Anti-retinal Antibodies in Sarcoidosis.

PURPOSE: To measure, characterize, and evaluate the clinical significance of anti-retinal antibodies in patients with sarcoid uveitis. SUBJECTS/METHODS: Prospective study of anti-retinal antibodies in 45 patients with biopsy-proven sarcoidosis (25 with and 20 without uveitis). Results were compared with patients with confirmed infectious uveitis (n = 40) and non-infectious uveitis (n = 40). RESULTS: Among sarcoidosis patients, anti-retinal antibodies were positive in 23/25 patients with uveitis and in 15/20 without uveitis [P = ns]. The most common antigens recognized were carbonic anhydrase II (14/23) and α-enolase (6/23). Anti-carbonic anhydrase II autoantibodies were infrequently detected in sarcoidosis patients without uveitis (2 out 15, P < .001), in patients with infectious uveitis (1 out 18, P < .001), and in patients with non-infectious uveitis (8 out 37, P < .001). CONCLUSIONS: Anti-retinal antibodies recognizing carbonic anhydrase II are common in sarcoid uveitis. Although not fully sensitive and specific, they might be a useful non-invasive diagnostic tool for the diagnosis of sarcoid uveitis.

Preoperative cataract surgery use of an intravitreal dexamethasone implant (Ozurdex) in a patient with juvenile idiopathic arthritis and chronic anterior uveitis.

We report a 6-year-old boy with anterior uveitis associated with juvenile idiopathic arthritis (JIA) who underwent cataract extraction in his right eye. One month before surgery he received an intravitreal sustained-release dexamethasone implant. During 10 months' follow-up, his uveitis remained quiet. To our knowledge this is the first report using an intravitreal sustained-release dexamethasone implant as a perioperative anti-inflammatory medication.

Serum cytokine profile in adalimumab-treated refractory uveitis patients: decreased IL-22 correlates with clinical responses.

PURPOSE: To report the effect of adalimumab on serum cytokines in chronic refractory uveitis. METHODS: Prospective study on the effects of adalimumab on serum cytokine levels at different time points in a cohort of 12 refractory chronic uveitis patients. Results were analyzed according to clinical outcomes and compared with systemic steroid-treated recurrent uveitis patients. RESULTS: Before treatment, patients exhibited significantly increased IL-1ß, IL-6, TNFα, IL-12 p70, IL-10, and IL-22. Adalimumab significantly decreased IL-6, and IL-12p70 at early time points (after 1 month of treatment). Adalimumab effects on IL-10 and IL-22 appeared later (after 6 months of treatment). IL-1ß, IL-17A, and TNFα were not modified at any time point. Only decreased IL-22 serum levels correlated with disease activity (p = 0.011). These effects were not observed in steroid-treated patients. CONCLUSIONS: Adalimumab induced drug-specific and time-dependent declines in serum levels of particular cytokines, although only IL-22 correlated with disease activity in 10 out 12 patients.

Refractory pyoderma gangrenosum of the orbit and the lacrimal sac.

Pyoderma gangrenosum (PG) is a rare, idiopathic, necrotizing, and non-infectious ulcerating skin disease included among the neutrophilic dermatoses. It rarely affects the eye, orbit, and/or ocular adnexa. We describe one case of PG affecting both orbits and the lacrimal sac in a patient with Crohn's disease.

Duodenal biopsy may be avoided when high transglutaminase antibody titers are present.

AIM: To evaluate the predictive value of tissue transglutaminase (tTG) antibodies for villous atrophy in adult and pediatric populations to determine if duodenal biopsy can be avoided. METHODS: A total of 324 patients with celiac disease (CD; 97 children and 227 adults) were recruited prospectively at two tertiary centers. Human IgA class anti-tTG antibody measurement and upper gastrointestinal endoscopy were performed at diagnosis. A second biopsy was performed in 40 asymptomatic adults on a gluten-free diet (GFD) and with normal tTG levels. RESULTS: Adults showed less severe histopathology (26% vs 63%, P < 0.0001) and lower tTG antibody titers than children. Levels of tTG antibody correlated with Marsh type in both populations (r = 0.661, P < 0.0001). Multiple logistic regression revealed that only tTG antibody was an independent predictor for Marsh type 3 lesions, but clinical presentation type and age were not. A cut-off point of 30 U tTG antibody yielded the highest area under the receiver operating characteristic curve (0.854). Based on the predictive value of this cut-off point, up to 95% of children and 53% of adults would be correctly diagnosed without biopsy. Despite GFDs and decreased tTG antibody levels, 25% of the adults did not recover from villous atrophy during the second year after diagnosis. CONCLUSION: Strongly positive tTG antibody titers might be sufficient for CD diagnosis in children. However, duodenal biopsy cannot be avoided in adults because disease presentation and monitoring are different.