Risks of relapse in patients with acute anterior uveitis

Abstract

Aim: To quantify the rate of recurrence of acute anterior uveitis (AAU), and evaluate the influence of associated risk factors. Methods: We retrospectively reviewed the case notes of 185 patients with acute anterior uveitis, from their time of presentation to August 2001. The time to the first three recurrences of AAU from the onset of the disease was recorded, as well as the site of recurrence. Information regarding risk factors (for example (HLA-B27) status, spondyloarthropathy (SpA), family history of AAU/SpA and history of non-specific joint pain) were also collected. Results: Patients were followed up until their third relapse, or up to the censoring date (August 2001) if less than three relapses had occurred. The median length of follow-up was 35 months. One hundred and twentytwo patients (66%) developed at least one relapse and 67 (36%) had three or more relapses. Kaplan-Meier estimate of median interval between disease onset and the first relapse was 24 months 95% CI (16 to 34) and between the first and second relapse was 14 months 95% CI (9 to 22), and was 15 months 95% CI (10 to 25) months between the second and third relapse. Using Cox regression only the number of previous relapses was significantly associated with the risk of AAU recurrence. There was no significant association between other reported risk factors and the risk of relapse, and neither did any risk factor significantly modify the association between previous relapses and AAU recurrence (p.0.066 for all interactions). There was a borderline significant difference in survival according to the laterality pattern of recurrences (ipsilateral, alternate, or bilateral) with a slightly greater than expected number of events in those with bilateral recurrence (p = 0.048). Conclusion: Patients with previous relapse(s) of AAU have a greater risk of AAU recurrence compared to those at disease onset but the risk of recurrence appears not to increase in a dose-response manner with increasing number of previous relapses. Demographic and extraocular features do not appear to influence the rate, or risk of recurrence of AAU.

Clinical Features and Prognosis of HLA B27-associated Acute Anterior Uveitis in an Italian Patient Population

“…13,15,21,22 The frequency of relapses per year showed no difference between the 2 groups as previous studies found, although some authors reported a higher number of relapses in HLA B27-positive patients and a longer duration of the episodes in HLA B27-negative patients. [12][13][14]23 No statistically significant difference was observed in our groups according to the type and frequency of complications, as already reported by Linssen and Meenken 19 and Tuncer et al 15 Power et al 13 and Rothova 14 showed a higher number of complications in AAU B27-positive patients.…”

Elevated levels of anti‐endotoxin antibodies in patients with bilateral idiopathic acute anterior uveitis

“…However, a detailed analysis revealed that HLA-B27-positive persons with the bilateral form of the disease had a three times smaller risk of recurrence than the HLA-B27-positive patients with unilateral inflammation. In the HLA-B27-negative patients, the relation between recurrences and the form of the disease was similar to the observations by Natkunarajah et al (2007) for all patients with AAU, irrespective of the aetiology of the disease, where a bilateral process promoted relapses. These clinical observations could allow better identification of patients with a higher risk of recurrence of idiopathic AAU.…”

MC5r and A2Ar Deficiencies During Experimental Autoimmune Uveitis Identifies Distinct T cell Polarization Programs and a Biphasic Regulatory Response

“…Patients with chronic autoimmune uveitis are treated until the ocular inflammation is resolved, but it often relapses5. The results of this manuscript suggest that the timing may be important to consider with respect to the induction of regulatory immunity that resists relapse.…”

“…Each year 17.6% of active uveitis patients experience a transient or permanent loss of vision, and 12.5% will develop glaucoma4. After an initial episode of anterior uveitis 33% will experience three or more recurrences within 5 years5. The mechanisms contributing to the relapsing and remitting nature of chronic autoimmune uveitis, and how to achieve prolonged remission is unknown.…”