10.1016/j.semarthrit.2018.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized. METHODS Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure). RESULTS Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of ≥ 2 years of uveitis inactivity. CONCLUSIONS An interdisciplinary, evidence-based treatment guideline for JIAU is presented.
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Affiliation(s)
- A Heiligenhaus
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany.
| | - K Minden
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Tappeiner
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H Baus
- The Participation of the Following Bodies: Parents' Group for Children with Uveitis and their Families, Germany
| | - B Bertram
- Professional Association of Ophthalmologists (BVA), Germany
| | - C Deuter
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - I Foeldvari
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - D Föll
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Frosch
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - G Ganser
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Gaubitz
- German Society of Rheumatology (DGRh), Germany
| | - A Günther
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Heinz
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - G Horneff
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Huemer
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - I Kopp
- Association of the Scientific Medical Societies in Germany (AWMF), Germany
| | - C Lommatzsch
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - T Lutz
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - H Michels
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - T Neß
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - U Neudorf
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - U Pleyer
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Schneider
- German Society of Rheumatology (DGRh), Germany
| | | | - S Thurau
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Zierhut
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H W Lehmann
- The Society for Paediatric Rheumatology (GKJR), Germany
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11
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Werner RN, Steinhorst NI, Nast A, Pleyer U. Diagnostik und Management des Herpes zoster ophthalmicus. Spektrum Augenheilkd 2018. [DOI: 10.1007/s00717-018-0408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Pohlmann D, Pleyer U. Skleritis – Fortschritte zur Diagnose und Therapie. Klin Monbl Augenheilkd 2018; 235:603-610. [DOI: 10.1055/s-0042-120542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie Skleritis umfasst ein breites Spektrum morphologischer Veränderungen, die häufig im Rahmen systemischer Erkrankungen auftreten. Während die Episkleritis meist unproblematisch verläuft, ist die Skleritis oft durch einen destruierenden Verlauf charakterisiert. Dies führt nicht selten zu visusrelevanten Folgekomplikationen, die sich als ulzerative Keratitis, Uveitis oder sekundäre intraokulare Drucksteigerung präsentieren. Aufgrund der Schwere dieser Entzündungsform und der häufig zugrunde liegenden Grunderkrankungen soll der Fokus des Beitrags auf die differenzialdiagnostischen Überlegungen und die aktuellen therapeutischen Optionen gelegt werden.
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Affiliation(s)
- D. Pohlmann
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
| | - U. Pleyer
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
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13
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Gajate N, Tufail A, Lightman S, Kamal A, Pleyer U, Dot C, Li X, Jiao J, Lou J, Hashad Y. Post-marketing surveillance study of the safety of dexamethasone intravitreal implant (DEX) in patients with retinal vein occlusion (RVO) or noninfectious posterior segment uveitis (NIPSU). Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0t083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- N.M. Gajate
- Servicio de Oftalmología; Hospital Universitario de Burgos; Burgos Spain
| | - A. Tufail
- Ophthalmology; Moorfields Eye Hospital; London UK
| | - S. Lightman
- Ophthalmology; Moorfields Eye Hospital; London UK
| | - A. Kamal
- Ophthalmology; Aintree University Hospital; Liverpool UK
| | - U. Pleyer
- Ophthalmology; Charite Universitätsmedizin Berlin; Berlin Germany
| | - C. Dot
- Ophthalmology; Ophtalmologie - Hôpital Desgenettes; Lyon France
| | - X.Y. Li
- Clinical Development; Allergan plc Irvine USA
| | - J. Jiao
- Biostatistics; Allergan plc; Irvine USA
| | - J. Lou
- Clinical Development; Allergan plc Irvine USA
| | - Y. Hashad
- Clinical Development; Allergan plc Irvine USA
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14
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15
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16
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Pleyer U, Klauß V, Wilking H, Nentwich MM. [Tropical ophthalmology : Intraocular inflammation caused by "new" infectious pathogens and travel-related infections]. Ophthalmologe 2017; 113:35-46. [PMID: 26649438 DOI: 10.1007/s00347-015-0176-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A number of "new" (emerging) infections that can also cause inflammatory eye changes are appearing and becoming increasingly important. In the past, diseases such as chikungunya, dengue fever or West Nile virus infections were endemic in tropical regions, but are now expanding worldwide and causing significant morbidity and even mortality. "Globalization" and human migration are important factors leading to the import of these infections. Climate changes are probably even more important. Increasing temperatures provide suitable conditions for new vectors, and may lead to autochthonous transmission of infectious pathogens. Diagnosis of these diseases requires not only careful assessment of medical and travel history, but also the application of specific laboratory diagnostic tests. A broad spectrum of ocular involvement has been reported, with frequent posterior segment involvement. Emerging infections should therefore be considered in the differential diagnosis of retinitis, chorioretinitis, retinal vasculitis and optic neuropathy in a patient living in or traveling back from an endemic area. Since these infections are often vector (insect) borne and effective treatments are almost uniformly lacking, prevention is at least as important as prompt diagnosis and initiation of supportive care. Here, we focus on Chikungunya, Dengue fever, Ebola fever, the West Nile virus and Rickettsioses, which frequently demonstrate ocular involvement.
