Recurrent Anterior Uveitis Research Articles

O27 Recurrent severe uveitis treated with secukinumab following anti-TNF induced cutaneous vasculitis in a patient with axial spondyloarthritis

O27 Recurrent severe uveitis treated with secukinumab following anti-TNF induced cutaneous vasculitis in a patient with axial spondyloarthritis

P22 Between the devil and the deep blue sea – a diagnostic dilemma

P22 Between the devil and the deep blue sea – a diagnostic dilemma

P24 Ankylosing spondylitis & uveitis - challenges in management

Case report - IntroductionAnkylosing spondylitis is a chronic inflammatory condition involving spine, chest and sacroiliac joints. It can be associated with extra spinal manifestations which include uveitis and enthesitis, as well as other features of an inflammatory spondyloarthropathy including psoriasis and inflammatory bowel disease. It is characterised by the presence of inflammatory back pain, limited range of spinal movement, sacroiliitis on imaging, excess spinal bone formation and a high prevalence of HLA-B27. The main aims of treatment are to improve symptoms and retain function as well as to prevent disease complications.Case report - Case descriptionA 49-year-old male diagnosed with ankylosing spondylitis at the age of 23 (HLA-B27 positive, classical radiographic features on plain radiographs and MRI), with background of meningitis and subsequent epilepsy (not on treatment since the age of 13), severe hip osteoarthritis and osteoporosis. He has peripheral elbow and knee synovitis. At the age of 27 he developed sight-threatening bilateral recurrent anterior uveitis complicated by cystoid macular oedema (causing central vision loss). Initial management included anti-inflammatories and steroids. He progressed to biologics but developed a rash on adalimumab. He was switched to infliximab in 2010. In 2015 it was switched due to reduced response to golimumab which was non-beneficial. Subsequently he was switched to etanercept but after 3 months it was discontinued due to eye flare. The patient’s therapy was switched to certolizumab, which was non-beneficial for spine and discontinued. In 2016, infliximab was retried as the patient thought it worked best. Unfortunately, in 2018 patient developed Infliximab antibodies and treatment was changed to secukinumab. After 9 months this was stopped owing to ongoing active eye and spine disease. Adalimumab was re-tried; however, it was discontinued as it was showing no benefit. In 2020 Eeanercept (Benepali) was re-tried; however, only for 4 months because of severe flare of joint and eye disease. Tofacitinib was commenced but was non-beneficial and hence it was discontinued. Currently he continues on ixekizumab, oral prednisolone and also receives steroid eye and joint injections. On commencing biologics he was on methotrexate; however, the patient stopped. He was switched to mycophenolate mofetil which he remained on for 10 years. It was switched to methotrexate to try and control peripheral inflammatory joint disease better (re-tried for the second time) which the patient has recently discontinued as he felt it was non-beneficial.Case report - DiscussionThe case is very challenging. The patient’s disease continues to flare despite changing therapies. He continues to get flares in his back disease, eye disease and peripheral synovitis. His latest BASDI was 5.1 and VAS was 9/10. Measurements: intermalleolar distance 15cm, modified Schober’s 4cm, right lateral flexion 3.8cm and left lateral flexion 11cm. His latest MRI of whole spine and SI joints (in 2020) showed signs of previously active seronegative spondyloarthropathy with established cervical and thoracic ankyloses as well as bilateral sacroiliac joint ankylosis. There is a need for repeated steroid injections to the knees as well as the eyes. He continues on oral prednisolone which was first started in 2006. This is associated with multiple side effects, i.e., osteoporosis. The patient has already completed 8 years of bisphosphonate therapy. He is under regular review with the osteoporosis clinic. His bone density scan showed worsening bone mineral density and bisphosphonates had to be restarted. The patient adjusted medications depending on his symptoms. Recently he also discontinued methotrexate as he felt it was of no benefit to him at all. We are very limited at present to find combined medications to manage both the patient’s inflammatory back disease and inflammatory eye disease.Case report - Key learning pointsThis patient was diagnosed with ankylosing spondylitis 26 years ago. To date he has tried 5 different anti-TNF agents (two of which have also been re-tried at a different time point). This failed to control his disease as he continued to experience flares in either inflammatory back or eye disease. The biologic classes were also changed – he has tried one IL-17A agent as well as a JAK-I. Unfortunately, they both failed to control his disease. He currently continues on a second IL-17A; however, he still requires steroid eye and joint injections as well as systemic steroids. Throughout the years he has tried different DMARDs – most recently methotrexate. Unfortunately, the patient decided to discontinue it as he felt it was of no benefit to him. All of the above indicates that there is still a need to find a collaborative treatment option that will control the patient’s inflammatory back disease, inflammatory eye disease and peripheral synovitis. The aim would be, if possible, to decrease the steroid dose as well (currently on prednisolone 15mg daily) in order to prevent the steroid-associated side effects.

