Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis)

Grumet, Pierre; Kodjikian, Laurent; Parisot, Audrey de; Errera, Marie‐Hélène; Sédira, Neila; Héron, Emmanuel; Pérard, L.; Schneider, Christelle; Rivière, Sophie; Ollé, Priscille; Pugnet, G.; Cathébras, P.; Manoli, Pierre; Bodaghi, Bahram; Saadoun, David; Baillif, Stéphanie; Tieulié, N.; André, M.; Chiambaretta, Frédéric; Bonin, Nicolas; Bielefeld, P.; Bron, Alain M.; Mouriaux, Frédéric; Bienvenu, Boris; Vicente, Stéphanie; Bin, Sylvie; Labétoulle, Marc; Broussolle, C.; Jamilloux, Yvan; Decullier, Évelyne; Sève, P.

doi:10.1016/j.autrev.2017.10.018

Cited by 37 publications

(12 citation statements)

References 97 publications

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“…According to different studies, the sensitivity varies from 58 to 84% for ACE and 60 to 78% for lysozyme, and the specificity from 83 to 95% for ACE and 76 to 95% for lysozyme. 55,75,76 ACE has a lower specificity in younger patients, while treatment with an ACE inhibitor makes this test uninterpretable. Lysozyme may be raised, particularly in infectious uveitis.…”

Section: Traditional Approachmentioning

confidence: 99%

“…The randomized study, named ULISSE (for Uveitis: medico-economical and cLInical evaluation of a Standardized Strategy for an Etiological diagnosis), whose primary purpose was to investigate the efficiency of a standardized strategy to diagnose uveitis over an open strategy in which the physician was free to order any kind of investigation, failed to assess the role of MSGB and 18-FDG PET in granulomatous uveitis and/or multifocal choroiditis in patients with normal or noncontributive radiologic procedures, since these tests were rarely performed. 75,106 Given the high cost of 18-FDG PET and dosimetric considerations, we think that its use should be limited to patients presenting with positive predictive factors. 55,105 The value of fine-needle mediastinal aspiration in patients with lymph node labeling on 18-FDG PET should be demonstrated.…”

Section: Algorithmmentioning

confidence: 99%

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Ocular Sarcoidosis

Sève

Jamilloux

Tilikete

et al. 2020

Semin Respir Crit Care Med

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Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.

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Section: Traditional Approachmentioning

confidence: 99%

Section: Algorithmmentioning

confidence: 99%

Ocular Sarcoidosis

Sève

Jamilloux

Tilikete

et al. 2020

Semin Respir Crit Care Med

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“…3,21,24,26 Algunos exámenes complementarios importantes son: angiografía retiniana fluoresceínica, útil en uveítis posterior; tomografía de coherencia óptica (OCT), que realiza una imagen óptica de las capas de la retina y ayuda en el manejo del proceso inflamatorio retiniano; ultrasonido ocular, útil en la visualización del segmento posterior, y la angiografía con indocianina verde, para el estudio de la coroides. [27][28][29][30] En caso de los pacientes que inician inmunosupresión, se deben revisar las serologías por hepatitis B y C, ELISA por VIH, además de la PPD y exámenes de heces por parásitos. Se debe revisar el esquema de vacunas; en caso de que esté incompleto, se debe actualizar antes del inicio de la inmunosupresión, si la condición clínica lo permite.…”

Section: Diagnósticounclassified

Recomendaciones pediátricas para el manejo de la uveítis no infecciosa en Costa Rica

Escoto¹,

Martínez²,

Obregón³

et al. 2020

AMC

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Justificación: la uveítis idiopática y la asociada a artritis idiopática juvenil son condiciones oculares que llevan a deterioro visual. En Costa Rica, la incidencia en pediatría se desconoce; aunque existe una clínica especializada en el Hospital Nacional de Niños para el manejo de estas patologías, no hay guías ni recomendaciones de manejo que hayan sido publicadas. Objetivos: resumir las recomendaciones de manejo vigentes para uveítis no infecciosas y ofrecer una guía adaptada a la realidad costarricense, específicamente para población pediátrica. Métodos: se efectuó una revisión no sistemática de bibliografía médica indexada en las plataformas PubMed y Scielo, sobre el diagnóstico y manejo de uveítis no infecciosa orientado a población pediátrica y en artritis idiopática juvenil. Se revisaron las guías recomendadas en Europa y se ajustaron a lo que se realiza en la Clínica de Uveítis del Hospital Nacional de Niños. Conclusiones: se realiza una propuesta de manejo que incluye una valoración oftalmológica oportuna, diagnóstico certero, y tratamiento temprano y agresivo para prevención de complicaciones y minimizar secuelas. Descriptores: uveítis no infecciosa, artritis idiopática juvenil, inflamación ocular, autoinmunidad, uveítis pediátrica

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“…clinical and medicoeconomic evaluation of a standardized strategy for etiological diagnosis) has shown that a standardized strategy for the etiological diagnosis of uveitis was neither inferior nor superior to an open strategy [11]. Subsequent analysis has shown that only a few diagnostic tests were useful for the etiological assessment of uveitis [12,13]. These were often cheap, simple, usually guided by clinical findings, and resulted in an etiological diagnosis for many patients.…”

Section: Introductionmentioning

confidence: 99%