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Current Opinion in Rheumatology Jul 2017Uveitis is the most common, clinically apparent, extra-articular manifestation of axial spondyloarthritis. This review summarizes recent publications related to this... (Review)
Review
PURPOSE OF REVIEW
Uveitis is the most common, clinically apparent, extra-articular manifestation of axial spondyloarthritis. This review summarizes recent publications related to this form of uveitis.
RECENT FINDINGS
Studies published since the start of 2015 address the worldwide prevalence of human leukocyte antigen (HLA) B27-associated uveitis, the prevalence of axial spondyloarthritis among patients with B27-associated acute anterior uveitis (AAU), the genetics of AAU and some of the clinical implications of AAU. Progress has been made in the treatment of uveitis in general and in the treatment of uveitis in association with spondyloarthropathy in particular. The pathogenesis of AAU might derive clues from the above as well as from an understanding of the microbiome and possibly from knowledge derived from uveitis in association with Ebola.
SUMMARY
Although HLA B27-associated uveitis has been recognized since 1973, a variety of recent observations shed new light on this common clinical association with spondyloarthritis.
Topics: Acute Disease; Adrenal Cortex Hormones; Antirheumatic Agents; HLA-B27 Antigen; Humans; Microbiota; Prevalence; Spondylarthropathies; Uveitis; Uveitis, Anterior
PubMed: 28376061
DOI: 10.1097/BOR.0000000000000403 -
European Journal of Ophthalmology Nov 2021To report a case series of anterior uveitis after Transepithelial Photorefractive Keratectomy (TransPRK) and determine its incidence, demographics and associated...
PURPOSE
To report a case series of anterior uveitis after Transepithelial Photorefractive Keratectomy (TransPRK) and determine its incidence, demographics and associated clinical features over a study period of 1 year.
METHODS
This retrospective case series comprised of 200 eyes (100 patients) which underwent elective TransPRK surgery for ametropia correction at a tertiary eye care center by two refractive surgeons over 1 year. TransPRK was performed on Streamlight software (EX500, Alcon Wavelight, Inc.). Postoperatively, all patients received topical antibiotic and steroid eye drops and tapered over 4 weeks.
RESULTS
The mean age of study patients was 25.76 ± 4.29 years with a pre-operative mean refractive spherical equivalent (MRSE) of -3.49 ± 2.12 diopter (D); 11.76% eyes had simple myopia and 88.23% had compound myopic astigmatism, mean ablation depth of 61.99 ± 24.27 um. Four patients (seven eyes) developed anterior uveitis with mean age of 25 ± 3.53 years, mean MRSE -2.91 ± 0.32 D, ablation depth 44.75 ± 5.29 um with a mean onset at 33.28 days postoperatively after surgery and 5.28 days after the routine postoperative topical steroid withdrawal. Laboratory and immunological tests were negative in all four patients. The incidence of TransPRK-related anterior uveitis was 3.5% over 1 year.
CONCLUSION
Anterior uveitis after TransPRK is infrequent. It could be due to intraocular transmittance of high frequency excimer laser beams used for longer durations to provide continuous, single step ablation in this novel type of PRK surgery. Further studies are needed to investigate the mechanisms of this association.
Topics: Adult; Astigmatism; Humans; Incidence; Lasers, Excimer; Photorefractive Keratectomy; Refraction, Ocular; Retrospective Studies; Treatment Outcome; Uveitis, Anterior; Young Adult
PubMed: 33238750
DOI: 10.1177/1120672120974946 -
Graefe's Archive For Clinical and... Nov 2022To compare iris affectation in cytomegalovirus anterior uveitis (CMVAU), rubella virus-associated uveitis (RVU), and healthy contralateral eyes, using swept-source...
PURPOSE
To compare iris affectation in cytomegalovirus anterior uveitis (CMVAU), rubella virus-associated uveitis (RVU), and healthy contralateral eyes, using swept-source anterior segment optical coherence tomography (SS-AS-OCT).
MATERIALS AND METHODS
A comparative, transversal, retrospective study examining 60 eyes from 30 patients-18 eyes (17 patients) with CMVAU, 14 eyes (13 patients) with RVU, and 28 healthy eyes-was performed. Six-millimeter cross-sectional SS-AS-OCT B-scans were obtained in each iris quadrant. Images were exported to ImageJ®. Qualitative and quantitative analyses were done: stromal thickness (ST), smooth index (SI), and optical density (OD) of pigment epithelium. Comparisons between measurements and clinical-demographic parameters were performed using SPSS®.
