First Episode Of Uveitis Research Articles

Prevalence and incidence of uveitis in patients with spondyloarthritis: the impact of the biologics era. Data from International ASAS-COMOSPA Study.

Uveitis is a common extra-musculoskeletal manifestation in Spondyloarthritis (SpA). The aim of this study was to analyze the prevalence of uveitis in SpA patients, its association with geographical areas and to determine whether its incidence was different before and after the biological era. ASAS-COMOSPA is a retrospective study that includes patients fulfilling ASAS SpA classification criteria from 22 countries. The overall prevalence of uveitis was calculated, and factors associated with the onset of a first episode of uveitis were evaluated using a Cox regression. A Log-Rank test was performed to compare the new onset of uveitis in the no biological era (SpA onset before 2000) vs biological era (SpA onset after 2000). 3984 patients were included. The likelihood of presenting a first uveitis episode increased over time, from a prevalence of 10.5% (95%CI 9.5%-11.4%) at the time of the SpA diagnosis to 46.6% (41.6%-51.5%) after 30 years since the SpA diagnosis. HLA-B27 positivity, family history of uveitis, peripheral enthesitis and IBD were associated with higher risk of uveitis. Patients with SpA disease onset after year 2000 showed a lower prevalence of uveitis compared with disease onset before year 2000 (8.2% vs 25.5%, p< 0.01), as well as a lower incidence (2.8 per 100 PY vs 6.1 per 100 PY, respectively). In our study the risk of having suffered from at least one episode of uveitis ranged from 10% at the time of the diagnosis of axSpA to 47% after 30 years of disease duration. Patients with disease onset after biologic therapy introduction showed a significantly lower prevalence and incidence of first episodes of uveitis.

Uveitis including Vogt-Koyanagi-Harada syndrome following inactive covid-19 vaccination: a case series

BackgroundCurrently, large populations have been vaccinated against COVID-19. The whole inactivated Sinopharm COVID-19 vaccine has been the main available COVID-19 vaccine in Iran. Ocular inflammatory reactions have been reported following vaccination. The present case reports aim to introduce four cases of uveitis after the Sinopharm vaccine administration.Case presentationOur first reported case is a 38-year-old woman with a positive medical history of inactive ulcerative colitis. Active uveitis had developed following the second dose of the COVID-19 vaccination. The remaining three cases were healthy individuals who developed the first episode of uveitis, after the COVID-19 vaccine administration. Vogt-Koyanagi-Harada syndrome was the final diagnosis in one of the aforementioned cases. All four patients demonstrated favorable responses to corticosteroid treatment.ConclusionThese observations are in line with incoming reports from all around the world and raise concerns about the possibility of post-vaccination uveitis development, especially in cases with a previous history of auto-immune systemic diseases or inactive uveitis.

Epidemiology and clinical characteristics of psoriatic arthritis-related uveitis in Madrid, Spain.

To describe the epidemiology and clinical characteristics of psoriatic arthritis (PsA) related uveitis in Madrid, Spain. A case series nested in a retrospective single-center cohort of 494 patients with PsA was performed. Patients older than 18years old whit a clinical diagnosis PsA-related uveitis who attended the Ramon y Cajal University Hospital in Madrid, Spain, between 1st January 2017 and 31st December 2019 were included in the study. Epidemiological and clinical data were retrieved from the electronic medical records. Thirteen cases of psoriatic arthritis-related uveitis (6 men and 7 women) were included. PsA-related uveitis showed an incidence of 0.05 cases per 100,000 persons/year (CI95 0.00-0.35), and a prevalence of 2.19 cases per 100,000 persons (CI95 1.24-3.79). The prevalence of active uveitis in the cohort of PsA patients was 2.6%. The first episode of uveitis (mean age of 48.15 ± 15.41years) was anterior and unilateral in 92.31% of the cases. Most of the patients had a recurrent course (69.2%) with 0.92 flare-ups per patient/year (CI95 0.85-0.96). The uveitis preceded the diagnosis of psoriatic arthritis in 62.5% of the patients. In patients with PsA-related uveitis, HLA-B27 was present in 23.1%, HLA-Cw6 in 7.7%. Uveitis is a PsA manifestation that affects roughly 1 in 37 PsA patients, and that may precede the articular symptoms. It generally presents as a unilateral acute anterior uveitis and has a recurrent course. The most frequent observed complications are elevated intraocular pressure and cataracts.

