Risk Of Uveitis Research Articles

Glycemic control is an important modifiable risk factor for uveitis in patients with diabetes: A retrospective cohort study establishing clinical risk and ophthalmic disease burden

AimTo characterize the risk uveitis, scleritis or episcleritis in relation to diabetes, glycaemic control, and co-existence of retinopathy. MethodsUsing the Royal College of General Practitioners Research and Surveillance Centre database, we established the prevalence of acute uveitis and scleritis or episcleritis over a six-year period among populations without(n = 889,856) and with diabetes(n = 48,584). We evaluated the impact of glycaemic control on disease risk. Regression modeling was used to identify associations, adjusting for clinical and demographic confounders. ResultsIncidence of acute uveitis was higher among patients with diabetes; Type 1 OR:2.01 (95% CI 1.18–3.41; p = 0.009), and Type 2 OR:1.23 (1.05–1.44; p = 0.01). Glycaemic control was established as an important effect modifier for uveitis risk, whereby those with poorer control suffered higher disease burden. Results confirmed a dose-response relationship such that very poor glycaemic control OR:4.72 (2.58–8.65; p < 0.001), poor control OR:1.57 (1.05–2.33; p = 0.03) and moderate control OR:1.20 (0.86–1.68; p = 0.29) were predictive of uveitis. Similar results were observed when evaluating retinopathy staging: proliferative retinopathy OR:2.42 (1.25–4.69; p = 0.01). These results were not maintained for scleritis or episcleritis. ConclusionAcute uveitis is more common in patients with diabetes; at highest risk are those with type 1 disease with poor glycaemic control. Glycaemic improvements may prevent recurrence.

Genetic profiling of ocular inflammation: further evidence for a gender-specific association of C5 with uveitis

// Ming Ming Yang 1 , Xiao Yuan Wang 1 , Ying Wei Liu 2 , Li Dong 1 , De Ju Kong 1 , Hong Yan Sun 1 , Jiao Jie Fan 1 , Xu Hui Yu 1 , and Jun Wang 3 1 Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin, China 2 Department of Ophthalmology, Hongqi Hospital of Mudanjiang Medical University, Mudanjiang, China 3 Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, China Correspondence to: Jun Wang, email: wangjun4622@163.com Keywords: complement system; C5; ocular inflammation; uveitis; molecular genetics Received: September 19, 2017&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Accepted: February 13, 2018&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Published: February 17, 2018 ABSTRACT Objective: Uveitis is a major cause for visual impairment, our previous studies have made significant advancements in depicting the genetic profile of complement genes in uveitis. This study aimed to further investigate whether the terminal pathway gene, Complement component 5 ( C5 ), confers susceptibility to uveitis. Methods: Six tagging SNPs in C5 were genotyped in 592 unrelated study subjects: 141 anterior uveitis patients, 158 patients with non-infectious intermediate and posterior uveitis, and 293 controls. Multiple in-depth analyses have been conducted. Results: Among the six C5 SNPs, rs17611 was significantly associated with uveitis after adjusted for gender and SNP-gender interaction ( P = 0.017). After stratification by gender, rs17611 G allele and GG homozygosity confers an increased risk for uveitis in males ( P = 0.004, OR = 1.67 and P = 0.009, OR = 2.69, respectively) but not in females. Moreover, genotype-phenotype correlation analysis revealed an association between rs17611 and disease recurrence ( P = 0.045). The haplotype GC, defined by rs17611 and rs2269066, was also found to be associated with total uveitis and specific intermediate and posterior uveitis subtype ( P = 0.0055, OR = 1.51 and P = 0.0084, OR = 1.58, respectively). Other polymorphisms were not significantly associated with either investigated uveitis entities. Conclusions: This study shows a gender-specific association of C5 -rs17611 with uveitis, indicating that C5 may have an epistatic effect with gender in the pathogenesis of uveitis. This study help us depict the disease profile and estimate the contribution of each complement activation pathway in ocular immunologic process.

Update on the Treatment of Uveitis in Patients with Juvenile Idiopathic Arthritis: A Review.

