Correlation of Uveitis and Arthritis Activity

Severity and duration of intraocular inflammation varies widely, but there appears no direct correlation between the activity of ocular and joint manifestations 9, 61 . Interestingly, on long-term follow-up, children with uveitis had more joints involved, more frequent intraarticular steroid injections were necessary to control arthritis and systemic immunosuppressive treatment had to be given more frequently. In addition, at the end of the observation period, systemic laboratory signs such as...

Classification of Arthritis

Chronic arthritis in children is a heterogeneous group of disorders that has been repeatedly classified. Juvenile rheumatoid arthritis (JRA), which affects up to 120,000 children in the US, has been defined by the American College of Rheumatology (ACR) as chronic peripheral arthritis of at least 6 weeks duration with onset before the age of 16 years, in the absence of any other cause 2 . Three subsets of arthritis have been differentiated the oligoarticular type accounting for 50-60 of patients...

References

Alsaeid KM, Haider MZ, al-Awadhi AM, et al. (2003) Role of the human leukocyte antigen DRB1*0307 and DRB1*0308 in susceptibility to juvenile rheumatoid arthritis. Clin Exp Rheuma-tol 21 399-402 2. American Academy of Pediatrics Section on Rheumatology and Section Ophthalmology (1993) Guidelines for ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics 92 295-296 3. Berk AT, Kocak N, Unsal E (2001) Uveitis in juvenile arthritis. Ocul Immunol Inflamm 9 243-251 4....

Risk Factors for the Development of Uveitis in JRA

Several clinical and laboratory factors have been associated with the development of uveitis in JRA. It has to be kept in mind, however, that retrospective studies investigating the prevalence of uveitis in children with JRA are limited because of differences in the classification systems in the past. Although these limitations need to be borne in mind, several factors including gender, type and onset of arthritis and laboratory findings such as autoantibodies have been proposed as risk factors...

With Ocular Inflammatory Disease

The association of the HLA-B*27 serotype with acute anterior uveitis (AAU) was first described 30 years ago. HLA-B*27 is also associated with ankylosing spondylitis, Reiter's syndrome, pso-riatic arthritis, and inflammatory bowel disease. Multiple studies have confirmed that between half and two-thirds of individuals with acute anterior uveitis are HLA-B*27 positive and a significant number of patients with AAU will have a spondyloarthropathy 100 . The relative risk for developing AAU for an...

Summary for the Clinician

Ham DI, Gentleman S, Chan CC, McDowell JH, Redmond TM, Gery I (2002) RPE65 is highly uveitogenic in rats. Invest Ophthalmol Vis Sci 43 2258-2263 16. Sun B, Rizzo LV, Sun SH, Chan CC, Wiggert B, Wilder RL, Caspi RR (1997) Genetic susceptibility to experimental autoimmune uveitis involves more than a predisposition to generate a T helper-1-like or a T helper-2-like response. J Immunol 159 1004-1011 17. Agnello D, Lankford CS, Bream J, Morinobu A, Gadina M, O'Shea JJ, Frucht DM (2003)...

Info

Peripheral retina of a Mestizo individual with Vogt-Koyanagi disease in the chronic phase showing retinal pigment epithelial changes. This patient had the HLA-DRBi*0102 allele 4 . It may be that multiple HLA-DR1 and HLA-DR4 subtypes can confer risk for VKH disease, perhaps by binding similar antigenic peptides, and the specific alleles present in the population at risk will determine the relative risk of a given allele. HLA-DQ associations with VKH disease have also been described 41,...

Diagnostic Tools

Anterior scleritis is generally a clinical diagnosis, based upon external examination under direct light and slit lamp examination 45 . Fluo-rescein angiography of the anterior segment may be an adjunctive diagnostic tool in differentiating the type of anterior scleritis, particularly in detecting early necrotizing scleritis 25, 44 . In diffuse anterior scleritis, rapid filling of all vascular networks with decreased transit time, subtle capillary alterations, and abnormal leakage patterns may...

Medical Management

For non-necrotizing forms of scleritis, such as diffuse and nodular, oral non-steroidal anti-inflammatory medications NSAIDs 24, 33, 42, 43, 45 , such as indomethacin, are considered first-line treatment with a 92 success rate 33 . When patients fail to respond to oral NSAIDs, systemic corticosteroids may be substituted or more effectively used in combination with NSAIDs 24 . Systemic corticosteroids can be administered as oral prednisone 60 mg daily or intravenously pulsed methylprednisolone....