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Uveitis management: a multidisciplinary approach to assess systemic involvement and side effects of treatments
A Peretz1, M P Guillaume, L Casper-Velu
1Internal Medicine Department, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Belgique. aperetz@ulb.ac.be
Objective:
Non-infectious uveitis is often associated with systemic diseases severe enough to require corticosteroids (CS) and immunosuppressive drugs, which have potential serious side effects.
Methods:
28 patients with non-infectious uveitis were referred by the ophthalmologist.
Results:
A systemic disease was found in 17/28 patients (60%): sarcoidosis in 11, spondylarthropathy in 3, Behcet's disease in 2, Crohn's disease in 1 patient. Eighteen patients received CS, 21 patients received immunosuppressive drugs. Most side effects were due to CS treatment: Cushing's syndrome in 12, cataract in 11, glucose intolerance in 3, gastric ulcus in 1, hypertension in 1, osteoporosis in 17, avascular bone necrosis in 3 patients. Prophylaxis or treatment of corticosteroids induced osteoporosis consists in calcium, 500 mg/day and vitamin D 400 IU in most of them with in addition hormone replacement therapy (n = 8) or bisphosphonates (n = 13).
Conclusion:
Sixty percent of patients with severe uveitis had a systemic disease. CS were the most deleterious drugs in spite of bi- or tri-therapy with CS sparing immunosuppressive drugs.