Uso de fármacos inmunomoduladores en una consulta de uveítis / Use of immunomodulatory drugs at a uveitis clinic

OBJETIVO: En el tratamiento de las uveítis no infecciosas se emplean corticoides y fármacos inmunomoduladores. Su uso ha aumentado en los últimos años y se ha enriquecido con la aparición de nuevos tratamientos. Sin embargo, no existen guías ni protocolos claros de actuación. El objetivo es analizar la respuesta a los fármacos empleados y las características de los pacientes atendidos en una consulta multidisciplinaria de uveítis. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo de los pacientes atendidos desde enero de 2012 hasta diciembre de 2015. Se excluyen las uveítis infecciosas, posquirúrgicas, postraumáticas y los síndromes de enmascaramiento. RESULTADOS: Se incluyeron 216 pacientes. El 58,80% son uveítis sin afectación sistémica, la mayoría idiopáticas, y el 35,65% uveítis con afectación sistémica, asociadas principalmente a espondiloartritis. Las uveítis sin afectación sistémica y las uveítis anteriores se controlaron mejor que el resto con tratamiento local (p = 0,002 y p < 0,001, respectivamente). El 49,76% de los pacientes requirió tratamiento sistémico. De los pacientes tratados con inmunomoduladores, el 53,26% precisó un segundo fármaco y el 31,52%, un tercero. Las mujeres necesitaron inmunomoduladores con más frecuencia que los varones (p = 0,042). El inmunomodulador más empleado fue metotrexato. Las uveítis posteriores respondieron al segundo inmunomodulador peor que las anteriores (p = 0,006). CONCLUSIONES: Casi la mitad de los pacientes necesitaron un fármaco inmunomodulador y algunos precisaron varios cambios sucesivos de fármaco. Las uveítis intermedias resultaron las más refractarias al tratamiento

OBJECTIVE: The treatment of noninfectious uveitis includes steroids and immunomodulatory drugs, the use of which has increased in the last few years, and the options have been enriched with the development of new treatments. However, clear therapeutic guidelines and protocols have not been developed. The purpose is to analyze the response to the drugs used and the characteristics of the patients treated at a multidisciplinary uveitis clinic. MATERIAL AND METHODS: Observational and retrospective study of the patients attended to from January 2012 to December 2015. Infectious, posttraumatic and postoperative uveitis, as well as masquerade syndrome, were excluded. RESULTS: Two hundred six patients were included. Overall, 58.80% had uveitis without association of systemic disease, mostly idiopathic uveitis, and 35.65% had uveitis with systemic involvement, mainly related to spondyloarthritis. Uveitis without systemic association and anterior uveitis achieved disease control with local treatment more frequently than others (p=.002 and p <.001, respectively). In all, 49.76% of the patients required systemic treatment. Among those treated with immunomodulators, 53.26% needed a second drug and 31.52% needed a third drug. Women required immunomodulators more often than men (P=.042). Methotrexate was the most widely used immunomodulator. Posterior uveitis responded less favorably to the second immunomodulator than anterior uveitis (p=.006). CONCLUSIONS: Almost half of the patients needed an immunomodulatory drug and some of them required successive drug changes. Intermediate uveitis was the most treatment-refractory uveitis

Use of Immunomodulatory Drugs at a Uveitis Clinic. / Uso de fármacos inmunomoduladores en una consulta de uveítis.

OBJECTIVE: The treatment of noninfectious uveitis includes steroids and immunomodulatory drugs, the use of which has increased in the last few years, and the options have been enriched with the development of new treatments. However, clear therapeutic guidelines and protocols have not been developed. The purpose is to analyze the response to the drugs used and the characteristics of the patients treated at a multidisciplinary uveitis clinic. MATERIAL AND METHODS: Observational and retrospective study of the patients attended to from January 2012 to December 2015. Infectious, posttraumatic and postoperative uveitis, as well as masquerade syndrome, were excluded. RESULTS: Two hundred six patients were included. Overall, 58.80% had uveitis without association of systemic disease, mostly idiopathic uveitis, and 35.65% had uveitis with systemic involvement, mainly related to spondyloarthritis. Uveitis without systemic association and anterior uveitis achieved disease control with local treatment more frequently than others (p=.002 and p <.001, respectively). In all, 49.76% of the patients required systemic treatment. Among those treated with immunomodulators, 53.26% needed a second drug and 31.52% needed a third drug. Women required immunomodulators more often than men (P=.042). Methotrexate was the most widely used immunomodulator. Posterior uveitis responded less favorably to the second immunomodulator than anterior uveitis (p=.006). CONCLUSIONS: Almost half of the patients needed an immunomodulatory drug and some of them required successive drug changes. Intermediate uveitis was the most treatment-refractory uveitis.

Uveitis as the initial clinical manifestation in patients with spondyloarthropathies.

OBJECTIVE: To investigate the frequency and pattern of presentation of uveitis as the first clinical manifestation to prompt diagnostic evaluation in patients with spondyloarthropathies (SpA). METHODS: Patients with uveitis were attended simultaneously by ophthalmologists and rheumatologists in our Uveitis Clinic between June 1997 and October 2000. An established clinical protocol based on the pattern of uveitis and the patient's symptoms was used to determine diagnosis. Evaluation included clinical history, ophthalmologic examination, hemogram, biochemistry, erythrocyte sedimentation rate, the fluorescent treponemal antibody absorption test, urinalysis, and chest radiograph. Additional studies were requested according to the protocol. RESULTS: Data from 394 patients were recorded in our database. Seventy-two (18%) had some type of SpA; their mean age was 44.7 years (SD 15.7) and 51 (71.8%) were men. Forty-two patients (59%) of the SpA group had been previously diagnosed. In the 30 (41%) who were undiagnosed, uveitis was the first manifestation to prompt diagnostic evaluation. The most frequent clinical pattern was acute unilateral anterior uveitis. The 2 main keys to confirm the diagnosis of SpA were the presence of recurrent acute unilateral uveitis and low back or joint pain, in addition to the uveitis flare. HLA-B27 was found in 94% of patients. CONCLUSION: In 41% of the patients diagnosed with SpA, uveitis was the first clinical sign, suggesting that collaboration between ophthalmologists and rheumatologists greatly aids the diagnosis and treatment of these patients. When this close collaboration is not possible, all patients with rheumatic complaints and recurrent acute unilateral uveitis should be referred to a rheumatologist.

Sulfasalazine reduces the number of flares of acute anterior uveitis over a one-year period.

OBJECTIVE: To evaluate the efficacy of sulfasalazine (SSZ) in the prevention of recurrent flares of acute anterior uveitis (AAU). METHODS: We included patients seen from June 1997 to October 2000 in this prospective, open, longitudinal study who fulfilled the following inclusion criteria: either (1) > or = 3 flares of AAU in the previous year or (2) > or = 2 recurrences of uveitis within 3 months before starting the trial. We excluded uveitis of infectious or malignant origin or patients with contraindications to the drug. The response criteria were defined as absence of symptoms and the presence of a normal ophthalmologic examination. The major outcome was the number of flares of uveitis over a one-year period compared in the same group of patients with the flares along the previous year without SSZ. RESULTS: Three hundred ninety-four patients with uveitis were evaluated during the period of the study and 10 patients fulfilled the inclusion criteria. The mean number of flares in the pre-SSZ year was 3.4 (SD 0.5), which was significantly reduced to 0.9 (SD 1.1) in the year of treatment (p = 0.007). CONCLUSION: SSZ treatment seems to reduce the number of flares over a one year period in patients with recurrent AAU.