The research progress of cytomegalovirus corneal endotheliitis

Cytomegalovirus(CMV) corneal endotheliitis is an inflammatory disease of corneal endothelium caused by CMV infection. It mainly occurs in middle-aged and elderly immunocompetent people and has a relatively high incidence in Asia. It is characterized by localized corneal edema, coin-shaped or linear keratic precipitates and mild anterior chamber reaction, possibly with raised intraocular pressure or a history of recurrent anterior uveitis. The pathogenesis of this disease is not yet clear. Previous studies suggested it was related to viral infection and immune response; Therefore, the current treatment is empirically using antiviral agents combined with topical corticosteroids. Making an accurate early diagnosis and continuous antiviral therapy are crucial in controlling disease progression and preserving corneal endothelial function. (Chin J Ophthalmol, 2021, 57: 624-629).

Iris Depigmentation in the Prediction of Cytomegalovirus Anterior Uveitis

ABSTRACT Purpose We hypothesize that the presence of iris depigmentation is associated with the prediction of cytomegalovirus (CMV) as the etiology of chronic or recurrent anterior uveitis. Methods A prospective cohort study on patients with recurrent or chronic anterior uveitis. Pre-operative data on iris depigmentation and corneal endothelial cell densities were compared between eyes with and without CMV. Results Forty-one eyes of 38 subjects with a mean age of 61.1 ± 11.2 years old were recruited. Seventeen eyes were positive for CMV. A greater proportion of eyes with CMV showed severe or diffuse iris depigmentation than eyes without CMV, and possessed larger corneal endothelial cells (p = .028). When severe iris depigmentation was present with a reduced endothelial cell density, the positive and negative predictive values were raised to 100.0% and 64.9% from 41.5% and 58.5%, respectively. Conclusion Iris depigmentation is a potential clinical biomarker in predicting CMV in chronic or recurrent anterior uveitis.

Triggering factors associated with a new episode of recurrent acute anterior uveitis

To identify triggering factors for the next inflammatory episode of recurrent acute anterior uveitis (RAAU), a 1:1 case–control study was conducted. We interviewed RAAU patients with recent acute anterior uveitis attack and quiescent controls for their information during a previous month using Srithanya Stress Test (ST-5) and questionnaires about potential triggering factors. Asymptomatic controls were matched for age (± 5 years), sex, and HLA-B27. There were 39 pairs of cases and controls. Patients who recently experienced a uveitis attack demonstrated higher mean ST-5 scores (3.7 ± 2.9 vs 0.7 ± 1.1) and shorter sleep time (6.3 ± 1.4 vs 7.4 ± 0.7 h per day) compared with their controls. In the multivariate conditional logistic regression analysis, ST-5 score ≥ 3 (OR 9.07, 95% CI 1.14–72.16, p = 0.037) and sleep time < 7 h per day (OR 12.12, 95% CI 1.37–107.17, p = 0.025) were more likely to trigger a uveitis attack in RAAU accounted for patients’ age, sex, HLA- B27 positivity, and presence of concurrent anti-inflammatory drugs for co-existing diseases. Other suspected triggering factors were not found to have any significant association. In short, stress and inadequate sleep may lead to the future episode of acute anterior uveitis in RAAU. Both physical and emotional stress management should be advised to RAAU patients to minimize recurrences and further complications.

