PurposeTuberculous optic neuropathy may follow infection with Mycobacterium tuberculosis or administration of the bacille Calmette–Guerin. However, this condition is not well described in the ophthalmic literature.MethodsOphthalmologists, identified through professional electronic networks or previous publications, collected standardized clinical data relating to 62 eyes of 49 patients who they had managed with tuberculous optic neuropathy.ResultsTuberculous optic neuropathy was most commonly manifested as papillitis (51.6 %), neuroretinitis (14.5 %), and optic nerve tubercle (11.3 %). Uveitis was an additional ocular morbidity in 88.7 % of eyes. In 36.7 % of patients, extraocular tuberculosis was present. The majority of patients (69.4 %) had resided in and/or traveled to an endemic area. Although initial visual acuity was 20/50 or worse in 62.9 % of 62 eyes, 76.7 % of 60 eyes followed for a median of 12 months achieved visual acuities of 20/40 or better. Visual field defects were reported for 46.8 % of eyes, but these defects recovered in 63.2 % of 19 eyes with follow-up.ConclusionVisual recovery from tuberculous optic neuropathy is common, if the diagnosis is recognized and appropriate treatment is instituted. A tuberculous etiology should be considered when evaluating optic neuropathy in persons from endemic areas.

Objective/Purpose Optic neuritis (ON) cases have been reported in patients using anti-tumor necrosis factor (TNF) alpha therapy. However, no population-based studies have been conducted to assess the risk of this complication associated with anti-TNF drugs. Design Cohort study Participants New users of anti-TNF therapy (etanercept, infliximab, or adalimumab) or non-biologic disease modifying agents (DMARDs) during 2000–2007 from the following data sources: Kaiser Permanente Northern California, Pharmaceutical Assistance Contract for the Elderly, Tennessee Medicaid, and National Medicaid/Medicare. Methods We used validated algorithms to identify ON cases occurring after onset of new drug exposure. We calculated and compared ON rates between exposure groups. Main outcome measures ON incidence rates by medication exposure group Results We identified 61,227 eligible inflammatory disease patients with either new anti-TNF or new non-biologic DMARD use. Among this cohort, we found three ON cases among anti-TNF new users, occuring a median 123 days (range, 37–221 days) after anti- TNF start. The crude incidence rate of ON across all disease indications among anti-TNF new users was 10.4 (95% CI 3.3–32.2) cases per 100,000 person-years. In a sensitivity analysis considering current or past anti-TNF or DMARD use, we identified a total of 6 ON cases; 3 among anti-TNF users and 3 among DMARD users. Crude ON rates were similar among anti-TNF and DMARD groups, 4.5 (95% CI 1.4–13.8) and 5.4 (95% CI 1.7–16.6) per 100,000 person-years, respectively. Conclusion Optic neuritis is rare among those who initiate anti-TNF therapy and occurs with similar frequency among those with non-biologic DMARD exposure.

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BackgroundRheumatologic diseases may cause neurologic disorders that mimic multiple sclerosis (MS). A panel of serum autoantibodies is often obtained as part of the evaluation of patients suspected of having MS.ObjectivesTo determine, in light of recently revised diagnostic criteria for MS, neuromyelitis optica, and Sjogren’s Syndrome, if testing for autoantibodies in patients with a confirmed diagnosis of MS would reveal a frequency or demonstrate a clinical utility divergent from previous reports or lead to identification of undiagnosed cases of Sjogren’s Syndrome.MethodsConvenience sample cross-sectional study of MS patients recruited from the OHSU Multiple Sclerosis Center.ResultsAutoantibodies were detected in 38% (35/91) of patients with MS and were not significantly associated with disease characteristics or severity. While four patients had SSA antibodies, none met diagnostic criteria for Sjogren’s Syndrome.ConclusionsRheumatologic autoantibodies are frequently found in MS patients and are not associated with disease severity or systemic rheumatologic disease. Our demonstration of the low specificity of these autoantibodies suggests that the diagnostic utility and cost-effectiveness of testing is not supported when there is strong clinical suspicion of MS and low clinical suspicion of rheumatologic disease.

NCT01003639, Post-results.