Drug-induced Sarcoid Uveitis with Biologics

ABSTRACT Purpose/Objectives: to evaluate new onset uveitis or reactivated uveitis by biologic agents and characterize their features. Materials and Methods: This is a multicenter, retrospective case series. Patients under biologic therapy were included if they developed uveitis for the first time or experienced intraocular inflammation which was different in location or laterality to previous inflammation. Results: Sixteen patients were identified. The underlying disorders included ankylosing spondylitis, juvenile idiopathic arthritis, rheumatoid arthritis, and Behçet’s Disease. The biologic agents associated with a first episode of uveitis (n = 11) or with a new recurrence of uveitis (n = 5) were etanercept, adalimumab, abatacept, infliximab, and golimumab. Sarcoidosis based on bihilar lymphadenopathy, other computer tomography-findings, or biopsy was diagnosed in five patients under therapy with etanercep, adalimumab, and abatacept. Additionally, seven patients developed clinical changes in their uveitis pattern, suggesting sarcoid uveitis. Conclusions: Biologic treatment-induced uveitis often presents as granulomatous disease.

Symptoms in noninfectious uveitis in a pediatric cohort: Initial presentation versus recurrences

To describe the prevalence of symptoms with noninfectious uveitis (NIU) in a pediatric cohort and to assess the association between the presence of symptoms with first episode of uveitis (first-U) compared to symptoms at uveitis recurrence. The medical records of patients with NIU treated at a tertiary referral hospital from March 2008 to November 2107 were reviewed retrospectively. Symptomaticity (eye pain, eye redness, photosensitivity) was captured at initial uveitis activation and subsequent episodes. Univariate logistic regression modeling was used to identify clinical features associated with symptomatic first-U. Ordinal regression identified patient characteristics associated with symptomatic recurrence. A total of 118 cases were reviewed; of these, 92 were followed for at least 6months and had at least 1 reactivation. Juvenile idiopathic arthritis-related uveitis (JIAU) was the most common diagnosis (67/118 [57%]), followed by idiopathic uveitis (33%). In the majority, uveitis was restricted to the anterior chamber (82%). Of the 118 cases, 58 patients (49%) had symptomatic first-U, 34% JIA versus 69% non-JIA. Non-JIAU, age ≥7years, and negative antinuclear antibody (ANA) test were significantly associated with symptomatic first-U; spondyloarthritis was not. With recurrence, half had symptoms: 41% JIA versus 66% non-JIA. Of those who had symptomatic first-U, 35% were asymptomatic at recurrence. Those with JIA had 50% or less odds of symptomaticity at reactivation. Complications did not vary based on having had symptoms at first-U. Non-JIA diagnosis, older age, and ANA-negativity were associated with symptomatic first-U in our study cohort, but no patient characteristics were significantly associated with symptomatic recurrence. Clinical patterns may change during disease course, with uveitis switching from symptomatic to asymptomatic, which has implications for uveitis monitoring recommendations.

Lymphopaenia as a predictor of sarcoidosis in patients with a first episode of uveitis

Background/aimsThe diagnostic properties of conventional diagnostic tests (ACE and chest radiography) for sarcoidosis-associated uveitis are not ideal. The diagnostic value of lymphopaenia for sarcoidosis-associated uveitis is investigated.MethodsA retrospective study of...

