Interface between Ophthalmology and Rheumatology in Uveitis and Retinal Vasculitis in Adult Patients, When Does Who Need Whom?

Abstract

Background There is a significant interface between ophthalmology and rheumatology, particularly in uveitis and retinal vasculitis. This will be described in detail here. Results Analyses of uveitis consultations from university centres in Austria and Germany show that approximately 30% of anterior uveitis cases, 17% of intermediate and posterior uveitis cases, 7% of panuveitis cases, and 20% of retinal vasculitis cases, are associated with an inflammatory rheumatic systemic disease. The most frequent association (30%) is between spondyloarthritis and psoriatic arthritis with anterior uveitis (AAU). In approximately 1.3% of cases of intermediate uveitis, sarcoidosis is present, while in posterior uveitis and panuveitis, Behcet's syndrome (BS) is the most likely cause (2.5% and 12.6%, respectively). Retinal vasculitis is associated with BS in 18% of cases. Easily detectable red flags for inflammatory rheumatic diseases and the influence of uveitis on systemic immunomodulatory therapy in rheumatology have been described. For example, in AAU during SPA, monoclonal tumour necrosis factor inhibitors (TNFi) are more effective than etanercept, a fusion protein of the TNF receptor and immunoglobulin Fc segment. IL-17 antagonists and Janus-Kinase (JAK) inhibitors are also able to reduce the risk of uveitis flares, but are less effective than monoclonal TNFi. Summary Close collaboration between rheumatologists and ophthalmologists is essential, particularly in the treatment of uveitis and retinal vasculitis. Assessment for certain warning signs and determination of specific laboratory parameters are helpful in detecting the association, present in approximately 20% of cases, between uveitis and retinal vasculitis and inflammatory rheumatic systemic diseases, and in referring patients specifically to rheumatology. Conversely, rheumatologists require precise ophthalmological findings and information on treatment response, in order to adjust therapy in a targeted manner or, in cases of ocular symptoms associated with an underlying inflammatory systemic disease, in order to appropriately adapt the therapy to the ocular involvement.