Pascal Sève1, Patrice Cacoub2, Bahram Bodaghi3, Salim Trad4, Jérémie Sellam5, David Bellocq3, Philip Bielefeld6, Damien Sène7, Gilles Kaplanski8, Dominique Monnet9, Antoine Brézin9, Michel Weber10, David Saadoun2, Christophe Chiquet11, Laurent Kodjikian5. 1. Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France; Faculté de Médecine Lyon-Sud, Université Claude Bernard-Lyon 1, France. Electronic address: pascal.seve@chu-lyon.fr. 2. Service de Médecine Interne et Immunologie Clinique, Hôpital Pitié Salpetrière, Université Paris 6, AP-HP, Paris, France; DHU I2B, Inflammation, Immunopathology, Biotherapy, UPMC, Paris VI, France. 3. Service d'Ophtalmologie, Hôpital Pitié Salpetrière, Université Paris 6, AP-HP, Paris, France. 4. Service de Médecine Interne, Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France. 5. Service de Rhumatologie, Hôpital Saint-Antoine, AP-HP, UPMC Univ Paris 06, INSERM UMRS 938, DHU i2B, 75012 Paris, France. 6. Service de Médecine Interne et Maladies Systémiques, CHU Dijon Bourgogne, 21000 Dijon, France. 7. Service de Médecine Interne, Hôpital Lariboisère, AP-HP, GH Saint-Louis Lariboisière Fernand-Widal, France; Université Sorbonne Paris Cité- Paris Diderot, Paris, France. 8. Service de Médecine Interne et Immunologie Clinique, Hôpital de la Conception, 147 Boulevard Baille, 13005 Marseille, France. 9. Service d'Ophtalmologie, Hôpital Cochin, Université Paris-Descartes, Assistance Publique - Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. 10. Service d'Ophtalmologie, Hôtel Dieu, Centre Hospitalo-Universitaire de Nantes, 1 place Alexis Ricordeau, 44093 cédex 1, France. 11. Service d'Ophtalmologie, Hôpital Albert Michalon, Université de Grenoble, F-38009 Grenoble, France.
Abstract
PURPOSE: Diagnosis of uveitis is difficult. Etiologic investigations should take into account the epidemiology of uveitis and should focus on the most severe forms of the disease and those which can be treated. This study was undertaken to establish recommendations for the diagnosis of uveitis. METHODS: Recommendations were developed by a multidisciplinary panel of 14 experts, including internists, ophthalmologists, and rheumatologists, and are based on a review of the literature and the results of the ULISSE study, which was the first prospective study to assess the efficacy of a standardized strategy for the etiologic diagnosis of uveitis. The following groups of patients are not included in these recommendations: children, immunocompromised patients, patients with severe retinal vasculitis, and those with specific eye diseases diagnosed by ophthalmologic examination only. RESULTS: Diagnosis should be guided by the medical history of the patient and physical examination. Serologic screening for syphilis is appropriate in all forms of uveitis. If uveitis is not diagnosed at this stage, investigations oriented by the anatomic characteristics of uveitis are proposed. These consist of assays for HLA-B27 (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin-converting enzyme, interferon-gamma release, chest computed tomography (chronic uveitis), cerebral magnetic resonance imaging and anterior chamber tap with interleukin-10 analysis (intermediate or posterior uveitis in patients >40years-old). Other investigations prescribed in the absence of orientation are usually unhelpful. CONCLUSIONS: A strategy is proposed for the etiologic diagnosis of uveitis. The benefit of more invasive investigations remains to be determined.
PURPOSE: Diagnosis of uveitis is difficult. Etiologic investigations should take into account the epidemiology of uveitis and should focus on the most severe forms of the disease and those which can be treated. This study was undertaken to establish recommendations for the diagnosis of uveitis. METHODS: Recommendations were developed by a multidisciplinary panel of 14 experts, including internists, ophthalmologists, and rheumatologists, and are based on a review of the literature and the results of the ULISSE study, which was the first prospective study to assess the efficacy of a standardized strategy for the etiologic diagnosis of uveitis. The following groups of patients are not included in these recommendations: children, immunocompromised patients, patients with severe retinal vasculitis, and those with specific eye diseases diagnosed by ophthalmologic examination only. RESULTS: Diagnosis should be guided by the medical history of the patient and physical examination. Serologic screening for syphilis is appropriate in all forms of uveitis. If uveitis is not diagnosed at this stage, investigations oriented by the anatomic characteristics of uveitis are proposed. These consist of assays for HLA-B27 (in unilateral acute anterior non-granulomatous uveitis), serum angiotensin-converting enzyme, interferon-gamma release, chest computed tomography (chronic uveitis), cerebral magnetic resonance imaging and anterior chamber tap with interleukin-10 analysis (intermediate or posterior uveitis in patients >40years-old). Other investigations prescribed in the absence of orientation are usually unhelpful. CONCLUSIONS: A strategy is proposed for the etiologic diagnosis of uveitis. The benefit of more invasive investigations remains to be determined.
Authors: Mohammad Ali Sadiq; Muhammad Hassan; Rubbia Afridi; Muhammad Sohail Halim; Diana V Do; Yasir J Sepah; Quan Dong Nguyen Journal: Int J Retina Vitreous Date: 2020-10-06
Authors: Waleed A Hassan; Basma M Medhat; Maha M Youssef; Yomna Farag; Noha Mostafa; Alshaimaa R Alnaggar; Mervat E Behiry; Rasha A Abdel Noor; Riham S H M Allam Journal: Clin Rheumatol Date: 2020-09-02 Impact factor: 2.980