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Affiliation(s)
- U Pleyer
- Augenklinik, Uveitis Zentrum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - V Klauß
- Augenklinik, Klinikum der Universität München, München, Deutschland
| | - H Wilking
- Robert Koch-Institut, Berlin, Deutschland
| | - M M Nentwich
- Augenklinik, Klinikum der Universität München, München, Deutschland.,Augenklinik, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
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17
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Abstract
Medical eye care in developing countries is very different from the situation in industrialized nations. In order to prevent rising numbers of blind people worldwide due to increased life expectancy and population growth, the global initiative Vision 2020 "The Right to Sight" was established in 1999. Coordinated initiatives are important as most causes of blindness are either preventable or curable (e.g. cataract surgery); however, due to a lack of resources eye care in developing countries cannot implement all necessary preventive and therapeutic measures at present. The epidemiology of causes of blindness and the situation of ophthalmic care are discussed. Because of increased mobility of people and goods (e.g. air travel and trucking), imported eye diseases are of increasing importance. The difference between travel medicine, which deals with the medical situation of travelers and international ophthalmology (i.e. diseases in tropical countries) is discussed and illustrated on the basis of several important disease patterns.
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Affiliation(s)
- M M Nentwich
- Augenklinik, Ludwig-Maximilians Universität München, Mathildenstr. 8, 80336, München, Deutschland. .,Augenklinik und Poliklinik, Julius-Maximilians Universität Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland.
| | - U Pleyer
- Augenklinik, Uveitis Zentrum, Charité, Universitätsmedizin Berlin, Berlin, Deutschland
| | - U C Schaller
- Augenklinik Herzog Carl-Theodor, München, Deutschland
| | - V Klauß
- Augenklinik, Ludwig-Maximilians Universität München, Mathildenstr. 8, 80336, München, Deutschland
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18
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Werner RN, Nikkels AF, Marinović B, Schäfer M, Czarnecka-Operacz M, Agius AM, Bata-Csörgő Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A. European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: Diagnosis. J Eur Acad Dermatol Venereol 2017; 31:9-19. [PMID: 27804172 DOI: 10.1111/jdv.13995] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/23/2016] [Indexed: 12/15/2022]
Abstract
Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction of the incidence of postherpetic neuralgia and other complications. The guideline development followed a structured and predefined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this first part of the guideline, diagnostic means have been evaluated. The expert panel formally consented recommendations for the management of patients with (suspected) HZ, referring to the assessment of HZ patients, considering various specific clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.
