Vol 9, No 3 (2023)
Review paper
Published online: 2023-09-29

open access

Page views 173
Article views/downloads 309
Get Citation

Connect on Social Media

Connect on Social Media

Uveitis in rheumatic diseases — therapeutic management

Artur Bachta1, Anna Byszewska2, Robert Kruszewski1, Marek Rękas2, Mateusz Tłustochowicz2, Witold Tłustochowicz1
Rheumatology Forum 2023;9(3):112-118.

Abstract

Treatment of uveitis requires a special approach because of the risk of significant complications, including loss of vision. The causes of the disease cannot always be determined, but a significant proportion of cases have a strong association with systemic connective tissue disorders, particularly spondyloarthropathies. This indicates the need for cooperation between an ophthalmologist and a rheumatologist in order to provide the patient with proper care. Several stages can be distinguished in the course of treatment, depending on the duration of therapy and the persistence of symptoms. Current research data justify the use of topical and systemic corticosteroids, as well as immunosuppressive drugs in subsequent lines of therapy. The article summarizes current recommendations and clinical observations, and presents a therapeutic regimen based on them.

Article available in PDF format

View PDF Download PDF file

References

  1. Willoughby C, Ponzin D, Ferrari S, et al. Anatomy and physiology of the human eye: effects of mucopolysaccharidoses disease on structure and function - a review. Clinical & Experimental Ophthalmology. 2010; 38: 2–11.
  2. Thorne J, Jabs D. The eye in rheumatic disease. Rheumatology. 2015: 260–266.
  3. Brydak-Godowska J, Moskal K, Borkowski PK, et al. A Retrospective Observational Study of Uveitis in a Single Center in Poland with a Review of Findings in Europe. Med Sci Monit. 2018; 24: 8734–8749.
  4. Prete M, Guerriero S, Dammacco R, et al. Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center. J Ophthalmic Inflamm Infect. 2014; 4: 17.
  5. Thorne J, Jabs D. The eye in rheumatic disease. Rheumatology. 2015: 260–266.
  6. Haroon M, O'Rourke M, Ramasamy P, et al. A novel evidence-based detection of undiagnosed spondyloarthritis in patients presenting with acute anterior uveitis: the DUET (Dublin Uveitis Evaluation Tool). Ann Rheum Dis . 2015; 74(11): 1990–1995.
  7. Godzenko A, Bochkova A, Rumyantseva O, et al. Course and outcome of uveitis in patients with ankylosing spondylitis. Annals of the Rheumatic Diseases. 2014; 73: 197–198.
  8. Omar A, Boyd T, Sari I, et al. SAT0233 Acute Anterior Uveitis in Ankylosing Spondylitis: Association with Inflammatory Bowel Disease and Psoriasis Independent of HLA-B27. Annals of the Rheumatic Diseases. 2015; 74(Suppl 2): 743.1–743.
  9. Constantin T, Foeldvari I, Anton J, et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann Rheum Dis. 2018; 77(8): 1107–1117.
  10. Angeles-Han ST, Ringold S, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken). 2019; 71(6): 703–716.
  11. Dick AD, Rosenbaum JT, Al-Dhibi AH, et al. Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis Fundamentals Of Care for UveitiS (FOCUS) Initiative. Ophthalmology. 2018; 125(5): 757–773.
  12. Jabs DA, Rosenbaum JT, Jabs DA, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol. 2000; 130(4): 492–513.
  13. Bachta A, Kisiel B, Tłustochowicz M, et al. High Efficacy of Methotrexate in Patients with Recurrent Idiopathic Acute Anterior Uveitis: a Prospective Study. Arch Immunol Ther Exp (Warsz). 2017; 65(1): 93–97.
  14. Ramanan AV, Dick AD, Jones AP, et al. SYCAMORE Study Group. Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis. N Engl J Med. 2017; 376(17): 1637–1646.
  15. Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care Res (Hoboken). 2019; 71(10): 1285–1299.
  16. Ramiro S, Nikiphorou E, Sepriano A, et al. Efficacy and safety of non-pharmacological and non-biological interventions: a systematic literature review informing the 2022 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. Ann Rheum Dis. 2023; 82(1): 142–152.
  17. Wen Ji, Hu H, Chen M, et al. Role of Janus Kinase (JAK) Inhibitor in Autoimmune Ocular Inflammation: A Systematic Review. J Immunol Res. 2021; 2021: 2324400.