"Post Coronavirus Disease (COVID-19) Reactivation of a Quiescent Unilateral Anterior Uveitis".

Coronavirus disease (COVID-19) can be associated with ophthalmic manifestations like conjunctivitis, retinal haemorrhages, retinal vascular occlusions, papillophlebitis, and Adie’s syndrome. We herein report for a case of a unilateral acute anterior uveitis which was quiescent for 13 years and was reactivated post COVID-19 infection in a 43-year-old Asian Indian male. He had a past history of recurrent unilateral granulomatous anterior and intermediate uveitis in the right eye (RE), and all the investigations done 14 years ago were negative and had been on treatment with topical and oral steroids. He developed cataract 6 months later in the RE and underwent surgery. Patient was in remission for the past 13 years. Uveitis investigations for the present episode were all negative. Topical steroid and cycloplegic helped in resolution of the uveitis. This may be the first instance of reactivation of a quiescent unilateral anterior uveitis following COVID-19 infection.

Signature of Circulating Biomarkers in Recurrent Non-Infectious Anterior Uveitis. Immunomodulatory Effects of DHA-Triglyceride. A Pilot Study.

The purpose of this study was to identify circulating biomarkers of recurrent non-infectious anterior uveitis (NIAU), and to address the anti-inflammatory effects of triglyceride containing docosahexaenoic acid (DHA-TG). A prospective multicenter study was conducted in 72 participants distributed into: patients diagnosed with recurrent NIAU in the quiescence stage (uveitis group (UG); n = 36) and healthy controls (control group (CG); n = 36). Each group was randomly assigned to the oral supplementation of one pill/day (+) containing DHA-TG (n = 18) or no-pill condition (−) (n = 17) for three consecutive months. Data from demographics, risk factors, comorbidities, eye complications and therapy were recorded. Blood was collected and processed to determine pro-inflammatory biomarkers by bead-base multiplex assay. Statistical processing with multivariate statistical analysis was performed. The mean age was 50, 12 (10, 31) years. The distribution by gender was 45% males and 55% females. The mean number of uveitis episodes was 5 (2). Higher plasma expression of interleukin (IL)-6 was detected in the UG versus the CG (p = 5 × 10−5). Likewise, significantly higher plasma levels were seen for IL-1β, IL-2, INFγ (p = 10−4), and TNFα (p = 2 × 10−4) in the UG versus the CG. Significantly lower values of the above molecules were found in the +DHA-TG than in the -DHA-TG subgroups, after 3 months of follow-up, TNFα (p = 10−7) and IL-6 (p = 3 × 10−6) being those that most significantly changed. Signatures of circulating inflammatory mediators were obtained in the quiescent stage of recurrent NIAU patients. This 3-month follow-up strongly reinforces that a regular oral administration of DHA-TG reduces the inflammatory load and may potentially supply a prophylaxis-adjunctive mediator for patients at risk of uveitis vision loss.

Ayurvedic management of recurrent anterior uveitis (Raktaja adhimantha) with bloodletting therapy: A case report

A 34-year-old female patient reported to the outpatient department with recurrent anterior uveitis who presented with blurred vision, severe pain, redness, watering, and unable to bear bright light since one day in the left eye. On examination, inflammatory changes were seen in the anterior chamber. These symptoms appeared alternatively in both the eyes; three to four times a year for consecutively two years. She was under pred forte 1% eye drops, homide eye drops, and prednisolone tablets during relapses as advised by an ophthalmologist. Further, she developed hyperglycemia and started medications for that. During this period, steroids were withdrawn. Considering the limited benefits, she opted for Ayurveda treatment. The condition was diagnosed with Raktaja adhimantha and treated with Jalaukavacharna (~leech therapy), Shirovirechana nasya (~intranasal drug delivery with cleansing action) with Shadbindu taila. Kaishora guggulu and Rasnaerandadi Kashaya were administered orally. The symptoms subsided within a week, while after a month, the signs of the anterior chamber were normalized. The oral medicines were continued for a month. She was asymptomatic for three years. A similar mild symptom appeared in the right eye that was managed in similar lines. Thereafter, no exacerbation was noticed till January 2021. Ayurveda bloodletting therapy along with Shirovirechana nasya and oral medicines is effective and safe as a stand-alone therapy in recurrent anterior uveitis and prolong the interval between recurrent attacks in uveitis.