Chronic uveitis is a common extra-articular manifestation of juvenile idiopathic arthritis. The classic clinical picture is one of chronic anterior uveitis, which usually remains asymptomatic until ocular complications arise. The risk of uveitis is increased in girls with an early onset of oligoarthritis and positive antinuclear antibodies. Even though the inflammation in patients with juvenile idiopathic arthritis is initially limited in the anterior part of the eye, chronic active inflammation may eventually cause significant damage to the posterior pole. Complications may include band keratopathy, cataract, secondary glaucoma, posterior synechiae, cystoid macular edema, and hypotony. The cooperation of ophthalmologists with rheumatologists may help define the best treatment plan. The ophthalmic therapeutic regimen includes topical corticosteroids and mydriatics, while in severe cases immunosuppressive and biological agents are introduced. Surgical management of complications might be needed.

Risk of uveitis and inflammatory bowel disease in people with psoriatic arthritis: a population-based cohort study

ObjectivesTo determine the risk of uveitis and inflammatory bowel disease (IBD) in patients with psoriatic arthritis (PsA) compared with the general population and patients with psoriasis.MethodsA cohort study using data...

Research roundup: May 2017

In brief Long-term antibiotic use by adults seems to increase the risk of colorectal adenoma Taking antidepressants during pregnancy does not seem to increase the risk of autism and other neurodevelopmental disorders People with psoriasis may be at increased risk of uveitis

Risk of Uveitis Among People With Psoriasis

Uveitis has been associated with psoriatic arthritis, but to our knowledge, the relationship between uveitis and psoriasis is unsettled among researchers. To evaluate the risk of incident uveitis among people with psoriasis. This nationwide, retrospective cohort study conducted in Taiwan from January 1, 2000, to December 31, 2012 included 147 954 people with psoriasis (including 10 107 with concomitant psoriatic arthritis and 137 847 without psoriatic arthritis) and 147 954 nonpsoriatic controls. Psoriasis. Risk of incident uveitis. The mean (SD) age of the 295 908 study participants was 44.4 (19.8) years, and 41.2% (n = 121 878) were women. We found that the group with severe psoriasis with psoriatic arthritis had the greatest risk of incident uveitis compared with the nonpsoriatic controls (adjusted hazard ratio, 2.40; 95% CI, 1.90-3.02). The group with severe psoriasis without psoriatic arthritis and the group with mild psoriasis with psoriatic arthritis also had an increased risk of incident uveitis (adjusted hazard ratio, 1.42; 95% CI, 1.23-1.64; and 1.42; 95% CI, 1.03-1.96; respectively). However, an increased risk for incident uveitis with mild psoriasis without psoriatic arthritis was not identified (adjusted hazard ratio, 1.09; 95% CI, 1.00-1.20). People with severe psoriasis and those with mild psoriasis have an increased risk of uveitis. Clinicians may use this finding as a guide for uveitis risk stratification among patients with different inflammatory presentations on the spectrum of psoriatic disease.

RELATIONSHIP BETWEEN UVEITIS, DIFFERENT TYPES OF VIRAL HEPATITIS, AND LIVER CIRRHOSIS: A 12-Year Nationwide Population-Based Cohort Study.

This study investigates whether patients with viral hepatitis and cirrhosis are at risk of uveitis in the years following hepatitis. We used data from Taiwan National Health Insurance system. The cases were patients newly diagnosed with viral hepatitis from 2000 to 2011. The end point of interest was a diagnosis of uveitis. A chi-square test was used for the difference of demographic characteristics between viral hepatitis and comparison. The risk of uveitis in hepatitis was stratified using Cox proportional hazard regression. We selected 17,389 patients with viral hepatitis and 34,778 matched comparison. The risk of uveitis in hepatitis cohort was 1.30-fold (95% confidence interval = 1.01-1.69). Patients with hepatitis B virus and hepatitis C virus coinfection had the highest risk (hazard ratio = 2.88; 95% confidence interval = 1.07-7.78), and followed by only hepatitis C virus infection (hazard ratio = 1.75; 95% confidence interval = 1.10-2.79). Patients with cirrhosis had a higher risk in the multivariable model but did not attach statistic difference. Patients with hepatitis B virus and hepatitis C virus coinfection had the highest risk of uveitis. In patients with hepatitis C virus and/or hepatitis B virus infection, the symptoms of uveitis should be alerted. Although these epidemiologic studies yielded informative results, the underlying mechanisms and the host's genetic factors remain to be investigated.

