Uveitis and immunosuppressive treatment: Experience in a multidisciplinary uveitis unit

Abstract

IntroductionDue to its association with systemic diseases and treatment, uveitis requires a multidisciplinary approach; however, there are few studies in uveitis units in Latin America. ObjectiveTo describe the clinical and therapeutic features of patients treated in the Uveitis Unit of the Hospital de Clínicas Dr. Manuel Quintela in Montevideo, Uruguay. Materiales y métodosObservational, descriptive, cross-sectional study in patients aged ≥15 years, attended from October 2018 to January 2020 with an uveitis diagnosis. ResultsOne hundred and three patients were included, with a median age of 47 years, and 71 (68.9%; p < 0.01) were women. The anatomical classification was anterior uveitis 46.6%, intermediate 1%, posterior 7.8%, and panuveitis 44.7%. The etiology was identified in 58 (56.3%) patients, 32 (31.1%) were idiopathic and 13 (12.6%) were still under aetiological study. Systemic autoimmune diseases occurred in 26.2%, with Vogt-Koyanagi-Harada disease being the most frequent (5.8%). Spondyloarthritis accounted for 5.8% of the cases. Infectious etiology was observed in 19.4%, with ocular toxoplasmosis predominant in 10.7%. Seventy-one percent of non-infectious uveitis required systemic immunosuppressive treatment, with methotrexate being the most used in anterior (46.4%) and intermediate (100%) uveitis and azathioprine in posterior (100%) and panuveitis (42.9%). Eight patients (13.6%) required the combination of ≥2 drugs; of them, 37.5% had anterior uveitis associated with juvenile idiopathic arthritis, and 37.5% had idiopathic panuveitis. ConclusionsThe etiology was established in more than half the patients with uveitis. The most frequent were ocular toxoplasmosis, VKH disease, and associated SpA disease. A high percentage of non-infectious uveitis required systemic immunosuppressive treatment, with methotrexate and azathioprine being the most used.