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Affiliation(s)
- R N Werner
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A F Nikkels
- Department of Dermatology, University Medical Center of Liège, Liège, Belgium
| | - B Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Schäfer
- Department of Anesthesiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Czarnecka-Operacz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - A M Agius
- Department of Otorhinolaryngology, The Medical School, University of Malta, Msida, Malta
| | - Z Bata-Csörgő
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - J Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - G E Gross
- Department of Dermatology and Venerology, Universitätsklinik Rostock, Rostock, Germany
| | - S Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R Lapid-Gortzak
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T H Lesser
- Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK
| | - U Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - G M Verjans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - P Wutzler
- Department of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany
| | - C Dressler
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Erdmann
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Rosumeck
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Nast
- Division of Evidence Based Medicine in Dermatology (dEBM), Department of Dermatology, Venereology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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19
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Daas L, Szentmáry N, Eppig T, Langenbucher A, Hasenfus A, Roth M, Saeger M, Nölle B, Lippmann B, Böhringer D, Reinhard T, Kelbsch C, Messmer E, Pleyer U, Roters S, Zhivov A, Engelmann K, Schrecker J, Zumhagen L, Thieme H, Darawsha R, Meyer-Ter-Vehn T, Dick B, Görsch I, Hermel M, Kohlhaas M, Seitz B. [The German Acanthamoeba keratitis register: Initial results of a multicenter study]. Ophthalmologe 2016; 112:752-63. [PMID: 25833754 DOI: 10.1007/s00347-014-3225-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE In September 2011 the cornea section of the German Ophthalmological Society (DOG) established the first German Acanthamoeba keratitis registry. The data of this multicenter survey are being collected, compiled and evaluated at the Department of Ophthalmology at the Saarland University. The aim of this article is to present an intermediate report. PATIENTS AND METHODS Data from 172 eyes with Acanthamoeba keratitis were collected during the last 10 years. For this interim report we actually evaluated 121 eyes (60.2 % female patients, average age 41.3 years) and collected the following data: date of onset of symptoms, date and method of diagnosis, initial diagnosis, anamnestic data, clinical symptoms and signs at diagnosis and during follow-up, conservative and surgical therapy. Criteria for inclusion in the Acanthamoeba registry was the established diagnosis of an Acanthamoeba keratitis with at least one of the methods described in this article. RESULTS Acanthamoeba keratitis could be histologically proven in 55.3 % of the cases, via PCR in 25.6 %, with confocal microscopy in 20.4 % and using in vitro cultivation in 15.5 %. Clinical symptoms and signs in Acanthamoeba keratitis were pain in 67.0 %, ring infiltrates in 53.4 %, pseudodendritiform epitheliopathy in 11.7 % and keratoneuritis in 5.8 %. In 47.6 % of the cases the initial diagnosis was herpes simplex virus keratitis followed by bacterial keratitis in 25.2 % and fungal keratitis in 3.9 %. Acanthamoeba keratitis was the correct initial diagnosis in only 23.2 % of cases. The average time period between first symptoms and diagnosis was 2.8 ± 4.0 months (range 0-23 months). A triple therapy with Brolene® Lavasept® and antibiotic eye drops at least 5 ×/day was used in 54.5 % of eyes (n = 66). Penetrating keratoplasty was performed in 40.4 %, in 18 cases in combination with cryotherapy of the cornea. The mean graft diameter was 7.9 ± 1.1 mm (range 3.5-11.0 mm). The final visual acuity (Snellen visual acuity chart at 5 m) was comparable in the two groups of eyes with (5/40 ± 5/25) and without (5/32 ± 5/25) keratoplasty. CONCLUSION Acanthamoeba keratitis is a rare and often very late diagnosed disease and two thirds of the cases were initially misdiagnosed. The early recognition of the typical symptoms is crucial for the prognosis of the disease. All ophthalmological departments in Germany are invited to submit further data of all confirmed cases (berthold.seitz@uks.eu), whether retrospectively or prospectively in order to generate an adequate standardized diagnostic and therapeutic approach for this potentially devastating disease.
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Affiliation(s)
- L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland.
| | - N Szentmáry
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland
| | - T Eppig
- Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Langenbucher
- Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Hasenfus
- Institut für Allgemeine und spezielle Pathologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - M Roth
- Universitätsaugenklinik, Düsseldorf, Deutschland
| | - M Saeger
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B Nölle
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B Lippmann
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - D Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Kelbsch
- Universitätsaugenklinik, Tübingen, Deutschland
| | - E Messmer
- Augenklinik der LMU, München, Deutschland
| | - U Pleyer
- Universitätsaugenklinik, Berlin Charité, Berlin, Deutschland
| | - S Roters
- Universitätsaugenklinik, Köln, Deutschland
| | - A Zhivov
- Universitätsaugenklinik, Rostock, Deutschland
| | | | | | - L Zumhagen
- Universitätsaugenklinik, Münster, Deutschland
| | - H Thieme
- Universitätsaugenklinik, Magdeburg, Deutschland
| | - R Darawsha
- Universitätsaugenklinik, Essen, Deutschland
| | | | - B Dick
- Universitätsaugenklinik, Bochum, Deutschland
| | - I Görsch
- Universitätsaugenklinik, Hamburg-Eppendorf, Deutschland
| | - M Hermel
- Universitätsaugenklinik, Aachen, Deutschland
| | - M Kohlhaas
- Augenklinik Dortmund, Dortmund, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland
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20
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Thurau S, Pleyer U. Differenzialdiagnose der anterioren intraokularen Entzündung. Spektrum Augenheilkd 2016. [DOI: 10.1007/s00717-016-0320-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Werner RN, Nikkels AF, Marinović B, Schäfer M, Czarnecka-Operacz M, Agius AM, Bata-Csörgő Z, Breuer J, Girolomoni G, Gross GE, Langan S, Lapid-Gortzak R, Lesser TH, Pleyer U, Sellner J, Verjans GM, Wutzler P, Dressler C, Erdmann R, Rosumeck S, Nast A. European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2: Treatment. J Eur Acad Dermatol Venereol 2016; 31:20-29. [PMID: 27579792 DOI: 10.1111/jdv.13957] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022]
Abstract
Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.
