Distinguishing Uveitis Secondary to Sarcoidosis From Idiopathic Disease

Han, Yong Seop; Rivera-Grana, Erick; Salek, Sherveen; Rosenbaum, James T.

doi:10.1001/jamaophthalmol.2017.5466

Cited by 24 publications

(26 citation statements)

References 48 publications

(118 reference statements)

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“…The characteristics of this group are summarized in Table 1. The frequency of sarcoidosis among patients with idiopathic uveitis in our clinic has been previously published in Han et al 16 In summary, 17/19 (89.5%) of these patients had chest CT scans that revealed adenopathy strongly suggestive of sarcoidosis. One patient was presumed to have sarcoidosis based on hilar adenopathy seen on chest radiography and ocular findings consistent with sarcoidosis.…”

Section: Resultsmentioning

confidence: 53%

“…As we reported previously, 36.5% (19/52) of patients with a referral diagnosis of idiopathic uveitis were found to have sarcoidosis. 16 Of these, 21.0% (4/19) were found to have cardiac involvement with EKG testing, all of whom eventually required intra-cardiac defibrillator implantation. A diagnosis of sarcoidosis was found in all 4 of these patients with the use of chest CT imaging.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reclassifying Idiopathic Uveitis: Lessons From a Tertiary Uveitis Center

Choi

Rivera-Grana

Rosenbaum

2019

American Journal of Ophthalmology

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Purpose-Idiopathic uveitis is frequently the most common diagnosis in series from uveitis clinics. We sought to determine the percentage of patients initially diagnosed as idiopathic, noninfectious uveitis referred to a tertiary uveitis center who were subsequently found to have an identifiable cause of uveitis. Design-Retrospective case series. Methods-We performed a computerized database analysis of 179 consecutive patients who were referred to our practice with the diagnosis of idiopathic, non-infectious uveitis between 2008 and 2016. Patients were evaluated by a thorough history and ophthalmic examination with selected laboratory testing targeted by clues from the history and exam. Standardization of Uveitis Nomenclature (SUN) criteria 1 were used to better assess different types of uveitis. Results-Fifty-two out of 179 (29.0%) patients initially diagnosed with idiopathic uveitis were subsequently diagnosed with an underlying condition. Among patients referred with a diagnosis of idiopathic disease, females were most commonly affected with 121/179 (67.6%). Among subsequent diagnoses, sarcoidosis was the most common (19/52 or 36.5%), followed by HLA-B27 associated uveitis (11/52, 21.1%), infectious (6/52,11.5%), tubulo-interstitial nephritis with uveitis (6/52, 11.5%), and juvenile idiopathic uveitis (4/52, 7.7%). Other diagnosable conditions included Behcet's disease, multifocal choroiditis and pan-uveitis, Crohn's disease, multiple sclerosis, and relapsing polychondritis. An underlying condition was not found in 127/179 (70.9%) patients.

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Section: Resultsmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Reclassifying Idiopathic Uveitis: Lessons From a Tertiary Uveitis Center

Choi

Rivera-Grana

Rosenbaum

2019

American Journal of Ophthalmology

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“…Han et al recently reported on a series of 249 patients with uveitis and found that 4 of the 19 patients (21%) who subsequently received a diagnosis of presumed sarcoidosis had ventricular tachycardia that required implantable cardiac defibrillators. 107 These data are in discrepancy with recent studies on patients with sarcoid uveitis reporting a prevalence of cardiac involvement in 1 to 2% of patients. 36…”

Section: Relation Between Ocular and Systemic Sarcoidosismentioning

confidence: 64%

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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“…In a study from the Cleveland Clinic, 57% of women older than age 61 years with idiopathic uveitis had normal findings on chest radiography but had chest CT evidence of sarcoidosis (21). We recently found a similar, slightly lower yield by performing chest CT on patients older than age 40 years with idiopathic uveitis (22). In addition, we noted that 21% of those discovered to have sarcoidosis on chest CT also had cardiac sarcoidosis with associated ventricular tachycardia (22).…”

Section: Rosenbaum and Dickmentioning

confidence: 89%

“…We recently found a similar, slightly lower yield by performing chest CT on patients older than age 40 years with idiopathic uveitis . In addition, we noted that 21% of those discovered to have sarcoidosis on chest CT also had cardiac sarcoidosis with associated ventricular tachycardia . Thus, recognition of the systemic illness had potentially life‐saving implications.…”

Section: Introductionmentioning

confidence: 90%

The Eyes Have it

Rosenbaum

Dick

2018

Arthritis & Rheumatology

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Uveitis is defined as intraocular inflammation. It is an extraarticular manifestation of many forms of joint disease, which include spondyloarthritis, juvenile idiopathic arthritis, and Behçet's disease. Rheumatologists may be asked to consult on the ophthalmologic care of patients with uveitis in order to identify an associated systemic illness. Diagnoses such as spondyloarthritis, sarcoidosis, and interstitial nephritis with uveitis are frequently overlooked by referring ophthalmologists. Alternatively, rheumatologists may be asked to help manage the patient's immunosuppression, including biologic therapy, which can be required to treat a subset of patients with uveitis. This review is intended to provide rheumatologists with the necessary information to facilitate collaboration in the comanagement of patients with uveitis.

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Distinguishing Uveitis Secondary to Sarcoidosis From Idiopathic Disease

Cited by 24 publications

References 48 publications

Reclassifying Idiopathic Uveitis: Lessons From a Tertiary Uveitis Center

Reclassifying Idiopathic Uveitis: Lessons From a Tertiary Uveitis Center

Ocular Sarcoidosis

The Eyes Have it

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