Uveitis in the Spondyloarthopathies
BEST PRACTICE & RESEARCH IN CLINICAL RHEUMATOLOGY
Authors: Sharma, Srilakshmi M.; Jackson, Daniel
Abstract
Uveitis is a frequently occurring extra-articular manifestation of spondyloarthropathies (SpAs), ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthritis (PsA) and inflammatory bowel disease (IBD), occurring in both adults and children with SpA. Uveitis occurs with varying frequency according to the SpA subtype (33% in AS, 6-9% in PsA, 25% in ReA,13% in undifferentiated SpA and 2-5% in IBD), the presence of HLA-B27 and with increasing duration of disease. The majority of cases of uveitis in SpA are attributed to acute anterior uveitis but a minority of uveitis cases occur in the posterior segment of the eye. The latter are more frequently complicated by cystoid macular oedema (CMO) and sight loss. The nature of the tissue specificity exhibited by the SpAs is poorly understood. Three current investigational approaches are discussed: high-throughput genomics to identify and confirm uveitis-specific susceptibility alleles; investigation of the role of the intestinal microbiome and its potential role in innate immune signalling in uveitis; and study of a novel IL23R-bearing cell population in several entheseal sites including the eye. The treatment for uveitis in SpAs is predominantly with topical corticosteroids for acute episodes. Among the systemic drugs used for the treatment of SpAs, infliximab, adalimumab and certolizumab are effective in reducing the frequency of uveitis but etanercept is not. Other targets in spondyloarthropathy include cytokines within the IL23/IL17 axis, of which the IL17A inhibitor secukinumab has not been shown to be effective in uveitis. Future therapeutic approaches may include small molecules such as selective and non-selective janus kinase and tyrosine kinase inhibitors. (C) 2018 Published by Elsevier Ltd.
The Study of Interleukin-17 Level in Vernal Keratoconjunctivitis Disease and its Relationship between Symptom and Sign Severity
SEMINARS IN OPHTHALMOLOGY
Authors: Validad, Mohammad Hosein; Khazaei, Hossein Ali; Pishjoo, Masoud; Safdari, Zohre
Abstract
Introduction: Vernal keratoconjunctivitis (VKC) is a bilateral multi-factorial disease. The pathogenesis of this disease is not obviously determined, but the role of various inflammatory cytokines has been specified. This study has provided a comparison between the level of interleukin-17 (IL17) in the serum and tears of case and control groups, and also the relationship between the level of this interleukin with severity of signs and symptoms of the disease. Materials and methods: This case-control study has been accomplished on 40 individuals (20 healthy people and 20 patients who suffer from VKC) in Al-Zahra Eye Center in 2014. The level of interleukin was isolated in an individual's tear by Schirmer strips; moreover, serum interleukin has been measured. Results: The average of interleukin 17 in serum in the case group was 25.5 +/- 4.1 pg/dl and in the control group was 12.5 +/- 5.7 pg/dl. The average of interleukin 17 in the case group was 259.6 +/- 91.4 pg/dl in the tear and was 50.6 +/- 20.8 pg/dl for the control group; the signs and symptoms of the IL-17 disease were associated with the severity of Trantas dots. Conclusions: Interleukin-17 has a role in the pathogenesis of VKC and also has been proven in the former studies.