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Affiliation(s)
- R N Werner
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A F Nikkels
- Department of Dermatology, University Medical Center of Liège, Liège, Belgium
| | - B Marinović
- Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Schäfer
- Department of Anesthesiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Czarnecka-Operacz
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - A M Agius
- Department of Otorhinolaryngology, The Medical School, University of Malta, Msida, Malta
| | - Z Bata-Csörgő
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - J Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - G E Gross
- Department of Dermatology and Venerology, Universitätsklinik Rostock, Rostock, Germany
| | - S Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R Lapid-Gortzak
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T H Lesser
- Department of Otolaryngology, University Hospital Aintree NHS Foundation Trust, Liverpool, UK
| | - U Pleyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - G M Verjans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - P Wutzler
- Department of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany
| | - C Dressler
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Erdmann
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Rosumeck
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine in Dermatology (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
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Pleyer U. The review process - reviewer friend or foe? Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pleyer U. Controversies in the use of NSAIDs. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pleyer U. Laboratory work-up and specialized investigations. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Pleyer U. Optimierung der Therapie von Autoimmunerkrankungen des Auges. Ophthalmologe 2016; 113:370-2. [DOI: 10.1007/s00347-016-0266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, mostly a diffuse large B-cell lymphoma. The PVRL, previously called primary intraocular lymphoma (PIOL), is a subset of primary central nervous system lymphoma (PCNSL). DIAGNOSIS The diagnosis of PVRL is often difficult as it often mimics chronic intermediate or posterior uveitis; therefore, PVRL requires various procedures for the diagnostics, e.g. immunohistochemistry, cytology, pathology, molecular pathology and cytokine analysis (interleukin 10) after surgically obtaining ocular specimens. THERAPY Treatment forms that are effective for systemic lymphomas have not been reliably successful for PVRL and PCNSL. Current management of PVRL consists of chemotherapy, such as methotrexate or rituximab, possibly combined with external beam radiation whereby both chemotherapeutic agents are administered systemically as well as intravitreally. Intravitreal treatment alone is recommended solely in the case of monocular PVRL, which is highly controversial. A PVRL usually responds well to initial treatment; however, relapse rates and CNS involvement are high, resulting in a poor prognosis and limited survival.
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Affiliation(s)
- N Stübiger
- Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland,
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Mergler S, Khajavi N, Pleyer U. TRP-Kanäle an der Augenoberfläche – therapeutische Relevanz? Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rachwalik D, Winterhalter S, Pleyer U. Intravitreales Dexamethason Implantat zur Behandlung der therapierefraktären Sklerouveitis. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Daas L, Szentmáry N, Eppig T, Langenbucher A, Hasenfus A, Roth M, Saeger M, Nölle B, Lippmann B, Böhringer D, Reinhard T, Kelbsch C, Messmer E, Pleyer U, Roters S, Zhivov A, Engelmann K, Schrecker J, Zumhagen L, Thieme H, Darawsha R, Meyer-Ter-Vehn T, Dick B, Görsch I, Hermel M, Kohlhaas M, Seitz B. [Erratum to: The German Acanthamoeba keratitis register : Initial results of a multicenter study]. Ophthalmologe 2015; 112:942. [PMID: 26441319 DOI: 10.1007/s00347-015-0144-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland.
