Lymphopaenia as a predictor of sarcoidosis in patients with a first episode of uveitis

Groen-Hakan, Fahriye; Eurelings, Laura; Rothová, Aniki; Laar, Jan van

doi:10.1136/bjophthalmol-2018-313212

Cited by 13 publications

(7 citation statements)

References 27 publications

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“…28 Based on a study of 191 patients with a first uveitis episode, Groen-Hakan et al found that lymphopaenia was strongly associated with a diagnosis of sarcoidosis, with an optimal cut-off of 1.47×10 9 /L, a strong sensitivity of 75% and a specificity of 77%. 15 Their study excluded patients undergoing immunosuppressive therapies. In our study, we found a low sensitivity of 15.3% which may be explained by the fact that we used a lower cut-off of 1.0×10 9 /L.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic value of lymphopaenia and elevated serum ACE in patients with uveitis

et al. 2020

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AimTo evaluate the diagnostic worth of elevated serum ACE (sACE) and lymphopaenia, singly or combined, in diagnosing sarcoid uveitis.MethodsMonocentric retrospective study, on a cohort of 996 adult patients referred to our department between March 2001 and December 2018 for a diagnostic work-up of uveitis. The sensitivity (SE), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the two biomarkers were calculated in different contexts.ResultsEight hundred and sixty-eight patient cases were reviewed. The mean age at uveitis onset was 49.4 (±18.6) years. Of them, 144 patients had a diagnosis of sarcoid uveitis. An elevated sACE had SE of 45.8%, Sp of 88.8%, PPV of 44.9% and NPV of 89.2% in diagnosing sarcoid uveitis. For lymphopaenia, SE was 15.3%, Sp was 96.7%, PPV was 47.8% and NPV was 85.2%. For the combination of elevated sACE and lymphopaenia, SE was 18.9%, Sp was 99.0%, PPV was 73.9% and NPV was 89.5%. The value of this combination varied according to patient age at diagnosis plus anatomoclinical entities: for patients aged ≤50 years, SE was 31.3%, Sp was 99.7%, PPV was 90.9% and NPV was 94.3%. For granulomatous uveitis, SE was 26.2%, Sp was 97.3%, PPV was 73.3% and NPV was 82.5%.ConclusionA combination of elevated serum ACE and lymphopaenia more convincingly suggests sarcoid uveitis than these investigational tests used alone, especially in patients with granulomatous uveitis, while a lack of these markers corresponds to a high NPV.Trial registration numberNCT03863782.

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Section: Discussionmentioning

confidence: 99%

“…14 However, large studies investigating lymphopaenia's value in predicting sarcoid uveitis remain scarce. [15][16][17] This study was conducted to investigate the value of lymphopaenia and elevated sACE, singly or in combination, as diagnostic biomarkers of sarcoid uveitis.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of lymphopaenia and elevated serum ACE in patients with uveitis

et al. 2020

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“…97 When adjusted for sex, ethnicity and age of onset of uveitis, lymphopenia (<1.5 Â 10 9 / L) was found to be associated with a 12-fold increased risk of sarcoid uveitis. 98…”

Section: Lymphopeniamentioning

confidence: 99%

Insights into the diagnosis and management of sarcoid uveitis: A review

Samalia,

Lim,

Niederer

2024

Clinical Exper Ophthalmology

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Sarcoidosis is a leading cause of non‐infectious uveitis that commonly affects middle‐aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non‐caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid‐sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes.

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“…Two studies have investigated the diagnostic value of lymphopenia (<1 Giga/L) as a marker of sarcoidosis in patients with de novo uveitis. 80,81 First Jones et al showed that lymphopenia was predictive of sarcoidosis in 31% of uveitis patients. 80 More recently, Groen-Hakan et al reported a sensitivity and a specificity of lymphopenia for the diagnosis of sarcoidosis of 75 and 77%, respectively.…”

Section: Traditional Approachmentioning

confidence: 99%

“…80 More recently, Groen-Hakan et al reported a sensitivity and a specificity of lymphopenia for the diagnosis of sarcoidosis of 75 and 77%, respectively. 81 Lymphopenia resulted in a 12-fold increased risk for having sarcoidosis, corrected by sex, ethnicity, and age at onset of uveitis. Several studies have suggested that bronchoalveolar lavage (BAL) fluid analysis may be useful for the diagnosis of sarcoidosis, even with normal chest imaging, 82,83 but bronchial biopsies are usually negative in this situation.…”

Section: Traditional Approachmentioning

confidence: 99%

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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Lymphopaenia as a predictor of sarcoidosis in patients with a first episode of uveitis

Cited by 13 publications

References 27 publications

Diagnostic value of lymphopaenia and elevated serum ACE in patients with uveitis

Diagnostic value of lymphopaenia and elevated serum ACE in patients with uveitis

Insights into the diagnosis and management of sarcoid uveitis: A review

Ocular Sarcoidosis

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