Clinical profile of patients with anterior uveitis

The anterior uveitis can be categorized as iritis, anterior cyclitis and iridocyclitis. It often causes a painful red eye. Patients with anterior uveitis complain of redness, photophobia, tearing and blurred vision. Acute anterior uveitis causes mild vision loss but still contributes significantly to the total burden. It causes vision loss both directly through inflammation and via complications such as macular edema, glaucoma, cataract, and others. A prospective clinical study was conducted. The material for this study included, 50 patients between age 20 and 80 years, attending outpatient department, Department of Ophthalmology with signs and symptoms of anterior uveitis. In the present study it was observed that most common presentation was acute anterior uveitis, accounting for 76%, then chronic 18% and only 6% of the patients had recurrent anterior uveitis. In the present study 45 (90%) patients had non granulomatous inflammation and in 5 (10%) patients it was granulomatous inflammation. Thus nongranulomatous inflammation was more common than granulomatous inflammation.

Associations between functional and structural measurements in non-acute Vogt-Koyanagi-Harada disease.

To evaluate associations between functional and structural measurements in patients with non-acute VKHD. In this cross-sectional study, 16 non-acute VKHD patients (32 eyes; 14 female) were evaluated with multifocal electroretinogram (mfERG), standardized automated perimetry (SAP) and optical coherence tomography (OCT)examinations. All included patients had a minimum 12months of follow-up from acute onset and were participants of an ongoing prospective study since acute phase with systematic clinical imaging evaluations and electroretinogram examinations within a predefined treatment. Age- and gender-matched controls were included. Main outcomes were functional and structural abnormalities and their correlation; secondary outcome was correlation of these findings with clinical characteristics, including fundus abnormalities. SAP and mfERG parameters were significantly worse in patients than in controls. Fourteen eyes (43.7%) had disrupted ellipsoid zone (EZ); visual acuity (VA) was similar between eyes with intact or disrupted EZ. Eyes with intact and disrupted EZ differed significantly concerning N1 and P1 amplitudes and N1 peak time values on mfERG and mean sensitivity (MS), central sensitivity (CS), foveal threshold, visual field index, mean deviation (MD) and pattern standard deviation values on SAP. The area under the curve on receiver operating curves for P1 amplitude was 0.81 (cut-off value=34.7 nV/deg2 ) and for MD value was 0.84 (cut-off value=-5.2dB). Central retinal thickness (CRT) significantly correlated with N1 and P1 amplitudes and P1 peak time values on mfERG (r=0.354, r=0.442 and r=-0.405, respectively) and MD, MS, CS and fovea threshold (log values) on SAP (r=0.372, r=0.406, r=0.431 and r=0.414, respectively). Statistically significant associations were found with the presence of peripapillary atrophy and recurrent anterior uveitis with a worse MD value (p=0.004 and p<0.001, respectively). In non-acute VKHD, disrupted EZ and reduced CRT were correlated with impaired mfERG and SAP parameters, even in patients with good VA.

Genetic diagnosis of Warmblood Fragile Foal Syndrome in equine in vitro produced preimplantation embryos

Equine recurrent uveitis (ERU) is a serious eye disease and the most common cause of blindness in horses. Until now, the cause of ERU is not fully understood. Persistent infections of pathogenic leptospires have been discussed. Chronic recurrent remitting episodes of inflammations and the positive therapeutic effects of corticosteroids have led to the hypothesis that ERU is an autoimmune disorder. The reason for a dysregulated autoimmune response may be linked to genetic factors. ERU shows similarities to human autoimmune uveitis with a genetic background. An association of the equine leukocyte antigen serological haplotype A9 with ERU in warmblood horses indicated that major histocompatibility complex I (MHCI) influences the development of ERU. The different types of human autoimmune and genetic uveitis, like Behçet's disease, systemic sarcoidosis, Vogt-Koyanagi-Harada syndrome, birdshot retinochoroidopathy, sympathetic ophthalmia, and acute recurrent anterior uveitis, had been associated with the human leukocyte antigen complex and genetic variants of the MHC. Furthermore non-MHC genes with a possible role in autoimmunity may also play a role in ERU-affected horses. The genes presented herein may be of interest for genome-wide association analyses of ERU-affected horses.

