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

Abstract

Objective. To describe the patterns of clinical presentation in a series of 407 patients with uveitis and to establish the relationship between these patterns and the final diagnosis. Methods. Patients were referred to the Uveitis Clinic of a tertiary hospital from January 1992 to January 1996. All patients received a complete ophthalmologic examination, and a general clinical history was obtained. The current International Uveitis Study Group classification system was used for anatomic classification. To establish the final diagnosis of the most common entities causing uveitis, current diagnostic criteria were used. A discriminant analysis, with diagnostic grouping as the outcome variable and the clinical presentation features as discriminating variables, was performed. Results. With our classification system, 66.5% of the cases could be correctly classified according to the clinical pattern and morphologic findings. By diagnostic groups, discriminant analysis showed that 75% of patients with Behçet's disease, 77.1% of those with spondylarthropathy (including inflammatory bowel disease), 33.3% of those with sarcoidosis, 97.9% of those with toxoplasmosis, 85.7% of those with Vogt‐Koyanagi‐Harada syndrome, 100% of those with herpes, and 50.4% of those with idiopathic uveitis were correctly classified. In the miscellaneous group, which included disease entities with fewer than 5 cases, 42.9% were correctly classified. Conclusion. Rheumatologic evaluation of the patient with uveitis can be more cost‐effective if the referring ophthalmologist follows the classification system described herein, allowing a tailored approach in which only specific and necessary diagnostic tests are used.

Measurement and clinical implications of choroidal thickness in patients with inflammatory bowel disease

“…Uveitis is the most worrisome complication as, if left untreated, it may lead to permanent vision loss. Nongranulomatous, low-grade, recurrent, acute anterior uveitisis is the most common type of IBD-associated uveitis, however posterior uveitis may also occur with chorioretinitis described in 10% of patients in one case series (23) . Steroid-responsive choroidal infiltrates and scattered patches of choroidal inflammation with overlying serous retinal detachment have all been previously described in IBD patients (24) .…”

Enthesis inflammation in recurrent acute anterior uveitis without spondylarthritis

“…The relationship between SpA, AAU, and HLA-B27 is well established. In a previous study, patients with recurrent AAU constituted 34.2% of a large series of 407 patients with uveitis (14). Of these, 48.2% were found to have SpA, 24.5% were found to have idiopathic AAU not related to HLA-B27, and 11.5% were classified as having idiopathic AAU related to HLA-B27.…”

Methotrexate: an option for preventing the recurrence of acute anterior uveitis

“…1,2 These patients with uveitis usually respond well to local topical treatment, and systemic drugs are usually not necessary. 3,4 However, it has been reported that 34% of patients with uveitis have AAU that recurs in either a variable period of time or after completion of topical corticosteroid taper.…”

“…3,4 However, it has been reported that 34% of patients with uveitis have AAU that recurs in either a variable period of time or after completion of topical corticosteroid taper. 1,2 In these cases, a benign disease, such as AAU can produce long-term pharmacological mydriasis, deleterious effects of chronic treatment with topical steroids, and complications due to the recurrent flare-ups of uveitis itself. There is no agreement on how to manage these patients, but treatment with disease-modifying antirheumatic drugs could be an option.…”