Ophthalmic Manifestations and Causes of Vision Impairment in Ebola Virus Disease Survivors in Monrovia, Liberia

To describe the ocular findings, visual impairment, and association of structural complications of uveitis with visual impairment in a cohort of survivors of Ebola virus disease (EVD) in Monrovia, Liberia. Retrospective, uncontrolled, cross-sectional study. Survivors of EVD who were evaluated in an ophthalmology clinic at Eternal Love Winning Africa (ELWA) Hospital in Monrovia, Liberia. A cohort of EVD survivors who underwent baseline ophthalmic evaluation at ELWA Hospital were retrospectively reviewed for demographic information, length of Ebola treatment unit (ETU) stay, visual acuity (VA), and ophthalmic examination findings. For patients with uveitis, disease activity (active vs. inactive) and grade of inflammation were recorded according to Standardization of Uveitis Nomenclature criteria. The level of VA impairment was categorized according to World Health Organization classification for VA impairment as follows: normal/mild, VA 20/70 or better; moderate, VA 20/70-20/200; severe, VA 20/200-20/400; blindness, VA <20/400. Visual acuity, length of ETU stay, and structural complications were compared between EVD survivors with and without uveitis. Structural complications associated with moderate VA impairment or poorer were analyzed. Frequency of ocular complications including uveitis and optic neuropathy in EVD survivors, level of VA impairment in EVD survivors with uveitis, and structural complications associated with VA impairment in EVD survivors. A total of 96 survivors of EVD were examined. A total of 21 patients developed an EVD-associated uveitis, and 3 patients developed an EVD-associated optic neuropathy. Visual acuity was blind (VA >20/400) in 38.5% of eyes with uveitis. Anatomic subtypes of uveitis included anterior, posterior, and panuveitis in 2, 13, and 6 patients, respectively. Examination findings associated with at least moderate visual impairment by World Health Organization criteria (VA <20/70) included keratic precipitates (P < 0.002), posterior synechiae (P < 0.002), vitritis (P < 0.005), and chorioretinal scars (P < 0.02). Survivors of EVD are at risk for uveitis, which may lead to secondary structural complications, visual impairment, and blindness. Eye care resources should be mobilized for EVD survivors in West Africa because of the frequency of this spectrum of disease complication and its potential for severe VA impairment and blindness.

Ankylosing Spondylitis Patients with HLA-B*2704 have More Uveitis than Patients with HLA-B*2705 in a North Chinese Population

ABSTRACTPurpose: To investigate the correlation between clinical features of ankylosing spondylitis (AS) and different human leukocyte antigen (HLA)-B27 subtypes.Methods: We conducted a cross-sectional study of 216 patients with AS. HLA-B27 and its subtypes were detected by polymerase chain reaction with sequence specific primer (PCR-SSP). Clinical features were compared between the different HLA-B27 subtypes. A meta-analysis on uveitis frequencies in AS patients with HLA-B*2705 vs 2704 was performed.Results: The most prevalent subtypes of HLA-B27 were HLA-B*2704 (66.1%) and HLA-B*2705 (32.2%). There were 57 HLA-B27-positive AS patients with the history of uveitis; 45 were B*2704 and 12 were B*2705. Patients with B*2704 had more uveitis than B*2705 (p = 0.021). After meta-analysis, there was no significant difference in the presence of uveitis between HLA-B*2704 and HLA-B*2705.Conclusions: AS patients with B*2704 have a higher risk of uveitis than AS with B*2705 in a north Chinese people.