Rare Hyperpigmentation of the Conjunctiva and Sclera: Ochronosis.

Alkaptonuria is a rare autosomal recessive disorder in which the metabolism of tyrosine is not properly functioning [1], [2] as a result of loss of homogentisate 1,2 dioxygenase (HGO) activity [3]. It has an estimated prevalence of 1 – 9/1.000.000 [4], [5], [6]. Literature suggests that the most common clinical finding is hyperpigmentation of the sclera [7], followed by conjunctival pigmentation and pigmented chamber angle, whereas recurrent anterior uveitis is a rare finding. Here, we present a case of a patient with this clinical condition.

A Cross-Sectional Online Survey Identifies Subspecialty Differences in the Management of Pediatric Cataracts Associated with Uveitis.

IntroductionTo determine if differences exist between pediatric ophthalmologists and uveitis ophthalmologists in the treatment of pediatric uveitic cataracts and placement of intraocular lenses.MethodsUveitis ophthalmologists and pediatric ophthalmologists were surveyed via an online poll regarding their therapeutic management of pediatric uveitic cataract and intraocular lens (IOL) placement.ResultsSixty-two responses from uveitis ophthalmologists and 47 responses from pediatric ophthalmologists were recorded. According to 79% of all responses, uveitis was not a contraindication for primary IOL implantation in patients with controlled intraocular inflammation. Pediatric ophthalmologists were more likely to respond that the presence of chronic juvenile idiopathic arthritis-associated iridocyclitis, pars planitis, or recurrent acute anterior uveitis is a contraindication for primary IOL implantation in pediatric cases with full control of intraocular inflammation. There was no consensus within either specialty with regard to the preferred IOL material for lens implantation. Uveitis ophthalmologists were more likely to report the use of intravenous and intravitreal steroids for perioperative treatment. In cataract surgery for a child with recurrent acute anterior uveitis, a higher percentage of uveitis ophthalmologists (71%) than pediatric ophthalmologists (50%) responded that the posterior capsule should be primarily opened. A higher percentage of uveitis ophthalmologists also stated that anterior vitrectomy should be performed at the time of cataract surgery in all three uveitis types.ConclusionsPediatric ophthalmologists and uveitis ophthalmologists have similar approaches to the management of pediatric uveitic cataract removal and IOL insertion, but several differences remain between these subspecialties. Continued collaboration between the subspecialties would be helpful to better develop consistent criteria to improve patient care.Electronic supplementary materialThe online version of this article (10.1007/s40123-020-00245-x) contains supplementary material, which is available to authorized users.

Metabolomic Profile of Posner-Schlossman Syndrome: A Gas Chromatography Time-of-Flight Mass Spectrometry-Based Approach Using Aqueous Humor.

