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Autoimmune Uveitis

Presentation

Patients with systemic disease may present with AU in about 27–40% of the cases. In approximately half of the cases with ocular involvement, the presentation is an acute, self-limited iridociclitis. [ncbi.nlm.nih.gov]

Presented at the American Society of Retina Specialists 38th annual scientific meeting. July 24-26, 2020 (virtual). Singer MA, Krambeer C, Paggiarino D. [europe.ophthalmologytimes.com]

Methods The present study is a cross-sectional study of a cohort of patients with uveitis. [ojrd.biomedcentral.com]

Neurologic

  • Neglect

    They may, however, have other extraocular symptoms that they have been neglecting, such as joint pain (inflammatory joint pain is typified by exacerbation following a period of inactivity, such as wakening in the morning), nail pitting, or hair loss. [europe.ophthalmologytimes.com]

Workup

MD roundtable: the uveitis workup. EyeNet. 2017 March. https://www.aao.org/eyenet/article/md-roundtable-uveitis-workup Accessed September 14, 2021. Knickelbein JE, Kim M, Argon E, Nussenblatt RB, Sen NH. [europe.ophthalmologytimes.com]

The rheumatologist is then in charge of the complete diagnostic workup and should look for additional autoimmune diseases. [ncbi.nlm.nih.gov]

Treatment

Treatment It is very important to distinguish between infectious and AU as the therapeutic approach and treatment is completely different. An infectious etiology always has to be rule out before beginning treatment of AU. [ncbi.nlm.nih.gov]

Still, in recent years, targeted biologic treatments for autoimmune disease have been approved, including some specifically for NIU. [europe.ophthalmologytimes.com]

The future of uveitis treatment. Ophthalmology. 2014;121:365–76. Article PubMed PubMed Central Google Scholar [link.springer.com]

Prognosis

Clinical features and prognosis of HLA B27-associated acute anterior uveitis in an Italian patient population. Ocul Immunol Inflamm. 2010;18:91–6. Article PubMed Google Scholar Monnet D, Breban M, Hudry C, Dougados M, Brezin AP. [link.springer.com]

This would help to reinforce existing international guidelines, raise the standards of treatment, facilitate drug development, and shed light on the prognosis and course of the disease. [ojrd.biomedcentral.com]

Etiology

Table 2 summarizes the most common etiologies of uveitis cases and their anatomical distribution. [ojrd.biomedcentral.com]

Categorization by etiological criteria may be appropriate in the field of uveitis as compared to other ophthalmologic subspecialties because of its significant degree of association with systemic disease (7). [ncbi.nlm.nih.gov]

Clinically, it can be classified into two groups: (a) infectious, e.g., bacterial endophthalmitis, toxoplasmosis, or herpetic retinopathy, in which there is an obvious infectious etiology, and (b) non-infectious, in which the pathophysiology is presumed [joii-journal.springeropen.com]

Epidemiology

Epidemiology Incidence of uveitis has been reported to range between 17 per 100,000 to 61 per 100,000 (10–14). [ncbi.nlm.nih.gov]

Article CAS PubMed Google Scholar Wakefield D, Chang JH: Epidemiology of uveitis. Int Ophthalmol Clin. 2005, 45: 1-13. [ojrd.biomedcentral.com]

Incidence and prevalence of uveitis in Northern California; the Northern California epidemiology of uveitis study. Ophthalmology. 2004;111:491–500. [link.springer.com]

Pathophysiology

Indeed, in the US, most uveitis is of noninfectious or autoimmune origin, with a majority of those cases being idiopathic.2 Pathophysiology The autoimmune mechanisms at work in the pathogenesis of uveitis are not completely understood; but it is known [europe.ophthalmologytimes.com]

Autoinflammatory syndromes and cellular responses to stress: pathophysiology, diagnosis and new treatment perspectives. Best Pract Res Clin Rheumatol. 2012;26:505–33. [PubMed: 23040364] 3. Chang JH, McCluskey PJ, Wakefield D. [ncbi.nlm.nih.gov]

Prevention

This compromise is considered one of the principal causes of preventable blindness around the world (1). Eye inflammation can be the initial presentation in many autoimmune diseases (AD) manifesting as conjunctivitis, episcleritis, or scleritis. [ncbi.nlm.nih.gov]

Prevention of flare recurrences in childhood-refractory chronic uveitis: an open-label comparative study of adalimumab versus infliximab. Arthritis Care Res. 2011;63:612–8. Article CAS Google Scholar Okada AA, Goto H, Ohno S, Mochizuki M. [link.springer.com]

Care must be taken when prescribing steroids to prevent further thinning of the cornea. It is important that the patient receive a thorough ocular examination with frequent slit lamp follow-up evaluations. [aafp.org]

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