Association of TRAF1-C5 with risk of uveitis in juvenile idiopathic arthritis

ObjectivesNumerous single nucleotide polymorphisms (SNPs) have been associated with JIA, but few of these studies were replicated. We conducted a candidate-gene approach study to assess if some SNPs could be related to clinical subtypes or other clinical features of the juvenile idiopathic arthritis (JIA) such as the risk of uveitis, ANA positivity and the age at onset. MethodsSNPs in six genes were analysed: PTPN22, STAT4, TRAF1-C5, TGFbeta, TNFAIP3, and C12orf30. We retrospectively included 104 JIA patients, fulfilling the ILAR classification criteria. Association between SNPs and JIA clinical subtypes, the presence of ANA, risk of uveitis and age at onset was evaluated using a Chi2 test or a Fischer test. ResultsNo associations between different clinical subtypes as well as presence of ANA and the 6 SNPs were found. However, the AA genotype of TRAF1-C5 appeared associated in a subgroup of patients with uveitis in oligoarticular and polyarticular forms [OR 3.77 (95% CI: 1.1067, 12.8527); P=0.066]. Furthermore, AA TRAF1-C5 was significantly more frequent in antinuclear antibodies (ANA) positive patients presenting uveitis, compared to patients without uveitis and without ANA (P<0.05). ConclusionTRAF1-C5 genotype could identify JIA patients with a risk to develop uveitis especially in oligo and polyarticular forms and among ANA-positive children. Given the moderate size of our cohort, this association has to be confirmed in other studies.

The influence of ERAP1 gene variants on clinical phenotype in ankylosing spondylitis

Objectives: Endoplasmic reticulum aminopeptidase 1 (ERAP1) gene variants diminish the risk of developing ankylosing spondylitis (AS) through a reduction in ERAP1 activity. We investigated whether disease expression was altered in patients who developed AS despite the presence of two protective ERAP1 variants.Method: We conducted a cross-sectional and longitudinal cohort study of patients with established AS (n = 334, 90% B27+, mean age at study 45 years) for whom clinical data and biological samples were collected during a research visit. Genotyping for the single nucleotide polymorphisms (SNPs) rs27044 and rs30187 was performed on genomic DNA by reverse transcription polymerase chain reaction (RT-PCR) with interleukin (IL)-6 and tumour necrosis factor (TNF) levels determined by a sandwich enzyme-linked immunosorbent assay (ELISA). Associations between genotypes and haplotypes, clinical and serological findings were analysed using SNPstats.Results: Both SNPs were in strong linkage disequilibrium and formed three common haplotypes (C/C 0.65, G/T 0.30, and C/T 0.04). Haplotype C/T carried a lower risk for uveitis [odds ratio (OR) 0.32, p = 0.03] and elevated C-reactive protein (CRP) levels (OR 0.26, p = 0.04). There was no effect of ERAP1 haplotypes on cytokine levels or major outcomes after 8 years of follow-up.Conclusions: The ERAP1 rs27044/rs30187 haplotype C/T is associated with lower risk of extraspinal disease and systemic inflammation in Nordic AS patients but has no impact on IL-6 or TNF levels.

Impact of Antiinflammatory Treatment on the Onset of Uveitis in Juvenile Idiopathic Arthritis: Longitudinal Analysis From a Nationwide Pediatric Rheumatology Database.

ObjectiveBased on a nationwide database, this study analyzed the influence of methotrexate (MTX), tumor necrosis factor (TNF) inhibitors, and a combination of the 2 medications on uveitis occurrence in juvenile idiopathic arthritis (JIA) patients.MethodsData from the National Paediatric Rheumatological Database in Germany were used in this study. Between 2002 and 2013, data from JIA patients were annually documented at the participating pediatric rheumatologic sites. Patients with a JIA disease duration of <12 months at initial documentation and ≥2 years of followup were included in this study. The impact of antiinflammatory treatment on the occurrence of uveitis was evaluated by discrete‐time survival analysis.ResultsA total of 3,512 JIA patients (mean ± SD age 8.3 ± 4.8 years, 65.7% female, 53.2% antinuclear antibody positive, and mean ± SD age at arthritis onset 7.8 ± 4.8 years) fulfilled the inclusion criteria. Mean ± SD total followup time was 3.6 ± 2.4 years. Uveitis developed in a total of 180 patients (5.1%) within 1 year after arthritis onset. Uveitis onset after the first year was observed in another 251 patients (7.1%). Disease‐modifying antirheumatic drug (DMARD) treatment in the year before uveitis onset significantly reduced the risk for uveitis as follows: MTX: hazard ratio (HR) 0.63, P = 0.022; TNF inhibitors: HR 0.56, P < 0.001; and a combination of the 2 medications: HR 0.10, P < 0.001. Patients treated with MTX within the first year of JIA had an even a lower uveitis risk (HR 0.29, P < 0.001).ConclusionThe use of DMARDs in JIA patients significantly reduced the risk for uveitis onset. Early MTX use within the first year of disease and the combination of MTX with a TNF inhibitor had the highest protective effect.