Clinical Profile, Ultra-Wide-Field Fluorescence Angiography Findings, and Long-Term Prognosis of Uveitis in Tubulointerstitial Nephritis and Uveitis Syndrome at One Tertiary Medical Institute in China

ABSTRACTPurpose: To analyze the clinical features and long-term prognosis of uveitis in tubulointerstitial nephritis and uveitis (TINU) syndrome in a cohort of Chinese patients.Methods: A total of 32 patients with TINU syndrome between 2000 - 2016 were analyzed retrospectively.Results: Mild anterior inflammation was observed in all cases. Ultra-wide-field fluorescence angiography (UWFA) was conducted on 13 patients, and peripheral vascular leakage was observed in 22/26 eyes (84.62%) compared with active anterior chamber inflammation in 13/26 eyes (50%). Three patients received increased corticosteroid dosage therapy on their first episode of uveitis guided by UWFA had stopped steroids without recurrence.Conclusion: The uveitis in TINU syndrome was mild. Corticosteroids were efficient in most cases, but a slower tapering and long-term treatment were required. UWFA is sensitive in detecting the activity of uveitis and might be useful in monitoring disease progression. Complete withdrawal of medication was difficult to achieve in some cases.

Clinical and Demographic Characteristics of Patients with Uveitis Starting Later in Life

Purpose: To evaluate uveitis cases presenting at older ages for the first time.Methods: We retrospectively analyzed the clinical data related to the 90 eyes of 68 patients who presented with a first episode of uveitis at the age of ≥60 years and were seen at the Uveitis Division of the Ulucanlar Eye Hospital from 1996 to 2013.Results: The location of the uveitis was anterior in 51 (75%) patients. Nine patients (13.2%) presented with panuveitis, 5 (7.3%) with posterior uveitis, and 3 (4.4%) patients with intermediate uveitis. Idiopathic uveitis in 23 (33.8%) and presumed herpetic anterior uveitis in 23 (33.8%) patients were the most common diagnoses, while other diagnostic entities accounted for 22 (32.3%) patients. The most common complications were elevation of intraocular pressure in 17.7%, cystoid macular edema (CME) in 11.1%, and corneal scar in 11.1% of eyes.Conclusions: While idiopathic uveitis and presumed herpetic anterior uveitis were the most common causes, although in an endemic country, Behçet disease was not a common cause of uveitis in the elderly population.

Female sex and oligoarthritis category are not risk factors for uveitis in Italian children with juvenile idiopathic arthritis.

To investigate the risk factors for chronic anterior uveitis in patients with juvenile idiopathic arthritis (JIA). The clinical charts of patients followed between January 1987 and December 2011 were reviewed to establish whether they had uveitis. Inclusion criteria were a diagnosis of JIA and a disease category of persistent oligoarthritis, extended oligoarthritis, rheumatoid factor-negative polyarthritis, psoriatic arthritis, or undifferentiated arthritis. Risk factors included sex, age at arthritis onset, disease category, and antinuclear antibody (ANA) status. The association of risk factors with occurrence of uveitis was evaluated by survival analysis, with first episode of uveitis as the event of interest, and Cox regression analysis. Of a total of 1189 patients, 278 (23.4%) had uveitis a median of 1.1 years after onset of arthritis. There was no difference in the cumulative probability of developing uveitis between males and females and between patients belonging to different JIA categories, whereas uveitis was strongly associated with age at arthritis onset ≤ 3.5 years and positive ANA. Patients possessing the latter 2 factors in combination had a greater probability of having uveitis than patients who had either of them alone. In our patients, the risk of uveitis was related to younger age at onset of arthritis and presence of ANA, but not to female sex and disease category. This finding suggests that the patients who require the most intensive ophthalmologic screening are those who have early-onset JIA and are ANA-positive, regardless of their sex or disease subtype.

THU0068 Clinical Risk Factors Associated with the Development of Systemic Disease in Patients with Isolated HLA-B27 Uveitis

BackgroundHLA-B27 uveitis has been defined as a unilateral acute syndrome without associated systemic disease [1]. However, in some patients the ocular disease precedes the occurrence of systemic diseases as ankylosing...