RESULTS
Qualitative analysis showed extensive damage in iris stroma but was unable to differentiate between both uveitis. RVU eyes had a lower mean ST (315.72 μm ± 42.4) compared to those with CMVAU (348.6 μm ± 46) (p = 0.047) and a lower ST in the upper (338.9 μm ± 38.52)/(386.25 μm ± 47.2) (p = 0.005) and temporal (281.5 μm ± 57.3)/(326.43 μm ± 62.3) (p = 0.016) quadrants. Mean (0.94 ± 0.02)/(0.9 ± 0.03) (p = 0.001), temporal (0.94 ± 0.02)/(0.89 ± 0.03) (p < 0.001), and nasal SI (0.094 ± 0.02)/(0.9 ± 0.04) (p = 0.005) were higher in RVU. OD was similar in both uveitis. In healthy eyes, mean ST (376.8 μm ± 39.7) was higher and mean SI was lower (0.87 ± 0.04) than in RVU (p < 0.001) and CMVAU eyes (p = 0.032). Mean OD was higher in healthy eyes (911 ± 130) than in CMVAU eyes (800 ± 200) (p = 0.037).
CONCLUSIONS
The quantitative analysis of the SS-AS-OCT iris images allows for the differentiation between healthy eyes and those with CMVAU and RVU, as well as between both uveitis.
Topics: Humans; Cross-Sectional Studies; Cytomegalovirus; Retrospective Studies; Rubella; Tomography, Optical Coherence; Uveitis; Uveitis, Anterior
PubMed: 35708847
DOI: 10.1007/s00417-022-05733-3 -
Zeitschrift Fur Rheumatologie Oct 2017Acute anterior uveitis (AAU) is the most frequent uveitis subtype. It is often associated with HLA-B27 and with inflammatory rheumatic diseases, in particular with... (Review)
Review
Acute anterior uveitis (AAU) is the most frequent uveitis subtype. It is often associated with HLA-B27 and with inflammatory rheumatic diseases, in particular with spondyloarthritis (SpA), which itself is strongly associated with HLA-B27. About 40-60% of patients with AAU have an associated spondyloarthritis, and 20-40% of patients with spondyloarthritis also have uveitis. The incidence of AAU in patients with SpA clearly correlates with disease duration. The AAU has an acute onset, usually affects only one eye at a time, and shows a tendency for recurrence. Early therapy of AAU with topical steroids is relevant for good visual outcomes. Minimum duration of therapy of flares of AAU is 6-8 weeks in order to prevent early recurrency. The rate of local complications correlates with the rate of AAU flares and the visual outcome is often good. Refractory uveitis and frequent recurrencies of AAU may be treated with conventional disease-modifying antirheumatic drugs (DMARDs, such as sulfasalazine and methotrexate) and biologicals (e.g. TNF-alpha inhibitors). Any first episode of AAU diagnosed by an ophthalmologist should prompt referral to rheumatology for suspected SpA, particularly if rheumatic symptoms are present.
Topics: Administration, Topical; Adrenal Cortex Hormones; Antirheumatic Agents; HLA-B27 Antigen; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Methotrexate; Prognosis; Spondylarthropathies; Sulfasalazine; Tumor Necrosis Factor-alpha; Uveitis, Anterior
PubMed: 28812149
DOI: 10.1007/s00393-017-0357-6 -
Korean Journal of Ophthalmology : KJO Aug 2020To evaluate the effect of adalimumab in pediatric uveitis and subsequent changes in anterior chamber inflammation following the inactivation of uveitis.
PURPOSE
To evaluate the effect of adalimumab in pediatric uveitis and subsequent changes in anterior chamber inflammation following the inactivation of uveitis.
METHODS
In this retrospective study, patients with noninfectious uveitis younger than 18 years of age who were treated with adalimumab for more than 12 months were included. The rate of complete suppression and the relapse in anterior chamber inflammation following the initiation of adalimumab therapy were evaluated using anterior chamber cell score and laser flare photometry (LFP) values, if available. Changes in visual acuity and the sparing effect of topical steroid agents were also evaluated.