Association of Psoriatic Disease With Uveitis: A Danish Nationwide Cohort Study.

Psoriasis, psoriatic arthritis, and uveitis are inflammatory disorders with significant overlap in their inflammatory pathways. Limited evidence is available about the relationship between psoriatic disease and uveitis. To investigate the potential bidirectional relationship between psoriatic disease, including psoriasis and psoriatic arthritis, and uveitis. We performed a nationwide cohort study of the Danish population from January 1, 1997, through December 31, 2011. We included 74,129 Danish patients with psoriasis who were 18 years or older during the study period. Patients were identified through administrative registries, and information on age, sex, socioeconomic status, medication, and comorbidity was obtained using individual-level linkage of administrative registers. We performed data analysis from January 27 through March 4, 2015. Diagnosis of mild or severe psoriasis or psoriatic arthritis for uveitis risk and diagnosis of uveitis for the risk for psoriasis or psoriatic arthritis. Diagnosis of uveitis, mild psoriasis, severe psoriasis, or psoriatic arthritis. We calculated incidence rates (IRs) and estimated IR ratios adjusted for potential confounders using Poisson regression. We identified 74,129 cases of psoriasis and psoriatic arthritis and 13,114 cases of uveitis. The IRs (95% CIs) for uveitis were 2.02 (1.99-2.06), 2.88 (2.33-3.56), 4.23 (2.40-7.45), and 5.49 (3.36-8.96) for the reference population and those with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. In the reference population, these IRs (95% CIs) were 9.37 (9.30-9.45), 1.12 (1.10-1.15), and 1.04 (1.01-1.06), and in patients with uveitis, these statistics were 15.51 (12.92-18.62), 2.66 (1.72-4.13), and 4.25 (3.00-6.01) for mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. Adjusted IR ratios (95% CIs) for uveitis were 1.38 (1.11-1.70 [P = .02]), 1.40 (0.70-2.81 [P = .34]), and 2.50 (1.53-4.08 [P < .001]) for patients with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. For patients with uveitis, IR ratios (95% CIs) were 1.59 (1.32-1.91 [P < .001]) for mild psoriasis, 2.17 (1.40-3.38 [P < .001]) for severe psoriasis, and 3.77 (2.66-5.34 [P < .001]) for psoriatic arthritis, respectively. We found a bidirectional association between psoriatic disease and uveitis. Increased focus on eye symptoms in patients with psoriasis and psoriatic arthritis and on skin and joint symptoms in patients with prior or current uveitis may be appropriate.

Can the Methotrexate Therapy Prevent the Development of Uveitis in Patients with Juvenile Idiopathic Arthritis: Results of a Retrospective Study