THU0417 Uveitis Associated with Bisphosphonate Treatment: A Case Series of 18 Patients.

BackgroundClinical trials suggested that bisphosphonates (BP) were safe and well tolerated drugs, but post-marketing studies have shown their association with rare adverse events but potentially serious, including inflammatory ocular disorders,...

Timing of uveitis onset in oligoarticular juvenile idiopathic arthritis (JIA) is the main predictor of severe course uveitis

Aim of the present study was to validate a statistical model to predict a severe course of anterior uveitis (AU) in patients with juvenile idiopathic arthritis (JIA). Consecutive patients with newly diagnosed uveitis have been followed for at least 1 year with a standardized protocol. For each patient, demographic, clinical and laboratory characteristics, including time interval between arthritis and uveitis onset, α(2)-globulins level at arthritis onset, number of uveitis relapses/year, ocular complications and therapy and visual acuity, have reported. The validation procedure included the assessment of sensitivity, specificity and efficiency of previously published statistical model (Zulian et al. J Rheumatol 2002; 29: 2446-2453) in a new inception cohort of patients during a short length follow-up. Sixty patients with JIA, followed at 14 paediatric rheumatology-ophthalmology centres in Italy, entered the study. The mean age at arthritis onset was 4.4 years (range 1.2-15.8 years), and the mean interval time between arthritis and uveitis onset was 1.8 years (range: 0.0-14.2 years). After the first AU, patients, followed for a mean of 3.2 years, had a mean of 2.9 uveitis relapses. Twenty-two patients (36.7%) presented at least one complication. Using a probability cut-off value = 0.7, the statistical model revealed 80% sensitivity, 58% specificity and 65% efficiency. The time interval between arthritis and uveitis onset resulted as the main predictor of severe course uveitis in JIA. The statistical model was able to predict the development of a severe course in 8 of 10 patients.

New Onset of Uveitis During Anti-Tumor Necrosis Factor Treatment for Rheumatic Diseases

Uveitis may be associated with various inflammatory diseases. Previous reports suggested that tumor necrosis factor (TNF) blockers, especially anti-TNF monoclonal antibodies, may reduce the incidence of uveitis flares in some inflammatory diseases. Under these circumstances, de novo occurrence, ie, new onset of the first episode of uveitis under anti-TNF therapy, is uncommon. The aim of this study was to collect cases of new onset of uveitis under anti-TNF therapy, using a nationwide network, to describe these cases, and to gather with cases reported in the literature. All French rheumatologists, pediatric rheumatologists, and internal medicine practitioners registered on the Club Rhumatismes et Inflammation web site were contacted in an attempt to declare the cases of new onset of uveitis, diagnosed by an ophthalmologist, in patients treated with TNF blockers. The analysis of the literature was performed through PubMed database and manual research. Thirty-one cases were recorded, 19 men, mean age 43 (5-70) years, occurring in ankylosing spondylitis (19 cases), psoriatic arthritis (4 cases), rheumatoid arthritis (6 cases), juvenile idiopathic arthritis (2 cases). The TNF blocker at the time of uveitis was etanercept 23 times, adalimumab 3 times, infliximab 5 times, with a mean total duration of exposure to anti-TNF agents of 27 (4-96) months at uveitis occurrence. Most of the patients were good responders to TNF blockers at the time of uveitis onset. Analysis of the literature revealed 121 similar cases published in English. Uveitis occurs de novo under anti-TNF therapy mainly in spondyloarthropathies, but also in rheumatoid arthritis and juvenile idiopathic arthritis patients and more frequently under etanercept.