RESULTS
Among 22 eyes of 12 pediatric uveitis patients enrolled, 13 eyes were associated with juvenile idiopathic arthritis and nine eyes had idiopathic uveitis. The mean ± standard deviation age was 10.2 ± 3.6 years. Types of uveitis included anterior uveitis (n = 17) and panuveitis (n = 5). Quiescence was observed in 14 eyes (63.6%) at 3 months and in 21 eyes (95.5%) at 12 months after initiation, respectively. After achieving inactive uveitis, uveitis relapsed in two eyes at 6 months, even with adalimumab treatment. In 11 eyes, anterior chamber showed 0.5+ cell scores during the rest of the follow-up period and one of those eyes met the criteria for the relapse based on LFP values. The dosage of topical steroids decreased significantly at 3, 9, and 12 months after the initiation of therapy ( ≤ 0.05). Visual acuity did not show improvement. There were no severe adverse effects of anti-tumor necrosis factor-α treatment reported.
CONCLUSIONS
In this study, adalimumab achieved a quiescent state in most eyes with pediatric noninfectious uveitis for 12 months with a relapse rate of 9.5%. LFP values together with the anterior chamber cell score can be utilized to monitor the improvement or relapse in anterior chamber inflammation in pediatric noninfectious uveitis.
Topics: Adalimumab; Adolescent; Anterior Chamber; Child; Female; Follow-Up Studies; Humans; Male; Retrospective Studies; Treatment Outcome; Uveitis, Anterior; Visual Acuity
PubMed: 32783419
DOI: 10.3341/kjo.2020.0005 -
CMAJ : Canadian Medical Association... Dec 2023
Topics: Humans; Pamidronate; Scleritis; Uveitis, Anterior; Diphosphonates
PubMed: 38110218
DOI: 10.1503/cmaj.230859 -
Veterinary Ophthalmology May 2022To evaluate the clinical application of spectral-domain optical coherence tomography (SD-OCT) for anterior uveitis in dogs. Animals and procedures Client-owned dogs...
OBJECTIVE
To evaluate the clinical application of spectral-domain optical coherence tomography (SD-OCT) for anterior uveitis in dogs. Animals and procedures Client-owned dogs presenting with anterior uveitis and clinically healthy dogs were enrolled in this study. Included eyes were divided into 5 groups by flare grade and 3 groups by cell grade through slit-lamp biomicroscopy. Each eye was examined using SD-OCT following slit-lamp biomicroscopy. The ratio of aqueous signal intensity to air signal intensity, which is called the aqueous-to-air relative intensity (ARI) index, was used to evaluate the flare grade. Cell number, central corneal thickness (CCT), and the presence of keratic precipitates (KPs) were analyzed on SD-OCT. The OCT parameters, including ARI index, cell number, and CCT, were compared to the slit-lamp clinical flare and cell grade.
RESULTS
Thirty-six eyes with anterior uveitis and 27 healthy eyes were enrolled. The ARI index showed a significant correlation with clinical flare grade (r = 0.811, p < .001). In multiple regression analysis, the ARI index and CCT showed a significant negative correlation (r = -0.258, p = .044). The number of cells on SD-OCT significantly increased with cell grade on slit-lamp biomicroscopy (r = 0.653, p < .001). The clinical flare grade and CCT were significantly correlated in the partial correlation analysis after controlling for age (partial correlation coefficient = 0.471, p = .002). KPs were observed in 61% of the eyes with flare using SD-OCT (22/36 eyes).
CONCLUSIONS
Spectral-domain optical coherence tomography could provide quantitative information, including the ARI index, cell counts, and CCT in dogs. SD-OCT is an auxiliary modality for slit-lamp biomicroscopy when evaluating anterior uveitis in dogs.
Topics: Animals; Dog Diseases; Dogs; Eye; Feasibility Studies; Slit Lamp; Tomography, Optical Coherence; Uveitis, Anterior
PubMed: 34793607
DOI: 10.1111/vop.12955 -
Journal of Translational Medicine Mar 2024Patients with spondyloarthritis (SpA)/HLA-B27-associated acute anterior uveitis (AAU) experience recurring acute flares, which pose significant visual and financial...
Investigation of the acute pathogenesis of spondyloarthritis/HLA-B27-associated anterior uveitis based on genome-wide association analysis and single-cell transcriptomics.
BACKGROUND
Patients with spondyloarthritis (SpA)/HLA-B27-associated acute anterior uveitis (AAU) experience recurring acute flares, which pose significant visual and financial challenges. Despite established links between SpA and HLA-B27-associated AAU, the exact mechanism involved remains unclear, and further understanding is needed for effective prevention and treatment.