Background: Uveitis is one of the most common extra-articular manifestations of juvenile idiopathic arthritis (JIA). Currently, the possibility of reducing the risk of uveitis in children with JIA by using methotrexate has been studied. Objective: Our aim was to analyze the results of treatment of children with JIA by studying the relation between the use of methotrexate and the risk of uveitis. Methods: A retrospective uncontrolled study. The case histories of patients with JIA who were treated for at least 2 years after the onset of the disease were studied. The results of treatment of patients who received and who did not receive methotrexate were studied (standard therapy — non-steroidal anti-inflammatory drugs and intra-articular injections of glucocorticoids). The established cases of uveitis were taken into account. Results: The study analyzed the results of observation of 281 children with JIA. In the methotrexate group, uveitis was detected in 22/191 (11.5%), and in the control group — in 42/90 (46.7%) of patients (OR 6.7; 95% CI 3.7–12.3). The time period between the onset of JIA and development of uveitis in two groups under study was the same and equal to 24 (12; 67) and 17 months (7; 35), respectively (p = 0.232). Multivariate regression analysis showed that the main predictors of uveitis were oligoarticular course of JIA (HR = 1.89), positive antinuclear antibody test (HR = 2.14), onset of JIA under the age of 5 (HR = 2.56), female gender (HR = 1.82), and the absence of methotrexate in the therapy (HR = 0.24). Conclusion : The treatment with methotrexate may reduce the risk of uveitis in patients with JIA. To confirm this hypothesis, randomized studies are needed.

Impact of disease modifying anti‐rheumatic drugs (DMARDs) on the uveitis risk in juvenile idiopathic arthritis

PurposeTo analyze the influence of methotrexate (MTX), Tumour necrosis factor (TNF) inhibitors, and their combination on uveitis occurrence in juvenile idiopathic arthritis.MethodsData of a nation‐wide prospective rheumatological and ophthalmological database in Germany were evaluated for the years 2002 to 2013. Patient with JIA disease duration of less than 12 months at initial documentation and with a follow‐up of ≥ 2 years were included in this analysis. Discrete‐time survival analysis was performed to evaluate the impact of disease modifying anti‐rheumatic drugs (DMARDs) on the occurrence of uveitis.ResultsA total of 3,512 JIA patients fulfilled the inclusion criteria (mean age 8.3 ± 4.8 years, female 65.7%, ANA‐positive 53.2%, mean age at arthritis onset 7.8 ± 4.8 years, mean follow‐up time 3.6 ± 2.4 years). Uveitis manifested in 180 patients (5.1%) within one year after JIA onset, and in further 251 patients (7.1%) after the first year. MTX (HR 0.63, p = 0.022), TNF inhibitors (HR 0.56, p &lt; 0.001) and a combination of the two (HR 0.10, p &lt; 0.001) in the year before uveitis onset significantly reduced the risk for uveitis. MTX treatment within the first year after JIA diagnosis revealed the lowest uveitis risk (HR 0.29, p &lt; 0.001).ConclusionsDMARDs in JIA patients significantly reduce the risk for uveitis onset. A relevant protective effect was found especially for early MTX use within the first year of arthritis onset and for the combination of MTX with a TNF inhibitor.

HLA Associations in a Cohort of Children With Juvenile Idiopathic Arthritis With and Without Uveitis.

Juvenile idiopathic arthritis (JIA)-associated uveitis can lead to ocular complications and vision loss. Alleles HLA-DRB1*08, *11, and *13 are risk alleles for JIA, whereas HLA-DRB1*11 and *13 alleles increase uveitis susceptibility. We examined the association of common HLA-DRB1 alleles in children with JIA alone and JIA-associated uveitis. High-resolution HLA-DRB1 genotyping was performed in 107 children with oligoarticular and polyarticular rheumatoid factor (RF) negative JIA and 373 non-Hispanic white controls. Children with JIA alone and JIA-associated uveitis were of similar race, ethnicity, sex, and age at arthritis diagnosis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. There were 47 children with JIA-associated uveitis and 60 with JIA alone. Compared to controls, only children with JIA-associated uveitis had increased odds of carriage of HLA-DRB1*11 (OR, 2.2 95% [CI, 1.1-4.3], P = 0.023). There also was increased carriage of HLA-DRB1*08 and *13 (OR, 12.6 [95% CI, 2.0-77.8], P = 0.011). Compared to controls and children with JIA alone, those with JIA-associated uveitis had increased odds of carriage of HLA-DRB1*11 and *13 (OR, 9 [95% CI, 2.8-29.0], P < 0.0001 and OR, 8.6 [95% CI, 1.0-74.4], P = 0.042), respectively. We report the novel finding that carriage of HLA-DRB1*11 and *13 appears to increase the risk of uveitis in children with JIA.

