Demographic and Clinical Data of Patients Presenting With Uveitis: A Single Center Experience

Year 2024, , 52 - 56, 29.02.2024

Yunus Emre Bayrak , Nihal Şahin , Ecem Önder Tokuç Hafize Emine Sönmez , Levent Karabas

https://doi.org/10.53446/actamednicomedia.1330298

Abstract

Objective: This study aimed to evaluate the demographic and clinical findings of patients presenting with uveitis who applied to the pediatric rheumatology outpatient clinic.
Method: The clinical features, laboratory and immunological findings, infection markers, and treatment responses of patients with uveitis were analyzed retrospectively. This cross-sectional study was conducted between August 2020 and March 2023.
Results: Sixty patients were included in the study. Of them, 26 (43%) were female and 34 (57%) were male. The median age, age of symptom onset, and diagnosis of the patients were 160 (23-240), 136 (16-204), and 136 (18-216), respectively. The most common complaint was redness of the eye (73%). The localization of uveitis was anterior (59%), posterior (16%), panuveitis (16%), and pars planitis (9%), respectively. Twelve (20%) patients had infectious uveitis. The causes of non-infectious uveitis were idiopathic (81%), Behçet's disease (8%), juvenile idiopathic arthritis (8%), and tubulointerstitial nephritis and uveitis syndrome (2%), respectively. Twenty-one patients (35%) were ANA positive and HLA-B27 positivity was 14%. Forty-five patients (75%) were treated with local steroid therapy. Other treatments were systemic steroids (n=30, 50%), DMARDs (n=29, 48.3%), and biologic agents (n=16, 26.7%), respectively. At last control, 26 (43.3%) patients were in remission without treatment. Nine patients discontinued follow-up. Twenty-five patients continued to be followed up with medication. In the follow-up, 2 patients developed glaucoma, 2 patients were operated for cataract and 2 patients were operated for posterior synechia.
Conclusion: Sixty patients with uveitis were examined. The most common cause of uveitis was idiopathic while the most common cause of infectious diseases was Bartonella henselae. The experiences in our clinic as a referral center may provide a roadmap for clinicians dealing with these patients in their daily practice.

Keywords

Uveitis, juvenile idiopathic arthritis, Bartonella henselae

Project Number

2023/187

Üveit İle Başvuran Hastaların Demografik ve Klinik Verileri: Tek Merkez Deneyimi

Abstract

Çocuk romatoloji polikliniğine başvuran üveit tanılı hastaların etyolojik faktörlerinin dağılımının değerlendirilmesini amaçladık.
Yöntem: Ağustos 2020-Mart 2023 arasında üveit tanısı alan olguların klinik özellikleri, laboratuvar ve immünolojik test verileri, enfeksiyon belirteçleri ve tedavi yanıtları geriye dönük olarak incelendi.
Bulgular: Çalışmaya 60 hasta dahil edildi. Hastaların 26’sı (%43) kız, 34’ü (%57) ise erkekti. Hastaların ortanca yaşı 160 (23-240), semptom başlama yaşı 136 (16-204), tanı yaşı 136 (18-216) aydı. Gözde kızarıklık (%73) en sık başvuru şikayetiydi. Üveit lokalizasyonu sırasıyla; anterior (ön) (%59), posterior (arka) (%16), pan-üveit (%16) ve pars planitti (%9). Hastaların 12’si (%20) enfeksiyöz üveitti. Enfeksiyöz dışı üveit nedenleri ise sırasıyla; idiyopatik (%81), Behçet hastalığı (%8), juvenil idiopatik artrit (%8) ve tübülointerstisyel nefrit ve üveit sendromuydu (%2). Yirmi bir hastada (%35) ANA değeri pozitif olarak saptandı. HLA-B27 pozitifliği %14 idi. Kırk beş hastaya (%75) tedavi lokal steroid tedavisi uygulandı. Diğer uygulanan tedaviler sırasıyla; sistemik steroid (30,%50 hasta), DMARD (29, %48,3 hasta) ve biyolojik ajandı (16, %26,7 hasta). Uygulanan tedaviler sonrasında 26 (%43,3) hasta tedavisiz remisyonda idi. Dokuz hasta takibi bırakmıştı. Yirmi beş hastanın ilaçla takibine devam etmekteydi. Takipte 2 hastada glokom gelişmişti, 2 hasta katarakt ve 2 hasta da posterior sineşi nedeni ile opere olmuştu.
Sonuç: Kliniğimizde 60 üveit tanılı hasta incelendi. En sık neden idiyopatik iken, enfeksiyöz hastalıklar içinde en sık etken kedi tırmığı idi. Çocuk romatoloji hekimlerinin sık sık karşısına çıkan üveit kalıcı görme kaybına neden olabilen önemli bir hastalıktır. Referans merkez olan kliniğimizdeki tecrübeler bu hastalarla günlük pratiğinde uğraşan çocuk ve çocuk romatoloji hekimlerine bir yol haritası çizebilir.