The Posner–Schlossman syndrome (PSS) is a disease with clinically recurrent unilateral anterior uveitis with markedly elevated intraocular pressure (IOP) and subsequent progression to optic neuropathy. Retrospective studies have reported increased annual incidence of PSS, especially in China. While currently, the clinical management of PSS is still challenging. Metabolomics is considered to be a sensitive approach for the development of novel targeted therapeutics because of its direct elucidation of pathophysiological mechanisms. Therefore, we adopted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS) technology-based non-targeted metabolomics approach to measure comprehensive metabolic profiles of aqueous humor (AH) samples obtained from patients with PSS, with an aim to demonstrate the underlying pathophysiology, identify potential biomarkers specific to PSS, and develop effective treatment strategies. A comparative analysis was used to indicate the distinct metabolites of PSS. Pathway analysis was conducted using MetaboAnalyst 4.0 to explore the metabolic reprogramming pathways involved in PSS. Logistic regression and receiver-operating characteristic (ROC) analyses were employed to evaluate the diagnostic capability of selected metabolites. Comparative analysis revealed a clear separation between PSS and control groups. Fourteen novel differentiating metabolites from AH samples obtained from patients with PSS were highlighted. Pathway analysis identified 11 carbohydrate, amino acid metabolism and energy metabolism pathways as the major disturbed pathways associated with PSS. The abnormal lysine degradation metabolism, valine–leucine–isoleucine biosynthesis, and citrate circle were considered to weigh the most in the development of PSS. The ROC analysis implied that the combination of glycine and homogentisic acid could serve as potential biomarkers for the discrimination of control and PSS groups. In conclusion, these results revealed for the first time the identity of important metabolites and pathways contributing to the development/progression of PSS, enabled the better understanding of the mechanism of PSS, and might lead to the development of metabolic biomarkers and novel therapeutic strategies to restrict the development/progression of PSS.

Sexual dysfunction in Behçet's syndrome.

Behçet's syndrome (BS) is an autoimmune, rare, and severe multisystemic inflammatory disease characterized by recurrent oral aphthous ulcers, genital ulcers, skin lesions, and both anterior and posterior uveitis; articular, vascular, gastroenteric and neurological involvement may also occur. The multi-organ involvement and the wide range of clinical spectrum make the diagnosis of BS challenging. As other systemic chronic diseases, BS can affect all aspects of patients' life, including sexual dysfunction (SD). So far, SD has been deeply studied among patients affected by many rheumatic diseases; however, little is known about the prevalence and the characteristics of SD among BS patients. The present work was aimed at providing a systematic literature review of the literature published on SD and BS. We carried out a systematic search in PubMed and Scopus based on controlled terms (MeSH) and keywords to identify literature data on SD in BS. The systematic search was independently performed by two clinicians based on the controlled medical subject heading terms for Behcet syndrome and SD. Systematic database search identified 32 records. Screening by title and abstract was then conducted and a total of 10 articles were eligible for full text assessment, five studies explored SD in male patients with BS, 3 studies in females and 2 works reported data on both genders. Globally, the systematic literature review results have underlined that SD seems frequent in BS patients. Both female and male patients experienced a significant correlation between SD and depression. The studies investigating sexuality in BS seem to demonstrate that in these patients SD may be mainly related to depression rather than to active organic manifestations.

53. An uncommon cause of pyrexia of unknown origin

53. An uncommon cause of pyrexia of unknown origin

Aqueous Humor Dynamics in Uveitic Eyes

To investigate aqueous humor dynamics in uveitic eyes. Cross-sectional study. Patients with recurrent (≥3 attacks) anterior uveitis (now quiescent) and being treated for glaucoma or ocular hypertension (OHT) (Group 1), previous recurrent anterior uveitis (≥3 attacks) without glaucoma or OHT (Group 2), and normal subjects with no ocular problems and IOP < 21mm Hg at screening (control group; Group 3). Patients had one-off measurements. Group 1 patients who were on antihypertensives were washed out for a 4-week period, prior to their study measurements. Main outcome measures were tonographic outflow facility, aqueous humor flow rate, and uveoscleral outflow. One hundred and one patients were screened between February 2014 and February 2017. Nine patients did not meet the inclusion criteria. Groups 1 and 3 each included 30 patients, and Group 2 included 32 patients. The mean intraocular pressure was higher in Group 1 compared to the others (25 ± 10.2mm Hg in Group 1 vs 16 ± 2.7mm Hg in Group 2 vs 16 ±2.2mm Hg in Group 3, P < .001). The tonographic outflow facility was lower in Group 1 compared to the others (0.18 ± 0.1μL/min/mm Hg in Group 1 vs 0.25 ± 0.1μL/min/mm Hg in Group 2 vs 0.27 ± 0.1μL/min/mm Hg in Group 3, P= .005). However, aqueous humor flow rate was not statistically different (2.47 ±0.9μL/min in Group 1 vs 2.13 ± 0.9μL/min in Group 2 vs 2.25 ± 0.7μL/min in Group 3, P= .3). There was also no significant difference in calculated uveoscleral outflow. This is the first aqueous humor dynamics study in patients with uveitic glaucoma/OHT and recurrent anterior uveitis compared with age-matched controls. We have demonstrated that the elevated intraocular pressure seen in the uveitic glaucoma/OHT eyes (3-6 attacks) was due to reduced tonographic outflow facility. The aqueous humor flow rate was not detectibly different, nor did the calculated uveoscleral outflow demonstrate any discernible difference. However, the exact mechanism remains to be elucidated.