METHODS
To investigate the acute pathogenesis of SpA/HLA-B27-associated AAU, Mendelian randomization (MR) and single-cell transcriptomic analyses were employed. The MR incorporated publicly available protein quantitative trait locus data from previous studies, along with genome-wide association study data from public databases. Causal relationships between plasma proteins and anterior uveitis were assessed using two-sample MR. Additionally, colocalization analysis was performed using Bayesian colocalization. Single-cell transcriptome analysis utilized the anterior uveitis dataset from the Gene Expression Omnibus (GEO) database. Dimensionality reduction, clustering, transcription factor analysis, pseudotime analysis, and cell communication analysis were subsequently conducted to explore the underlying mechanisms involved.
RESULTS
Mendelian randomization analysis revealed that circulating levels of AIF1 and VARS were significantly associated with a reduced risk of developing SpA/HLA-B27-associated AAU, with AIF1 showing a robust correlation with anterior uveitis onset. Colocalization analysis supported these findings. Single-cell transcriptome analysis showed predominant AIF1 expression in myeloid cells, which was notably lower in the HLA-B27-positive group. Pseudotime analysis revealed dendritic cell terminal positions in differentiation branches, accompanied by gradual decreases in AIF1 expression. Based on cell communication analysis, CD141CLEC9A classic dendritic cells (cDCs) and the APP pathway play crucial roles in cellular communication in the Spa/HLA-B27 group.
CONCLUSIONS
AIF1 is essential for the pathogenesis of SpA/HLA-B27-associated AAU. Myeloid cell differentiation into DCs and decreased AIF1 levels are also pivotal in this process.
Topics: Humans; Acute Disease; Bayes Theorem; Gene Expression Profiling; Genome-Wide Association Study; HLA-B27 Antigen; Spondylarthritis; Uveitis, Anterior
PubMed: 38475831
DOI: 10.1186/s12967-024-05077-y -
Journal of Neuroinflammation May 2024The human gut microbiome (GM) is involved in inflammation and immune response regulation. Dysbiosis, an imbalance in this ecosystem, facilitates pathogenic invasion,...
BACKGROUND
The human gut microbiome (GM) is involved in inflammation and immune response regulation. Dysbiosis, an imbalance in this ecosystem, facilitates pathogenic invasion, disrupts immune equilibrium, and potentially triggers diseases including various human leucocyte antigen (HLA)-B27-associated autoinflammatory and autoimmune diseases such as inflammatory bowel disease (IBD) and spondyloarthropathy (SpA). This study assesses compositional and functional alterations of the GM in patients with HLA-B27-associated non-infectious anterior uveitis (AU) compared to healthy controls.
METHODS
The gut metagenomes of 20 patients with HLA-B27-associated non-infectious AU, 21 age- and sex-matched HLA-B27-negative controls, and 6 HLA-B27-positive healthy controls without a history of AU were sequenced using the Illumina NovaSeq 6000 platform for whole metagenome shotgun sequencing. To identify taxonomic and functional features with significantly different relative abundances between groups and to identify associations with clinical metadata, the multivariate association by linear models (MaAsLin) R package was applied.
RESULTS
Significantly higher levels of the Eubacterium ramulus species were found in HLA-B27-negative controls (p = 0.0085, Mann-Whitney U-test). No significant differences in microbial composition were observed at all other taxonomic levels. Functionally, the lipid IV biosynthesis pathway was upregulated in patients (p < 0.0001, Mann-Whitney U-test). A subgroup analysis comparing patients with an active non-infectious AU to their age- and sex-matched HLA-B27-negative controls, showed an increase of the species Phocaeicola vulgatus in active AU (p = 0.0530, Mann-Whitney U-test). An additional analysis comparing AU patients to age- and sex-matched HLA-B27-positive controls, showed an increase of the species Bacteroides caccae in controls (p = 0.0022, Mann-Whitney U-test).
CONCLUSION
In our cohort, non-infectious AU development is associated with compositional and functional alterations of the GM. Further research is needed to assess the causality of these associations, offering potentially novel therapeutic strategies.
Topics: Humans; HLA-B27 Antigen; Female; Male; Gastrointestinal Microbiome; Middle Aged; Uveitis, Anterior; Adult; Case-Control Studies; Aged
PubMed: 38715051
DOI: 10.1186/s12974-024-03109-4 -
American Journal of Ophthalmology Dec 2014
Topics: Female; Fluocinolone Acetonide; Humans; Male; Tattooing; Uveitis, Anterior
PubMed: 25457706
DOI: 10.1016/j.ajo.2014.09.006