| | - N Szentmáry
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland
| | - T Eppig
- Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Langenbucher
- Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - A Hasenfus
- Institut für Allgemeine und spezielle Pathologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - M Roth
- Universitätsaugenklinik, Düsseldorf, Deutschland
| | - M Saeger
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B Nölle
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B Lippmann
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - D Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Kelbsch
- Universitätsaugenklinik, Tübingen, Deutschland
| | - E Messmer
- Augenklinik der LMU, München, Deutschland
| | - U Pleyer
- Universitätsaugenklinik, Berlin Charité, Berlin, Deutschland
| | - S Roters
- Universitätsaugenklinik, Köln, Deutschland
| | - A Zhivov
- Universitätsaugenklinik, Rostock, Deutschland
| | | | | | - L Zumhagen
- Universitätsaugenklinik, Münster, Deutschland
| | - H Thieme
- Universitätsaugenklinik, Magdeburg, Deutschland
| | - R Darawsha
- Universitätsaugenklinik, Essen, Deutschland
| | | | - B Dick
- Universitätsaugenklinik, Bochum, Deutschland
| | - I Görsch
- Universitätsaugenklinik, Hamburg-Eppendorf, Deutschland
| | - M Hermel
- Universitätsaugenklinik, Aachen, Deutschland
| | - M Kohlhaas
- Augenklinik Dortmund, Dortmund, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland
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Pleyer U. Laboratory work-up and specialized investigations. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- U. Pleyer
- Charite; Campus Virchow Augenklinik Berlin Germany
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Affiliation(s)
- U. Pleyer
- Charite; Campus Virchow Augenklinik Berlin Germany
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Abstract
Worldwide inflammatory corneal diseases are considered to be one of the leading causes of monocular blindness. Bacterial infectious are still predominant and are found in 80 % of patients with ulcerative keratitis. In recent years, both changes in risk conditions and changes in the bacterial spectrum can be observed. Contact lenses and refractive surgery are factors that have increased in importance according to some studies. Microorganisms especially Pseudomonas spp. and atypical mycobacteria are detectable in these patients. In contrast, the bacterial keratitis is observed less frequently after trauma. The broad, often unsighted use of highly effective antimicrobial agents, especially of fluoroquinolones is assumed to be a factor in the transformation of the microbial spectrum. Due to the frequent course of keratitis and a targeted, effective therapy to initiate a pathogen is desirable. The possibilities of diagnostics have been expanded in recent years by molecular biological techniques, but cannot replace established methods. The aim of this paper is to provide a positioning on current aspects of bacterial keratitis.
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Affiliation(s)
- D Rachwalik
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
| | - U Pleyer
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin
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Tsangaridou MA, Rossel M, Rübsam A, Salchow DJ, Pleyer U. Die topische Anwendung von RGTA Peptid – ein neuer Behandlungsansatz bei Hornhautulkus. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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36
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Winterhalter S, Pleyer U. Dexamethasonimplantate zur Behandlung der nicht infektiösen Uveitis intermedia und posterior bei Kindern und Jugendlichen. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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37
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Pleyer U, Jahnke K, Korfel A, Joussen AM, Herwig M, Guthoff R, Lüke M, Meyer-ter-Vehn T, Böhm M, Heiligenhaus A, Nolte C, Jordan K, Mackensen F, Stübiger N, Thiel E. Behandlung des primären intraokularen Lymphoms (PIOL): Ergebnisse des prospektiven Deutschen PIOL-Registers. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schönfeld S, Metzner S, Winterhalter S, Thieme C, Pleyer U. Behandlungsergebnisse der Cytomegalievirus-assoziierten anterioren Uveitis. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brocke GAV, Steurer T, Jacob S, Thees S, Winterhalter S, Pleyer U. Ergebnisse zur Re-Injektion von Dexamethason im Langzeitverlauf bei nicht-infektiöser Uveitis. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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40
