The Role of Estradiol in Idiopathic Anterior Uveitis during the Eumenorrheic Stage of Life

Abstract

Previous studies have showed that fluctuation of estrogen and progesterone affects inflammatory status, as seen with higher serum levels of human serum-CRP and the pro-inflammatory cytokines interleukin-6, interleukin-1, and tumor necrosis factoralpha. [5][6][7][8] Acharya et al demonstrated that women have been reported to demonstrate more uveitis relapses during the premenstrual and menstrual phases of their cycles. [9] In addition, on our Uveitis Service we have observed that many pregnant women did not relapse during the course of their pregnancy, and instead experienced a severe relapse two to four months after giving Women with idiopathic anterior uveitis do not appear to relapse while pregnant. Relapses are reported more frequently and intensely during premenstrual and menstrual stages. These observations suggest that uveitis may be related to fluctuations of sex steroid hormones. Aims:To assess the effect of female sex steroid hormones on the course of idiopathic anterior uveitis. Settings and Design:Comparative study done by retrospective chart review assessing the course of anterior uveitis for 60 patients (30 women each from eumenorrheic and postmenopausal stages) recently seen in uveitis clinic. Methods and material:Retrospective review over one year from the date of the most recent visit after Institutional Review Board approval was obtained. Main outcome measurements were based on severity and duration of the intraocular inflammation. Other outcome measurements included recurrence of flare-up and response to treatment regimens, including steroids and immunomodulatory agents. Statistical analysis:Differences between the number of patients in groups were tested for significance using a chi-square analysis.Results: A higher incidence of uveitis flare-up occurred during the eumenorrheic stage compared to postmenopausal stage of life. The course of uveitis was of markedly increased severity in the eumenorrheic stage. Conclusion:The incidence and intensity of uveitis flare-up is more pronounced during the active reproductive period of life. Differences in typical treatment may reflect the severity of the flare-ups or relate to concerns for side effect profiles amongst the groups. Differences in sexual hormone milieu are likely a major factor contributing to the differences in presentation of uveitis amongst eumenorrheic and postmenopausal women.Keywords: Women; Estradiol; Menopause; Idiopathic; Uveitis Key MessagesUveitis occurs more frequently and more intensely during the eumenorrheic stage due to fluctuations in sex steroid hormones, such as estradiol. Blocking fluctuations in sex steroid hormones, therefore, has the potential to treat idiopathic anterior uveitis. Further studies are needed to assess the value of blocking fluctuations in sex steroid hormones on the course of idiopathic anterior uveitis.