Vogt–Koyanagi–Harada syndrome: a rheumatologic perspective

Vogt-Koyanagi-Harada Syndrome

“…Although still relatively rare, changing population demographics are leading to increased incidence of VKH syndrome and therefore this condition is an important differential to consider in your patient of a more heavily pigmented race, such as Hispanics, Asians, and Native Americans, which presents with similar symptoms and physical examination findings. 2 This case also highlights the importance of comanagement of a complex condition by a team of specialists-ophthalmology and rheumatology in this case. Recognition of the syndrome and prompt initiation of immunosuppressive therapy is critical to avoid visual impairment and blindness.…”

“…2 Genetic associations such as with HLA-DR4 have been identified, and current research suggests the role of IL-23 in the inflammatory cascade and subsequent formation of Th17 cells and IL-17. 2 Vogt-Koyanagi-Harada syndrome is a chronic recurrent disease requiring long-term immunosuppression. Although systemic corticosteroids were the initial mainstay of treatment, combination therapy with immunomodulation has proven to lead to better visual outcomes than steroids alone.…”

“…1 Mandatory diagnostic criteria includes no history of ocular trauma/ surgery before onset of uveitis, bilateral involvement, and no clinical or laboratory evidence of another ocular disease. 2 Integumentary, neurological, and auditory findings are not necessary for diagnosis. Etiopathogenesis of VKH syndrome is not well understood, particularly the trigger that initiates this autoimmunemediated response against autoantigens expressed in melanocytes, although a viral trigger has been hypothesized that may result in molecular mimicry.…”

“…Although systemic corticosteroids were the initial mainstay of treatment, combination therapy with immunomodulation has proven to lead to better visual outcomes than steroids alone. 2 Rheumatology was consulted for evaluation of systemic disease and initiation of steroid sparing agent for our patient. She was started on adalimumab (Humira), which is Food and Drug Administration approved for idiopathic panuveitis, as a means of steroid sparing therapy.…”

Treatment-Refractory Autoimmune Sensorineural Hearing Loss: Response to Infliximab

“…Thus, perhaps the true effi cacy of infl iximab is still unclear; we have found no controlled studies that have investigated the use of infl iximab as the primary treatment for AISNHL, although there have been several reports on its use for various conditions in which hearing was discussed. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] There have also been a few interesting reports suggesting the value of intratympanic administration of infl iximab. [40][41][42] To better evaluate infl iximab as a treatment option for AISNHL, a large, double-blind, placebo-controlled study is needed.…”