Clinical Features of Patients with Diabetes Mellitus Presenting with Their First Episode of Uveitis

Purpose: Little is known about uveitis in patients with diabetes mellitus (DM). The authors studied diabetic patients with their first episode of uveitis.Methods: Cross-sectional, case note study documenting the uveitis, underlying cause/syndrome, treatment, type of DM and treatment, and any diabetic retinopathy.Results: There were 34 patients (M/F: 17/17, 48 eyes) with their first uveitis episode (33 had type 2 DM). Mean age of onset of DM 49 years and uveitis 56 years. Uveitis was bilateral in 14 (45%), with most having idiopathic anterior uveitis. Visual acuity 6/18–6/60 in 15 eyes, and worse than 6/60 in 11 eyes. There was 3–4+ flare in 16 eyes, 3–4+ anterior chamber cells in 13 eyes. Diabetic retinopathy was seen in 20 (42%) eyes, and mean blood glucose was 13.64 mmol/L in 11 patients.Conclusions: Diabetic patients presenting with uveitis, whatever the aetiology, may have severe inflammation, reduced vision, and poor glycaemic control.

Características clínicas de 64 indivíduos portadores de uveítis posterior activa presumiblemente toxoplásmica en Pernambuco

To describe clinical characteristics of posterior active uveitis presumptively by Toxoplasma gondii (PAUPT) in patients with typical lesion. Tranversal study. Sixty-four patients with retinochoroiditis scatter and active satellite lesions examined in Pernambuco, Brazil. All were older than 10 years and immunocompetent. Gender, age, skin color, and residence were recorded. Previous uveitis, visual accuracy, intraocular pressure (IOP), and ocular examination were analyzed. 52% were males, most of them with white skin (68.8%). Mean age 29 years (+/-10.87). Eighty-four percent of the patients lived in the metropolitan area. 56.2% were having the first episode of uveitis. In the damaged eye, visual accuracy mean was 20/200, IOP mean 14.5 mmHg (+/-64). Hyperemia of the conjunctiva was observed in 29.7% of the patients and alterations of the cornea in 51.6%. There were cells in the aqueous humor in 62.7%. 6.2% had posterior synechiae. All had vitreous damage and 45.3% retinal vasculitis. In 42.2% of the patients, lesions were located in zone I of Holland and 90.6% had the size of one discus diameter or greater. Neuritis was observed in 28.2%. Uveitis was more frequent in the right eye (54.7%). PAUPT affects young people and the main symptom was reduction of visual acuity. IOP mean was normal. Alterations of the vitreous were observed in all cases. Injuries were equal to one discus diameter or greater and located in zone I of Holland.

Unusually Resistant Post-Traumatic Uveitis with High Serum ACE—An Occult Ocular Sarcoidosis?

Purpose: The initiation of acute anterior uveitis following non-penetrating trauma comprises a defined clinical entity although its pathophysiology is not yet completely understood. Design and Methods: Case presentation. Results: We present two cases of young boys in whom a first episode of resistant anterior uveitis developed following relatively minor non penetrating ocular injury. Further investigation revealed high levels of serum ACE in both cases. Conclusion: To the best of our knowledge there are no previous published reports implicating minor ocular trauma in precipitating a first episode of uveitis associated with high serum ACE. A better understanding of the pathophysiology may provide insight into alternative treatments.

Uveíte das espondiloartropatias: prevalência e relação com doença articular

To study uveitis prevalence in the local population with spondyloarthritis and its temporal relationship with joint complaints. We reviewed seventy-seven charts of spondyloarthropathy patients from the rheumatology clinic of the "Hospital Universitário Evangélico de Curitiba" for spondyloarthritis class, patients' sex and age, occurrence of uveitis and its location and relationship between the first episode of uveitis and initial joint complaints. Uveitis was found in 12 of 77 patients (15.6%) which was anterior in 83.3% of the cases, without preference for spondyloarthropathy class (p=0.72) and patients' sex (p=0.74). In patients with reactive arthritis, the mean time between uveitis appearance and joint complaints was 4.04 months and in ankylosing spondylitis 73 months (p=0.009). Spondyloarthropathy patients have uveitis that is anterior in most of the cases and that appears earlier in reactive arthritis than in ankylosing spondylitis.