Association of MCP-1-2518A/G polymorphism with uveitis susceptibility: a Meta-analysis

Background Monocyte chemoattractant protein-1 (MCP-1) polymorphisms are demonstrated to be significantly associated with the susceptibility to uveitis in recent years, while a consistent conclusion for the association of MCP-1-2518A/G polymorphism and uveitis risk is not reached yet. Objective This study was to comprehensively investigate the correlation between MCP-1-2518A/G polymorphism and uveitis susceptibility. Methods General searches of electronic database including PubMed, Embase, Web of Science, CNKI, VIP, Wanfang database and China biomedical literature database (CBD) were performed to retrieve published case-control studies regarding the association between MCP-1 -2518A/G polymorphism and uveitis risk. The data were screened according to the inclusion and exclusion criteria and extracted, and the quality of included studies was evaluated. The pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. Publication bias and sensitivity analysis were also assessed. All statistical analyses were conducted with RevMan 5. 2 and Stata 12. 0 software. Results A total of 8 eligible case-control studies involving 1 197 cases and 1 570 controls were included in the Meta-analysis. The results showed no significant association of MCP-1 -2518A/G polymorphism with uveitis susceptibility in the G vs. A, GG vs. AA and GG vs. AG+ AA models (all at P>0. 05). MCP-1 -2518A/G polymorphism was found to be significantly associated with uveitis risk in the GG+ AG vs. AA model (P=0. 01, OR=1. 25, 95%CI: 1. 06-1. 48), while no significant association was found by the sensitive analysis(GG+ AG vs. AA: P=0. 19, OR=1. 16, 95%CI: 0. 93-1. 45). The subgroup analysis by uveitis types revealed that the individuals carrying allele-G or GG genotype harbored a significantly increased risk for anterior uveitis (G vs. A: P=0. 01, OR=1. 49, 95%CI: 1. 16-1. 90; GG vs. AA: P=0. 01, OR=2. 09, 95%CI: 1. 21-3. 61; GG+ AG vs. AA: P=0. 01, OR=1. 58, 95%CI: 1. 12-2. 23; GG vs. AG+ AA: P=0. 01, OR=1. 78, 95%CI: 1. 12-2. 83). The individuals with GG+ AG vs. AA genotype harbored a significantly increased risk for Behcet's disease (BD) (P=0. 04, OR=1. 35, 95%CI: 1. 01-1. 79) but not for other types of uveitis (P>0. 05). Additionally, a significantly elevated risk was found in uveitis patients with allele-G or GG genotype in Asian population in the subgroup analysis based on ethnicity (G vs. A: P=0. 04, OR=1. 15, 95%CI: 1. 01-1. 32; GG vs. AA: P=0. 04, OR=1. 32, 95%CI: 1. 02-1. 71; GG+ AG vs. AA: P=0. 01, OR=1. 36, 95%CI: 1. 09-1. 70), but that was not found in Caucasians population (all at P>0. 05). Conclusions MCP-1 -2518A/G polymorphism is significantly associated with the risk of uveitis in Asian population, anterior uveitis and BD. The allele-G or GG genotype may increase the risk of uveitis in Asian population, anterior uveitis and BD. Key words: Uveitis; Monocyte chemoattractant protein-1; Polymorphism; Meta-analysis

Uveitis in juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is the most common systemic disease causing uveitis in childhood, with a prevalence of 10 per 100 000 persons. JIA often takes a severe inflammatory course, and its complications often endanger vision. This review is based on pertinent articles retrieved by a selective literature search up to 18 August 2014 and on the current interdisciplinary S2k guideline on the diagnostic evaluation and anti-inflammatory treatment of juvenile idiopathic uveitis. Uveitis arises in roughly 1 in 10 patients with JIA. Regular eye check-ups should be performed starting as soon as JIA is diagnosed. 75-80% of patients are girls; antinuclear antibodies are found in 70-90%. The risk to vision is higher if JIA begins in the preschool years. As for treatment, only a single, small-scale randomized controlled trial (RCT) and a small number of prospective trials have been published to date. Topical corticosteroids should be given as the initial treatment. Systemic immunosuppression is needed if irritation persists despite topical corticosteroids, if new complications arise, or if the topical steroids have to be given in excessively high doses or have unacceptable side effects. If the therapeutic effect remains inadequate, conventional and biological immune modulators can be given as add-on (escalation) therapy. Treatment lowers the risk of uveitis and its complications and thereby improves the prognosis for good visual function. Severely affected patients should be treated in competence centers to optimize their long-term outcome. Multidisciplinary, individualized treatment is needed because of the chronic course of active inflammation and the ensuing high risk of complications that can endanger vision. Future improvements in therapy will be aided by prospective, population-based registries and by basic research on biomarkers for the prediction of disease onset, prognosis, tissue damage, and therapeutic response.

