Eye Inflammation and HLA-B27 gene

Print
Category: Other Autoimmune Diseases Published on Thursday, 23 July 2015 Written by Yong Tsai, MD
Share

Tim, a 45-year-old man, had experienced recurrent episodes of eye redness and pain for several years. 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, finally, he was diagnosed to have ankylosing spondylitis associated with his acute anterior uveitis.

Emily, a 10-year-old girl, had frequent joint pain and swelling of the knees and ankles and was diagnosed with juvenile rheumatoid arthritis. Even though she had no eye symptoms, chronic uveitis was confirmed after slip lamp examination.

As we know, the symptoms of uveitis depend on the site of involvement. Acute anterior uveitis (AAU) develops suddenly and causes eye redness, pain, and sensitivity to light. AAU is the most common form (90%) of uveitis. Approximately half of all patients with AAU are positive for HLA-B27 gene. 50 % of patients with HLA- B 27 gene will also develop seronegative spondyloarthropathy (SPA) such as ankylosing spondylitis or inflammatory bowel disease. First attack of AAU with HLA B-27 gene usually occurs between 20 and 40 years of age. Male are affected about 2.5 times more frequently than females.

AAU generally runs a short course of a few days to weeks up to 3 months, with a tendency to recur in the same eye, especially in individuals who are HLA-B27 positive. The prognosis of anterior uveitis associated with HLA-B27, is less favorable when compared with patients who are HLA-B27 negative. Classic AAU resolves completely with prompt and aggressive treatment. Undertreated or misdiagnosed cases may cause permanent damage.

Chronic persistent uveitis, as with juvenile rheumatoid 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 Behcet’ disease or sarcoidosis, are more likely to be pain-free, but most commonly experience visual changes such as floaters or haziness. Recurrent oral and genital ulcers with chronic bilateral uveitis characterize Behçet’s disease, most commonly seen in the Mediterranean and eastern rim of Asia. Sarcoidosis is an inflammatory disease and commonly affects the lungs, lymph glands, joints and skin. Although not a common cause of uveitis, infection such as syphilis and toxoplasmosis still need be considered.

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. Intraocular corticosteroid injections or short-term oral corticosteroid is sometimes needed. Immunosuppressive drugs such as methotrexate, azathioprine, cyclosporine or cyclophasmide, and new biologic agents such as Remicade or Humira are a good choice for patients with a poor response to corticosteroids or on high doses oral corticosteroids for a prolonged period.

Hits: 2522