Regarding testing specifics, Dr. Palestine noted, “Syphilis and sarcoid screening have a high positive predictive value in uveitis. Anti-neutrophil cytoplasmic antibody testing is reasonable in retinal vasculitis. Viral serologies, quantiferon testing, anti-nuclear antibody, rheumatoid factor and inflammatory markers, on the other hand, are rarely useful.”
Regarding immunosuppression, Dr. Palestine encouraged rheumatologists to take the reins. “Rheumatologists have the expertise in prescribing and managing these drugs, and ocular immunologists are uncommon. Few randomized, controlled trials (RCT) exist to guide therapeutic choices, so work closely with the ophthalmologist to determine the best drug regimen, duration and goal of therapy. Then, communicate the plan to the patient as a unified front,” he said.
Dr. Palestine typically treats inflammatory eye disease for two to three years at minimum, but no RCT data exist to support this approach. “Stopping therapy depends on the consequences of recurrence. Some recurrences do not lead to permanent vision loss. Others do, so the risk of discontinuation is higher,” he added.
In Sum
Drs. Kolfenbach and Palestine celebrated the benefits of collaboration across their fields, and hope other institutions will follow suit in developing rheumatology-ophthalmology clinics. When we work together, it’s easy to see how the rheumatologist, ophthalmologist and patient all win, they noted.
Samantha C. Shapiro, MD, is an academic rheumatologist and an affiliate faculty member of the Dell Medical School, University of Texas at Austin. She received her training in internal medicine and rheumatology at Johns Hopkins University, Baltimore. She is also a member of the ACR Insurance Subcommittee.
References
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- Jakob E, Reuland MS, Mackensen F, et al. Uveitis subtypes in a German interdisciplinary uveitis center—Analysis of 1916 patients. J Rheumatol. 2009 Jan;36(1):127–136.
- Mazlumzadeh M, Matteson EL. Cogan’s syndrome: An audiovestibular, ocular, and systemic autoimmune disease. Rheum Dis Clin North Am. 2007 Nov;33(4):855–874.
- Nevares A, Raut R, Libman B, Hajj-Ali R. Noninfectious autoimmune scleritis: Recognition, systemic associations, and therapy. Curr Rheumatol Rep. 2020 Mar 26;22(4):11.
- Standardization of Uveitis Nomenclature (SUN) Working Group. Development of classification criteria for the uveitides. Am J Ophthalmol. 2021 Aug;228:96–105.
