EYE INVOLVEMENT IN THE SPONDYLOARTHROPATHIES
Section snippets
DEFINITION
Uveitis is a general term used to define inflammation in the uveal tract, which is the middle layer of the eye (Fig. 1). Uveitis can be classified according to parameters such as anatomic location, clinical course, or laterality. Thus, based on its anatomic location, uveitis may be denominated as anterior when it involves the iris or the ciliary body (also called iritis or iridocyclitis); posterior when it affects the choroid or, by extension, the retina (also called choroiditis or
INCIDENCE OF EYE DISEASE IN SPONDYLOARTHROPATHIES
The reported incidence of rheumatic diseases in patients with uveitis varies substantially in the literature, mainly depending on selection biases and specialty interests.29, 33, 36 Table 2 reflects the likelihood of uveitis in patients with a given spondyloarthropathy and the complementary likelihood of spondyloarthropathy in patients with uveitis. In the authors' experience, roughly one third of patients attending the Uveitis Clinic at the Hospital Clínico San Carlos (HCSC) with any type of
CHARACTERIZATION OF SPONDYLOARTHROPATHY-ASSOCIATED UVEITIS
The clinical presentation of idiopathic, AS and RS HLA-B27–related uveitis is quite characteristic.32 Uveitis associated with psoriatic spondyloarthritis, IBD, or undifferentiated spondyloarthropathy can be less distinctive in its presentation and at times can pose a challenge for the clinician. Furthermore, some of these patients are HLA-B27 positive, whereas others are not. Because many patients present with a mixture of signs and symptoms that do not always fit into established patterns,
THE LINK BETWEEN EYE AND JOINT INFLAMMATION IN SPONDYLOARTHROPATHIES
Current advances in the etiology and physiopathology of the spondyloarthropathies are already outlined in other articles of this issue. Findings linking eye and joint inflammation in these diseases are briefly overviewed here. The similarities and differences in the pathogenesis of uveitis and arthritis remain a matter of discussion and research; however, although a great bulk of data derived from experimental animal models and human research indicate certain common pathogenic features, the
UVEITIS AS A GUIDE FOR THE DIAGNOSIS OF SPONDYLOARTHROPATHY
For the rheumatologist approaching a patient with uveitis, a complete ophthalmologic description of the uveitis is essential and can help to avoid unnecessary tests that can delay the treatment and can be occasionally misleading. A chest roentgenogram and an FTA-ABS test for syphilis should be the only tests ordered routinely in all patients with uveitis because sarcoidosis and syphilis can mimic all other causes of uveitis.31 All other tests should be ordered on the basis of clinical
UVEITIS IN PATIENTS WITH KNOWN SPONDYLOARTHROPATHIES
Another interesting question for the rheumatologist is whether it is possible to anticipate which patients with spondyloarthropathy will develop AAU in the future. In a preliminary study, the authors have compared the clinical characteristics of 89 patients with spondyloarthropathy-related uveitis attended at the Uveitis Clinic with another 100 consecutive patients with spondyloarthropathy without uveitis attended at the Rheumatic Diseases Clinic. No differences were observed between both
TREATMENT
As a rule, with the probable exception of Crohn's disease–related ocular manifestations, ocular symptoms associated with spondyloarthropathies present an excellent response to topical treatment with corticosteroids and mydriatics. Initial treatment should be intense and aggressive and includes hourly administration of topical corticosteroids, such as betamethasone, dexamethasone, or prednisolone, which can be combined with night administration of a topical corticosteroid cream. Mydriatics or
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2015, Clinics in DermatologyCitation Excerpt :Uveitis (Figure 2) represents another ocular manifestation that can affect patients with ReA, and it is characterized by eye discomfort, pain and redness, photophobia, blepharospasm, and miosis. Uveitis is usually monolateral and, if untreated, can cause blindness; keratitis is a rare manifestation of ReA.35 Skin manifestations are common and are largely associated with the HLA-B27 allele.
The eye in rheumatic disease
2015, Rheumatology: Sixth Edition
Address reprint requests to César Hernández-García, Service of Rheumatology, Hospital Clínico San Carlos, c/Prof. Martín Lagos s/n, 28040 Madrid, Spain, [email protected]
This work was supported by Grant No. 97/0789 from the Fondo de Investigación Sanitaria (FIS) of Spain.
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Service of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain