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Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center

BACKGROUND: The aim of this study was to identify the main features of a cohort of Caucasian patients with idiopathic (I) and systemic disease-associated (SDA) autoimmune uveitis (AU) who were followed up at a single tertiary reference center. The study consisted of a retrospective analysis of the d...

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Autores principales: Prete, Marcella, Guerriero, Silvana, Dammacco, Rosanna, Fatone, Maria Celeste, Vacca, Angelo, Dammacco, Francesco, Racanelli, Vito
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108222/
https://www.ncbi.nlm.nih.gov/pubmed/25097673
http://dx.doi.org/10.1186/s12348-014-0017-9
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author Prete, Marcella
Guerriero, Silvana
Dammacco, Rosanna
Fatone, Maria Celeste
Vacca, Angelo
Dammacco, Francesco
Racanelli, Vito
author_facet Prete, Marcella
Guerriero, Silvana
Dammacco, Rosanna
Fatone, Maria Celeste
Vacca, Angelo
Dammacco, Francesco
Racanelli, Vito
author_sort Prete, Marcella
collection PubMed
description BACKGROUND: The aim of this study was to identify the main features of a cohort of Caucasian patients with idiopathic (I) and systemic disease-associated (SDA) autoimmune uveitis (AU) who were followed up at a single tertiary reference center. The study consisted of a retrospective analysis of the demographic, clinical, and laboratory features and the response to treatment of 104 patients with AU evaluated between 2004 and 2013, with a median follow-up of 4.8 years. The primary outcome measure was the response to systemic treatment after 24 months of therapy. The data are expressed as the range, percentage, or mean ± standard error. Categorical variables were assessed by Fisher's exact test. RESULTS: The mean age at diagnosis was 40.1 ± 17.8 years for men and 44.1 ± 15.3 years for women. There was a slight female predominance. Of the 104 patients, 72.1% had I-AU and 27.9% SDA-AU. The most frequent associations were with ankylosing spondyloarthritis, autoimmune thyroiditis, inflammatory bowel diseases, and Behcet's disease. Symptoms at presentation consisted of eye redness and pain (28.8%), decreased visual acuity (25.9%), and floaters (18.3%). Complications included cataracts (24%), retinal neovascularization (16.3%), chorio-retinal scars (10.6%), cystoid macular edema (8.6%), glaucoma/ocular hypertension (7.7%), epiretinal membranes (4.8%), and retinal detachment (3.8%). The prevalence of autoantibodies, mostly antinuclear antibodies, was comparable between the I-AU and SDA-AU groups. Fisher's exact test showed a direct correlation between patients with class I HLA B27, Cw8, B5 (51, 52), B51, or Cw2 and the presence of AU, whereas among patients with class II HLA, only DQ1 was a predisposing factor for AU. The therapeutic spectrum included corticosteroids and immunosuppressive agents, given either alone or in various combinations according to the severity of AU and the extent of the clinical response. Among the immunosuppressive drugs, azathioprine was preferentially used for anterior uveitis, and cyclosporine-A for intermediate and posterior uveitis. An assessment of the patients after 24 months of therapy showed a complete remission in 43.3% and a significant clinical improvement in 26.9%. CONCLUSIONS: At our tertiary reference center, the prevalence in Caucasian patients of I-AU was approximately 2.5-fold higher than that of SDA-AU. Our findings point to the need for a patient-tailored therapeutic approach according to the anatomic site and the severity of AU. Therapy should be prolonged, over a period of months and even up to 1–2 years, in order to achieve stable control of the disease and to prevent severe complications. The outcome of SDA-AU is also influenced by treatment of the underlying systemic disease. Additional controlled trials are needed to assess the efficacy and the long-term safety of both the prescribed therapeutic agents and their combinations.
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spelling pubmed-41082222014-08-05 Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center Prete, Marcella Guerriero, Silvana Dammacco, Rosanna Fatone, Maria Celeste Vacca, Angelo Dammacco, Francesco Racanelli, Vito J Ophthalmic Inflamm Infect Original Research BACKGROUND: The aim of this study was to identify the main features of a cohort of Caucasian patients with idiopathic (I) and systemic disease-associated (SDA) autoimmune uveitis (AU) who were followed up at a single tertiary reference center. The study consisted of a retrospective analysis of the demographic, clinical, and laboratory features and the response to treatment of 104 patients with AU evaluated between 2004 and 2013, with a median follow-up of 4.8 years. The primary outcome measure was the response to systemic treatment after 24 months of therapy. The data are expressed as the range, percentage, or mean ± standard error. Categorical variables were assessed by Fisher's exact test. RESULTS: The mean age at diagnosis was 40.1 ± 17.8 years for men and 44.1 ± 15.3 years for women. There was a slight female predominance. Of the 104 patients, 72.1% had I-AU and 27.9% SDA-AU. The most frequent associations were with ankylosing spondyloarthritis, autoimmune thyroiditis, inflammatory bowel diseases, and Behcet's disease. Symptoms at presentation consisted of eye redness and pain (28.8%), decreased visual acuity (25.9%), and floaters (18.3%). Complications included cataracts (24%), retinal neovascularization (16.3%), chorio-retinal scars (10.6%), cystoid macular edema (8.6%), glaucoma/ocular hypertension (7.7%), epiretinal membranes (4.8%), and retinal detachment (3.8%). The prevalence of autoantibodies, mostly antinuclear antibodies, was comparable between the I-AU and SDA-AU groups. Fisher's exact test showed a direct correlation between patients with class I HLA B27, Cw8, B5 (51, 52), B51, or Cw2 and the presence of AU, whereas among patients with class II HLA, only DQ1 was a predisposing factor for AU. The therapeutic spectrum included corticosteroids and immunosuppressive agents, given either alone or in various combinations according to the severity of AU and the extent of the clinical response. Among the immunosuppressive drugs, azathioprine was preferentially used for anterior uveitis, and cyclosporine-A for intermediate and posterior uveitis. An assessment of the patients after 24 months of therapy showed a complete remission in 43.3% and a significant clinical improvement in 26.9%. CONCLUSIONS: At our tertiary reference center, the prevalence in Caucasian patients of I-AU was approximately 2.5-fold higher than that of SDA-AU. Our findings point to the need for a patient-tailored therapeutic approach according to the anatomic site and the severity of AU. Therapy should be prolonged, over a period of months and even up to 1–2 years, in order to achieve stable control of the disease and to prevent severe complications. The outcome of SDA-AU is also influenced by treatment of the underlying systemic disease. Additional controlled trials are needed to assess the efficacy and the long-term safety of both the prescribed therapeutic agents and their combinations. Springer 2014-07-24 /pmc/articles/PMC4108222/ /pubmed/25097673 http://dx.doi.org/10.1186/s12348-014-0017-9 Text en Copyright © 2014 Prete et al.; licensee Springer. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Original Research
Prete, Marcella
Guerriero, Silvana
Dammacco, Rosanna
Fatone, Maria Celeste
Vacca, Angelo
Dammacco, Francesco
Racanelli, Vito
Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center
title Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center
title_full Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center
title_fullStr Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center
title_full_unstemmed Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center
title_short Autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center
title_sort autoimmune uveitis: a retrospective analysis of 104 patients from a tertiary reference center
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108222/
https://www.ncbi.nlm.nih.gov/pubmed/25097673
http://dx.doi.org/10.1186/s12348-014-0017-9
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