Uveitis and Pseudouveitis Presenting for the First Time in Japanese Elderly Patients

Purpose: To evaluate the clinical characteristics of uveitis or pseudouveitis presenting de novo in Japanese elderly patients. Methods: We retrospectively examined 296 patients with uveitis or pseudouveitis who were treated at Toyama Medical and Pharmaceutical University Hospital. Patients were followed up for 1 week to 5 years (mean, 11 months). Results: Of 296 patients, 82 (38 men and 44 women, 120 eyes) presented with their first episode of uveitis or pseudouveitis at the age of ≧60 years. Forty patients had anterior uveitis, 2 had intermediate uveitis and the other 40 had posterior and/or pan-uveitis. Of 82 patients, 53 (64.6%) had idiopathic uveitis. The prevalence of Vogt-Koyanagi-Harada syndrome and Behçet disease in elderly patients was lower than that in younger patients. Complicated cataract was frequently seen in the eyes with uveitis. Most eyes with uveitis had poor visual acuity. Conclusions: The prevalence of Vogt-Koyanagi-Harada syndrome and Behçet disease in elderly patients was lower than that in younger patients.

Ophthalmic findings and frequency of extraocular manifestations in patients with HLA-B27 uveitis: A study of 175 cases

Objective To analyze ocular and extraocular manifestations in patients with HLA-B27–associated uveitis. Design Large, observational case series. Participants One hundred seventy-five consecutive patients with HLA-B27–associated uveitis seen in a single center between January 1996 and March 2001. Methods Features of uveitis were noted and patients were referred systematically to rheumatologists. The history of previous uveitis attacks and extraocular manifestations of spondyloarthropathy was recorded. Assessments of spondyloarthropathies were based on criteria established by the European Spondyloarthropathy Study. Main outcome measures Percentage of patients with extraocular manifestations. The time between the first episode of uveitis and symptoms or diagnosis of extraocular disease was estimated. Characteristics of uveitis were analyzed. Results The male-to-female ratio was 1.3 to 1, and the median age at the time of the first attack of uveitis was 31 years. An HLA-B27–associated extraocular disorder was seen in 136 cases (77.7%). Of these, ankylosing spondylitis was diagnosed in 81 patients (46.3%) and presumed in 17 (9.7%). Undifferentiated spondyloarthropathy was observed in 21 patients (12%) and other HLA-B27–associated diseases in 17 patients (9.7%). The onset of extraocular symptoms occurred at a younger age (mean±standard deviation [SD], 26.4±11.1 years) than the first attack of uveitis (mean±SD, 34.0±14.1 years; P<0.0001). The diagnosis of an extraocular disease was made only after the appearance of ophthalmic manifestations in 88 of 136 patients. Among 117 patients (66.9%) with more than 1 episode of uveitis, same eye attacks were observed in 48 of 117 patients (41.0%), more than the expected percentage than attacks of a random eye ( P<0.0001). The median ± SD frequency of active episodes of uveitis was 0.8±0.6 per year and decreased as the duration of the disease lengthened ( P<0.0001). Patients with extraocular disease had a greater total number of attacks of uveitis ( P = 0.02), but other ophthalmic findings did not differ between patients with and without an extraocular disorder. Conclusions Uveitis is frequently the first indication of a previously undiagnosed HLA-B27–associated extraocular disease. The most common of these diseases are spondyloarthropathies.

Uveitis presenting de novo in the elderly.

Seventy-one consecutive patients presenting with their first episode of uveitis at the age of 60 or more years, were studied retrospectively. The majority were found to have idiopathic uveitides on investigation. In those who did have associated systemic disease, the commonest finding was non-insulin-dependent diabetes mellitus or an autoimmune disease. There were no cases of ocular lymphoma in this series. We conclude that, contrary to some previous reports, idiopathic uveitis may occur in the elderly, and that the relative frequencies of acute anterior, chronic anterior, intermediate and posterior uveitides are similar to those seen in young patients.