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Pleyer U, Behndig A, Cochener-Lamard B, Güell JL, Nuijts R, Tassignon MJ, Mencucci R, Rosen P. Antisepsis und antimikrobielle Vorgehensweise bei Katarakteingriffen: Ergebnisse einer europaweiten Erhebung. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Thieme C, Metzner S, Schlickeiser S, Pleyer U. Zytokinprofil in Kammerwasserproben mit Erstmanifestation und Rezidiv einer okulären Toxoplasmose. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Kiltz U, Rudwaleit M, Sieper J, Krause D, Chenot JF, Stallmach A, Jaresch S, Oberschelp U, Schneider E, Swoboda B, Böhm H, Heiligenhaus A, Pleyer U, Böhncke WH, Stemmer M, Braun J. [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 3 Clinical symptoms]. Z Rheumatol 2014; 73 Suppl 2:28-39. [PMID: 25181971 DOI: 10.1007/s00393-014-1428-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- U Kiltz
- Deutsche Gesellschaft für Rheumatologie (DGRh), -, -,
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Kiltz U, Sieper J, Rudwaleit M, Kellner H, Krause D, Böhle E, Böhm H, Böhncke WH, Chenot JF, Heiligenhaus A, Jaresch S, Mau W, Oberschelp U, Pleyer U, Repschläger U, Schneider E, Smolenski U, Stallmach A, Stemmer M, Swoboda B, Ulrich C, Winking M, Braun J. [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 8 Therapy, 8.1 Treatment concept, 8.2 Therapy targets and strategy]. Z Rheumatol 2014; 73 Suppl 2:69-70. [PMID: 25181976 DOI: 10.1007/s00393-014-1433-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- U Kiltz
- Deutsche Gesellschaft für Rheumatologie (DGRh), -, -,
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Kiltz U, Sieper J, Rudwaleit M, Kellner H, Krause D, Böhle E, Böhm H, Böhncke WH, Chenot JF, Heiligenhaus A, Hermann KG, Jaresch S, Mau W, Oberschelp U, Pleyer U, Repschläger U, Schneider E, Smolenski U, Stallmach A, Stemmer M, Swoboda B, Ulrich C, Winking M, Braun J. [German Society for Rheumatology S3 guidelines on axial spondyloarthritis including Bechterew's disease and early forms: 1 Introduction/preliminary comments]. Z Rheumatol 2014; 73 Suppl 2:23-5. [PMID: 25181969 DOI: 10.1007/s00393-014-1426-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- U Kiltz
- Deutsche Gesellschaft für Rheumatologie (DGRh), -, -,
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Heiligenhaus A, Bertram B, Heinz C, Krause L, Pleyer U, Roider J, Sauer S, Thurau S. [Statement of the German Ophthalmological Society, the Retina Society and the Professional Association of German Ophthalmologists for intravitreal treatment of macular edema in uveitis (as of 02. 07. 2014)]. Klin Monbl Augenheilkd 2014; 231:929-36. [PMID: 25181508 DOI: 10.1055/s-0034-1382893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kiltz U, Sieper J, Rudwaleit M, Kellner H, Krause D, Böhle E, Böhm H, Böhncke WH, Chenot JF, Heiligenhaus A, Hermann KG, Jaresch S, Mau W, Oberschelp U, Pleyer U, Repschläger U, Schneider E, Smolenski U, Stallmach A, Stemmer M, Swoboda B, Ulrich C, Winking M, Braun J. DGRh-S3-Leitlinie Axiale Spondyloarthritis inklusive Morbus Bechterew und Frühformen. Z Rheumatol 2014; 73 Suppl 2:26-7. [DOI: 10.1007/s00393-014-1427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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47
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Gundlach E, Riechardt AI, Maier AK, Joussen AM, Pleyer U. Diagnostik von intraokularen Lymphomen. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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48
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Yermalitski A, Metzner S, Ruokonen P, Dobner B, Winterhalter S, Pleyer U. Klinische Befunde bei dem virusassoziierten Fuchs'schen Uveitis-Syndrom. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brockmann T, Brockmann C, Maier AK, Schroeter J, Pleyer U, Bertelmann E, Joussen AM, Torun N. Pathomechanismen der Transplantatablösung nach Descemet's membrane endothelial keratoplasty (DMEK). Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Behcet's disease (also called Admantiades-Behcet syndrome) is a chronic vasculitis. The disease is characterized by exacerbations and remissions of symptoms and organ manifestations and may produce only mild mucocutaneous lesions, whereas ocular lesions can cause blindness. In addition, involvement of the gastrointestinal tract, central nervous system (CNS) and large blood vessels is sometimes life-threatening. Cyclosporin A is the only agent for treatment of ocular lesions registered in Germany; however, the neurotoxicity and nephrotoxicity restrict usage of the drug. In patients suffering from severe uveitis, biologics have been a breakthrough. Interferon (IFN) alpha therapy has shown significant efficacy for intraocular inflammation. Monoclonal antibodies to TNF-alpha and interleukin-1 have been successful in clinical trials and are approved in some countries. This article summarizes the current state of knowledge and emphasizes the important role of the ophthalmologist in the therapy of Behcet's disease.
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Affiliation(s)
- U Pleyer
- Universitäts-Augenklinik, Uveitis Zentrum, Charité, Universitätsmedizin Berlin, Humboldt University, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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