Ultrasonographic Enthesis Evaluation in Patients with Recurrent Acute Anterior Uveitis with and without Spondyloarthropathy

Background: spondyloarthritis (SpA) is a group of chronic diseases recognized by arthritis and extraarticular lesions e.g. uveitis, enthesitis, dermatological affection. About 35% of SpA patients may present with recurrent attacks of acute anterior uveitis (AAU). Purpose: it was to detect whether patients with idiopathic recurrent AAU who were positive or negative for Human Leukocyte Antigen B27 (HLA–B27) had a frequency of enthesis lesions compared to that seen in patients with SpA. Patients and Methods: a prospective study of enthesis evident on musculoskeletal ultrasound examination was done on sixty patients and twenty controls, the eighty were categorized into 4 groups; group 1 included 20 patients with known SpA group 2 included 20 with recurrent AAU HLA–B27 positive and didn’t have SpA aspects group 3 included 20 with recurrent AAU HLA–B27 negative and didn’t have SpA and group 4 included 20 healthy controls. Using Madrid Sonography Enthesitis Index (MASEI) twelve enthesis locations were assessed in each participant. Results: a total of 960 entheses sites were examined by ultrasonography in all 80 participants. The MASEI cut-off limit of ≥18 points was 75%, 60%, 45%, and 10% of the participants in the 4 groups; respectively. The MASEI score was significantly higher in groups 1&2 than in groups 3&4. The differences between the two groups were statistically significant. Conclusion: a high percent of HLA–B27 positive patients with idiopathic recurrent AAU without characteristics of SpA have enthesis lesions with about percent to those seen in patients with known SpA.

The effects of losartan on cytomegalovirus infection in human trabecular meshwork cells.

BackgroundHuman cytomegalovirus (CMV) has been emerged as one of the causes of acute recurrent or chronic hypertensive anterior uveitis in immunocompetent. In hypertensive anterior uveitis, human trabecular meshwork (TM) cells are considered a focus of inflammation. We investigated the effects of losartan, a selective angiotensin II receptor antagonist, on CMV infection in human TM cells.MethodsHuman TM cells were infected with CMV AD169. Virus infected and mock-infected cells were treated with losartan or dexamethasone or ganciclovir with or without transforming growth factor (TGF)-β1. Viral DNA accumulation and host cell response were analyzed using real-time PCR. Levels of secreted TGF-β1 were measured by determining its concentration in conditioned medium using a commercially available sandwich enzyme-linked immunosorbent assay (ELISA) kits.ResultsCMV infection significantly increased the concentrations of the secreted TGF-β1 at 3, 5, and 7 day post infection in TM cells. Treatment with dexamethasone or losartan significantly decreased the levels of TGF-β1, whereas treatment with ganciclovir did not affect TGF-β1 levels. TM cells treated with TGF-β1 along with the presence of losartan for 48 hours showed marked decrease in the expression of α-smooth muscle actin (SMA), lysyl oxidase (LOX), connective tissue growth factor (CTGF), fibronectin and collagen-1A, compared with cells treated with TGF-β1 alone. CMV-infected TM cells stimulated by TGF-β1 significantly increased the expression of α-SMA and CTGF, which were attenuated by additional treatment with losartan.ConclusionLosartan inhibited the expression of TGF-β1 and fibrogenic molecules in human TM cells. Thus, losartan has the potential to decrease TM fibrosis in patients with CMV-induced hypertensive anterior uveitis.