Risk for uveitis with oral moxifloxacin: a comparative safety study.

Numerous case reports have suggested that the recent use of moxifloxacin may lead to uveitis. This epidemiologic study is, to our knowledge, the first to explore the relationship between oral moxifloxacin hydrochloride use and uveitis. We conducted a case-control study within a cohort of men aged 40 to 85 years followed up from January 2001 through December 2011. All cases with a new diagnosis of uveitis were identified. For each case, 10 control subjects were matched by age, cohort entry date, and follow-up duration. For identified uveitis cases, current use of moxifloxacin, levofloxacin, or ciprofloxacin hydrochloride was compared with nonuse. Rate ratios were adjusted for potential confounding variables. We identified 13,313 uveitis cases and 133,130 corresponding controls. Compared with nonusers of fluoroquinolones, current first-time users of moxifloxacin demonstrated the highest risk for uveitis (adjusted rate ratio, 2.98 [95% CI, 1.80-4.94]). Current first-time users of ciprofloxacin (adjusted rate ratio, 1.96 [95% CI, 1.56-2.47]) showed an increased risk for uveitis, while current first-time users of levofloxacin (adjusted rate ratio, 1.26 [95% CI, 0.90-1.77]) did not show a significant association with uveitis. Current use of moxifloxacin or ciprofloxacin appears to increase the risk for uveitis. A statistically significant association of current first-time use of levofloxacin with uveitis could not be identified. Levofloxacin may pose the least risk for uveitis compared with moxifloxacin and ciprofloxacin.

Comparing the risk of developing uveitis in patients initiating anti-tumor necrosis factor therapy for ankylosing spondylitis: an analysis of a large US claims database

Objective:To compare the risk of developing uveitis in patients initiating anti-tumor necrosis factor (anti-TNF) agents (adalimumab, etanercept, and infliximab) for ankylosing spondylitis (AS).Methods:Anti-TNF-naive patients with a diagnosis of AS and without a history of uveitis (N = 2115) who subsequently initiated anti-TNF therapy for AS were identified in a large claims database (2005 to 2011). A multivariate Cox proportional-hazards model was used to compare the risk of uveitis in patients who received etanercept or infliximab vs adalimumab.Results:The median number of days to the first occurrence of uveitis after initiation of anti-TNF was 191. Among the three anti-TNF groups, the median time to event of uveitis was longest in patients taking adalimumab (243 days), followed by etanercept (182 days) and infliximab (144 days). The incidence rate for uveitis over 1 year was lowest for patients who received adalimumab (2.4%, N = 717), highest for patients who received etanercept (4.5%, N = 1087), and intermediate for patients who received infliximab (3.2%, N = 311). The risk of uveitis was 1.9 times higher in patients receiving etanercept compared with those taking adalimumab (hazard ratio [HR]: 1.91, 95% confidence interval [CI]: 1.1 to 3.31). For patients taking infliximab, the risk of uveitis was not statistically significantly different (HR: 1.35, 95% CI: 0.62 to 2.95) compared to adalimumab.Conclusion:The results indicated that initial adalimumab therapy is associated with a significantly lower risk of developing uveitis compared to initial etanercept therapy in patients diagnosed with AS and no prior history of uveitis; however, the risk was not different between adalimumab and infliximab. Limitations to consider when interpreting this conclusion include that disease-level clinical data, such as disease duration, were not available for inclusion in the model and that risk of uveitis beyond 1 year was not evaluated.