Abstract
Spondyloarthritis (Spa), Behçet’s disease (BD) and sarcoidosis are major systemic inflammatory diseases worldwide. They are all multisystem pathologies and share a possible ocular involvement, especially uveitis. We hereby describe selected cases who were referred by ophthalmologists to our internal medicine department for unexplained uveitis. Physical examination and/or the use of laboratory and imaging investigations allowed to make a diagnosis of a systemic inflammatory disease in a large proportion of patients. In our tertiary referral center, 75 patients have been diagnosed with Spa (n = 20), BD (n = 9), or sarcoidosis (n = 46) in the last two years. There was a significant delay in the diagnosis of Spa-associated uveitis. Screening strategies using Human Leukocyte Antigen (HLA)-B27 determination and sacroiliac magnetic resonance imaging in patients suffering from chronic low back pain and/or psoriasis helped in the diagnosis. BD’s uveitis affects young people from both sexes and all origins and usually presents with panuveitis and retinal vasculitis. The high proportion of sarcoidosis in our population is explained by the use of chest computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography CT that helped to identify smaller hilar or mediastinal involvement and allowed to further investigate those patients, especially in the elderly. Our results confirm how in these sight- and potentially life-threatening diseases a prompt diagnosis is mandatory and benefits from a multidisciplinary approach.
Highlights
Uveitis is defined as the inflammation of the iris, ciliary body, vitreous, retina, or choroid.Its incidence is 10.5–52/100,000 person–years and the prevalence is 38–284/100,000 persons [1,2,3]
Each case report was selected as they were considered by the authors to be either representative of a classical clinical presentation of the disease or representative of the diagnostic issues faced by the clinician
In order to describe the updated management of uveitis associated with these diseases, we conducted a review of the English and French medical literature on the Medline database, using the keyword “uveitis”
Summary
Uveitis is defined as the inflammation of the iris, ciliary body, vitreous, retina, or choroid. Epidemiology varies according to genetic and ethnic factors (e.g., Human Leukocyte Antigen (HLA)-B27, sarcoidosis, etc.), environmental factors (e.g., tuberculosis in endemic countries), the definition of the disease (e.g., sarcoidosis), the inclusion of certain ophthalmologic entities in the group of idiopathic uveitis (e.g., pars planitis), the paraclinical investigations performed (e.g., nuclear imaging) and the method of patient recruitment (e.g., tertiary centers). This explains the great heterogeneity of the studies reported in the literature.
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