Keywords

Üveit, juvenil idiyopatik artrit, Bartonella Hanselae

Supporting Institution

Kocaeli Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu

Project Number

2023/187

References

• Clarke SL, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J. 2016;14(1):27. doi: 10.1186/s12969-016-0088-2.
• Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369(9563):767-778. doi:10.1016/S0140-6736(07)60363-8
• Suttorp-Schulten MS, Rothova A. The possible impact of uveitis in blindness: a literature survey. Br J Ophthalmol. 1996;80(9):844-8. doi: 10.1136/bjo.80.9.844
• Deschenes J, Murray PI, Rao NA, Nussenblatt RB. International Uveitis Study Group. International Uveitis Study Group (IUSG): clinical classification of uveitis. Ocul Immunol Inflamm. 2008;16(1):1-2. doi:10.1080/09273940801899822
• Oliver GF, Carr JM, Smith JR. Emerging infectious uveitis: Chikungunya, dengue, Zika and Ebola: A review. Clin Exp Ophthalmol. 2019;47:372-380. doi: 10.1111/ceo.13450
• Merle H, Donnio A, Jean-Charles A, et al. Ocular manifestations of emerging arboviruses: Dengue fever, Chikungunya, Zika virus, West Nile virus, and yellow fever. J Fr Ophtalmol. 2018;41(6):235-243. doi:10.1016/j.jfo.2018.05.002
• Cunningham ET Jr, Downes KM, Chee SP, Zierhut M. Cytomegalovirus Retinitis and Uveitis. Ocul Immunol Inflamm. 2015;23(5):359-61. doi:10.3109/09273948.2015.1090820
• Lindström BE, Skogman BH, Lindström AK, Tallstedt L, Nilsson K. Borrelia Ocular Infection: A Case Report and a Systematic Review of Published Cases. Ophthalmic Res. 2022;65(2):121-130. doi: 10.1159/000521307
• Cann M, Ramanan AV, Crawford A, et al. Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy. Pediatr Rheumatol Online J. 2018;16(1):51. doi:10.1186/s12969-018-0266-5
• Chan NS, Choi J, Cheung CMG. Pediatric Uveitis. Asia Pac J Ophthalmol (Phila). 2018;7(3):192-199. doi:10.22608/APO.2018116
• Gamalero L, Simonini G, Ferrara G, Polizzi S, Giani T, Cimaz R. Evidence-Based Treatment for Uveitis. Isr Med Assoc J. 2019;21:475-479.
• 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;140(3):509-16. doi:10.1016/j.ajo.2005.03.057
• Ozdel S, Baglan E, Gungor T, et al. Comparison of pediatric patients with noninfectious idiopathic uveitis and noninfectious uveitis associated with an underlying systemic disease: from a referral center in Turkey. Postgrad Med. 2021 May;133(4):444-448. doi:10.1080/00325481.2021.1902684
• Çakan M, Yildiz Ekinci D, Gül Karadağ Ş, Aktay Ayaz N. Etiologic Spectrum and Follow-Up Results of Noninfectious Uveitis in Children: A Single Referral Center Experience. Arch Rheumatol. 2019;34(3):294-300. doi:10.5606/ArchRheumatol.2019.7253
• Arslanoglu Aydin E, Ozdel S, Cakar Ozdal P, et al. Changing face of non-infectious pediatric uveitis in the pre-pandemic and pandemic periods: a comparison study. Postgrad Med. 2023 May;135(4):418-423. doi:10.1080/00325481.2023.2184092
• Yeung IY, Popp NA, Chan CC. The role of sex in uveitis and ocular inflammation. Int Ophthalmol Clin. 2015;55(3):111-31. doi:10.1097/ IIO.0000000000000072
• Sen HN, Davis J, Ucar D, Fox A, Chan CC, Goldstein DA. Gender disparities in ocular inflammatory disorders. Curr Eye Res. 2015;40(2):146-61. doi:10.3109/02713683.2014.932388
