Cutting-Edge Issues in Autoimmune Uveitis

Abstract

Autoimmune uveitis (AIU) is among the leading causes of preventable blindness. It can be isolated, precede, or appear in the course of a systemic autoimmune inflammatory disease. When suspected, AIU should be promptly referred to an ophthalmologist for proper anatomic classification and local treatment. In recurrent and chronic forms, systemic treatment should be started, usually with corticosteroids and immunesuppressors. In cases of lack of efficacy or intolerance, biologic agents such as monoclonal antibodies anti-TNF (infliximab and adalimumab) and others (abatacept and tocilizumab) are being used. The clinical diseases associated to AIU and the experimental models have helped in the understanding of the pathogenic mechanism. The treatment schemes have improved, and recent advances in basic knowledge are leading to even more effective targeted therapies.

A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

“…Non-infectious uveitis may occur as an ocular manifestation of a systemic autoimmune condition such as Behçet's disease, sarcoidosis, multiple sclerosis or Vogt-Koyanagi-Harada disease (VKH). 13,14 A study from the Netherlands including almost 400 patients with posterior uveitis, intermediate uveitis or panuveitis reported that around half of all cases were likely to be related to systemic disease. 15 In the remaining cases, no systemic association could be found; these cases are known as idiopathic uveitis, although it is presumed that the disease is still likely to be autoimmune in nature.…”

“…However, pain and redness in the eye, sensitivity to light, loss of peripheral vision and headaches may also be reported. 13 In general, clinical manifestations of uveitis of different aetiologies may be similar but treatment strategies are predominantly determined by the underlying pathophysiology 3 and may often require a multidisciplinary approach.…”

“…Treatment failure: HURON trial Treatment failure in the HURON trial 48 was defined as a VH grade increase of ≥ 1 unit at weeks 3-8 or a VH of ≥ +1.5 at weeks [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. No data were reported in the journal article, 48 company submission 43 or clinical study report, 71 but a statistically significant difference between the DEX 700 arm and the sham arm (p < 0.001) was noted.…”

Proteomic Profile of Tears for the Diagnosis of Uveitis Associated with Juvenile Idiopathic Arthritis: Setting Targets to Achieve Results

“…Традиционно предполагается, что неинфекцион-ные увеиты по своей природе являются аутоиммун-ными заболеваниями, возникающими вследствие потери иммунной толерантности к аутоантиге-нам и последующей активации аутореактивных T-лимфоцитов [15,55,57,68,96]. Эта точка зрения сформировалась в результате анализа исследова-ний, проведенных на экспериментальных моделях аутоиммунного увеита, ассоциированного с энце-фалитом, а также вызванного введением эндотокси-на, меланина [64].…”

“…2 [15]. Неинфекционный увеит считается обусловленным вовлечением в патологический про-цесс Т-клеточного звена иммунитета с участием CD4 + T-хелперных клеток типов 1 и 17, продуциру-ющих соответственно интерферон-гамма и интер-лейкин-17 [15,57,68].…”