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Uveitis

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Uveitis is a prevalent disease that mainly affects young people. It leads to a significant number of visual losses. Acute anterior uveitis is the most prevalent form, and it is often associated with spondyloarthritides in which uveitis can be the first manifestation of disease. Precise patterns of uveitis are frequently associated with systemic diseases. Thus, the close collaboration between ophthalmologists and rheumatologists avoids unnecessary diagnostic tests and is essential for the correct assessment and treatment of these patients. Acute anterior uveitis usually has a good prognosis compared with other forms of uveitis. However, it is a cause of disability when flares are frequent. Small prospective studies conducted with sulphasalazine have demonstrated a reduction in the number of flares. Other patterns of uveitis have a worse prognosis, and systemic corticosteroids and/or immunosuppressive drugs are usually required. Infliximab is a promising therapeutic option in selected patients.

Section snippets

Definition

Uveitis is a general term used to describe inflammation of the uveal tract, which is the middle layer of the eye, between the sclera, conjunctiva and the anterior chamber on the outside and the retina on the inside (Figure 1). The International Uveitis Study Group classification system is widely used for classification1 (Table 1). Uveitis is categorized by location as follows:

  • •

    ‘anterior’ when it involves the iris or the ciliary body (iritis of iridocyclitis) (Figure 2);

  • •

    ‘posterior’ when it

Epidemiology of uveitis in the general population and in the spondyloarthritides

A recently published epidemiological study from North Carolina reported that the incidence of uveitis in the general population is 52 cases per 100 000 people per year with a prevalence of 0.1%.2 People aged 20–50 years are most commonly affected, and uveitis is uncommon in children under 10 years of age and in adults over 70 years of age. In addition, uveitis is the cause of 10% of visual losses and 5–20% of cases of legal blindness in developed countries.3 Most epidemiological studies on

Pathogenesis of eye inflammation in the spondyloarthritides

The similarities and differences in the pathogenesis of uveitis and arthritis remains a matter of discussion and research. Common pathogenic features have been described, but the precise mechanisms underlying the involvement of these tissues remain unclear.

Clinical features and assessment of uveitis

Uveitis may be the presenting symptom resulting in the diagnosis of SpA or other rheumatic diseases. Therefore, for better long-term care of these patients, ophthalmologists and rheumatologists should collaborate in identifying systemic diseases that may be present, to avoid unnecessary tests that can delay treatment or may occasionally be misleading. Close collaboration between these two specialities contributes to more effective diagnosis and treatment of patients. The uveitis clinic at the

Treatment of AAU flares

In general, AAU responds well to topical therapy with corticosteroids, mydriatics and cyclopegics. Exceptions to this rule include juvenile idiopathic arthritis and Beçhet's disease, in which uveitis generally indicates severe activity and requires immunosuppressive systemic drugs in addition to the topical therapy given for the flare.

AAU usually has a good prognosis; nonetheless, topical therapy needs to be given intensively, as a medical emergency and for an adequate period of time.

The two

Summary

Uveitis is a prevalent disease that mainly affects young people. It leads to a significant number of visual losses. Anterior uveitis is the most prevalent form, and the majority of AAU cases are related to HLA-B27 either with or without SpA. In nearly half of patients with AAU and SpA, the rheumatic disease is undiagnosed and AAU is the first manifestation that leads to a correct diagnosis.

The pathogenesis of uveitis in SpA is still not well understood. However, experimental models of uveitis

Acknowledgements

The authors wish to thank Dr David Díaz Valle, from the Ophthalmology Service, Hospital Clínico San Carlos, Madrid for permission to reproduce Figure 2, Figure 3, Figure 4, Figure 5, Figure 6.

References (49)

  • C.M. Samson et al.

    Methotrexate therapy for chronic noninfectious uveitis: analysis of a case series of 160 patients

    Ophthalmology

    (2001)
  • M. Mochizuki et al.

    A clinical trial of FK506 in refractory uveitis

    American Journal of Ophthalmology

    (1993)
  • S. Baltatzis et al.

    Mycophenolate mofetil as an immunomodulatory agent in the treatment of chronic ocular inflammatory disorders

    Ophthalmology

    (2003)
  • D.A. Goldstein et al.

    Long-term follow-up of patients treated with short-term high-dose chlorambucil for sight-threatening ocular inflammation

    Ophthalmology

    (2002)
  • J.T. Rosenbaum et al.

    The treatment of refractory uveitis with intravenous immunoglobulin

    American Journal of Ophthalmology

    (1999)
  • H. Demiroglu et al.

    Interferon alfa-2b, colchicine, and benzathine penicillin versus colchicine and benzathine penicillin in Behcet's disease: a randomised trial

    Lancet

    (2000)
  • B. Bodaghi et al.

    Chronic severe uveitis: etiology and visual outcome in 927 patients from a single center

    Medicine (Baltimore)

    (2001)
  • A. Banares et al.

    Patterns of uveitis as a guide in making rheumatologic and immunologic diagnoses

    Arthritis and Rheumatism

    (1997)
  • L. Edmunds et al.

    New light on uveitis in ankylosing spondylitis

    The Journal of Rheumatology

    (1991)
  • J. Fernandez-Melon et al.

    Uveitis as the initial clinical manifestation in patients with spondyloarthropathies

    The Journal of Rheumatology

    (2004)
  • A. Linssen et al.

    The lifetime cumulative incidence of acute anterior uveitis in a normal population and its relation to ankylosing spondylitis and histocompatibility antigen HLA-B27

    Investigative Ophthalmology and Visual Science

    (1991)
  • T.E. Feltkamp

    Ophthalmological significance of HLA associated uveitis

    Eye

    (1990)
  • S.D. Khare et al.

    Spontaneous inflammatory arthritis in HLA-B27 transgenic mice lacking β2-microglobulin: a model of human spondyloarthropathies

    The Journal of Experimental Medicine

    (1995)
  • S.M. Monowarul Islam et al.

    HLA-DR8 and acute anterior uveitis in ankylosing spondylitis

    Arthritis and Rheumatism

    (1995)

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