Uveitis: A Brief Primer for the Rheumatologist

Referral Recommended

Based on the myriad treatment options and the possible complications of unrecognized ocular inflammation, referral to a uveitis specialist is warranted to screen for ocular manifestations of autoimmune disorders. A prompt referral should be placed for evaluation of a patient with a painful, red eye. If an infection is suspected, same-day referral is necessary.

Bridging the gap between systemic disease and the eye, the uveitis specialist is a fellowship-trained ally in the treatment of patients with autoimmune disease.

Meghan Berkenstock, MD, is an assistant professor of ophthalmology at the Johns Hopkins School of Medicine, Baltimore, and practices at the Ocular Immunology Division of the Wilmer Eye Institute. Her research focuses on quality improvement in the treatment of patients with uveitis, and identifying and treating ocular side effects of oncologic immunotherapy medications.

References

1. Sharma SM, Jackson D. Uveitis and spondyloarthropathies. Best Pract Res Clin Rheumatol. 2017 Dec;31(6):846–862.
2. Gritz DC, Wong IG. Incidence and prevalence of uveitis in Northern California: The Northern California Epidemiology of Uveitis Study. Ophthalmology. 2004 Mar;111(3):491–500.
3. Suhler EB, Lloyd MJ, Choi D, et al. Incidence and prevalence of uveitis in Veterans Affairs Medical Centers of the Pacific Northwest. Am J Ophthalmol. 2008;146(6):890–896.e8.
4. Taylor A. Ocular immune privilege. Eye (Lond). 2009 Oct;23(10):1885–1889.
5. Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005 Sep;140(3):509–516.
6. Thorne JE, Suhler E, Skup M, et al. Prevalence of noninfectious uveitis in the United States: A claims-based analysis. JAMA Ophthalmol. 2016 Nov 1;134(11):1237–1245.
7. Tomkins‐Netzer O, Talat L, Bar A, et al. Long‐term clinical outcome and causes of vision loss in patients with uveitis. Ophthalmology. 2014 Dec;121(12): 2387–2392.
8. Miserocchi E, Fogliato G, Modorati G, Bandello F. Review on the worldwide epidemiology of uveitis. Eur J Ophthalmol. 2013 Sep–Oct;23(5):705–717.
9. Thorne JE, Skup M, Tundia N, et al. Direct and indirect resource use, healthcare costs and work force absence in patients with non-infectious intermediate, posterior or panuveitis. Acta Ophthalmol. 2016 Aug;94(5):e331–e339.
10. Acharya NR, Tham VM, Esterberg E, et al. Incidence and prevalence of uveitis: Results from the Pacific Ocular Inflammation Study. JAMA Ophthalmol. 2013 Nov;131(11):1405–1412.
11. Thorne JE, Woreta FA, Dunn JP, Jabs DA. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology. 2010 Jul;117(7):1436–1441.
12. Birnbaum AD, Jiang Y, Vasaiwala R, et al. Bilateral simultaneous-onset nongranulomatous acute anterior uveitis: Clinical presentation and etiology. Arch Ophthalmol. 2012 Nov;130(11):1389–1394.
13. Jabs DA, Rosenbaum JT, Foster CS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: Recommendations of an expert panel. Am J Ophthalmol. 2000 Oct;130(4):492–513.
14. Levy-Clarke G, Jabs DA, Read RW, et al. Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology. 2014 Mar;121(3):785–796.e3.
15. Writing Committee for the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study Research Group, Kempen JH, Altaweel MM, Holbrook JT, et al. Association between long-lasting intravitreous fluocinolone acetonide implant vs systemic anti-inflammatory therapy and visual acuity at 7 years among patients with intermediate, posterior, or panuveitis. JAMA. 2017 May 16;317(19):1993–2005.