• Choudhary MM, Hajj-Ali RA, Lowder CY. Gender and ocular manifestations of connective tissue diseases and systemic vasculitides. J Ophthalmol. 2014;2014:403042. doi:10.1155/2014/403042
• Yalçındağ FN, Özdal PC, Özyazgan Y, Batıoğlu F, Tugal-Tutkun I. BUST Study Group. Demographic and Clinical Characteristics of Uveitis in Turkey: The First National Registry Report. Ocul Immunol Inflamm. 2018;26(1):17-26. doi: 10.1080/09273948.2016.1196714.
• Yalçındağ FN, Güngör SG, Değirmenci MFK, et al. The Clinical Characteristics of Pediatric Non-Infectious Uveitis in Two Tertiary Referral Centers in Turkey. Ocul Immunol Inflamm. 2021;29(2):282-289. doi:10.1080/09273948.2019.1674890
• Ekici Tekin Z, Otar Yener G, Akbulut S, Çetin EN, Yüksel S. Follow-up Findings of Non-infectious Pediatric Uveitis Patients. Turk J Ophthalmol. 2021;51(6):351-357. doi:10.4274/ tjo.galenos.2021.38585.
• Darrell RW, Wagener HP, Kurland LT. Epidemiology of uveitis. Incidence and prevalence in a small urban community. Arch Ophthalmol. 1962;68:502-14. doi:10.1001/ archopht.1962.00960030506014
• Keino H, Watanabe T, Taki W, et al. Clinical features of uveitis in children and adolescents at a tertiary referral centre in Tokyo. Br J Ophthalmol. 2017;101(4):406-410. doi: 10.1136/ bjophthalmol-2015-308194
• Tsirouki T, Dastiridou A, Symeonidis C, et al. A Focus on the Epidemiology of Uveitis. Ocul Immunol Inflamm. 2018;26(1):2-16. doi:10.1080/09273948.2016
• Cimino L, Aldigeri R, Salvarani C, et al. The causes of uveitis in a referral centre of Northern Italy. Int Ophthalmol. 2010;30(5):521-9. doi:10.1007/ s10792-010-9359-y
• Grajewski RS, Caramoy A, Frank KF, et al. Spectrum of Uveitis in A German Tertiary Center: Review of 474 Consecutive Patients. Ocul Immunol Inflamm. 2015;23(4):346-352. doi:10.3109/09273948.2014.1002567.
• Jakob E, Reuland MS, Mackensen F, et al. Uveitis subtypes in a german interdisciplinary uveitis center--analysis of 1916 patients. J Rheumatol. 2009;36(1):127-36. doi:10.3899/ jrheum.080102
• Jones NP. The Manchester Uveitis Clinic: the first 3000 patients--epidemiology and casemix. Ocul Immunol Inflamm. 2015;23(2):118-26. doi:10.3109/09273948.2013.855799
• Sahin S, Acari C, Sonmez HE, et al. Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER. Pediatr Rheumatol Online J. 2021;19(1):134. doi:10.1186/ s12969-021-00613-2
• 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;130(4):492-513. doi:10.1016/s0002-9394(00)00659-0
• Pasadhika S, Kempen JH, Newcomb CW, et al. Azathioprine for ocular inflammatory diseases. Am J Ophthalmol. 2009;148(4):500-509. doi:10.1016/ j.ajo.2009.05.008
• Daniel E, Thorne JE, Newcomb CW, et al. Mycophenolate mofetil for ocular inflammation. Am J Ophthalmol. 2010;149(3):423-432. doi:10.1016/ j.ajo.2009.09.026
• Ali A, Rosenbaum JT. Use of methotrexate in patients with uveitis. Clin Exp Rheumatol. 2010;28(5 Suppl 61):145-150.
• Maccora I, Sen ES, Ramanan AV. Update on noninfectious uveitis in children and its treatment. Curr Opin Rheumatol. 2020;32(5):395-402. doi:10.1097/BOR.0000000000000723