Eye Inflammation and Arthritis

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Category: Inflammatory Spondyarthropathy Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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Like rheumatoid arthritis, uveitis is an inflammatory process.  Rather than affecting our joints, uveitis causes inflammation of one or several specific areas of the eye.

Two cases that I commonly see are like Tom, a 45-year-old man with recurrent episodes of eye redness and pain.  Diagnosed with anterior uveitis after slip lamp examination, a simple and painless test in which a light is shined into the eye while looking through a magnifying microscope, Tom's ophthalmologist referred him to me.  I found him to also have ankylosing spondylitis associated with his acute anterior uveitis.

Another common case, like Emily, a 10-year-old girl with frequent joint pain and swelling of the knees and ankles, diagnosed with juvenile idiopathic arthritis.  Even though she had no eye symptoms, she was referred to an ophthalmologist, who confirmed associated chronic uveitis after slit lamp examination.

As you see, the symptoms of uveitis depend on the site of involvement.  Acute anterior uveitis develops suddenly and causes eye redness, pain and sensitivity to light (photophobia).  Commonly associated with ankylosing spondylitis, more so in males than in females, the HLA B27-specific gene marker has been seen in about half of patients.

On the other hand, persistent uveitis, as with juvenile idiopathic arthritis, may show no symptoms despite inflammation and intra-ocular damage, until scarring, loss of vision or cataracts develops.  People with chronic posterior uveitis, such as with Behçet disease, are more likely to be pain-free, but most commonly experience visual changes such as floaters or haziness.

Although not a common cause of uveitis, infection must be ruled out.  Other possible causes of uveitis, at least half of the time, are due to systemic inflammatory diseases including Behçet’s disease, sarcoidosis, juvenile idiopathic arthritis, inflammatory bowel disease and HLA-B 27- associated disease, especially ankylosing spondylitis and reactive arthritis.   Recurrent oral and genital ulcers with chronic bilateral uveitis characterize Behçet disease, most commonly seen in the Mediterranean and eastern rim of Asia.

Topical corticosteroids are usually effective in treating mild to moderate anterior uveitis, but are not recommended for posterior uveitis because of limited penetration and efficacy.  Immunosuppressive drugs such as methotrexate, azathioprine, cyclosporine, cyclophasmide and new biologic agents are a good choice for patients with a poor response to corticosteroids or on high doses oral corticosteroids for a prolonged period.

In order to avoid complications of uveitis, such as cataracts, glaucoma or even vision loss, the best plan of action is to have your uveitis managed by an ophthalmologist and rheumatologist and internist if systemic disease is involved. In general, dosing and toxicity of immunosuppressive agents are managed by your rheumatologist, while disease activity and ocular damage, which would show the need for a change in therapy, will be directed by your ophthalmologist.

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