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Uveitis and spondyloarthropathies.

Srilakshmi M Sharma1, Daniel Jackson2

  • 1Oxford Eye Hospital, John Radcliffe Hospital, United Kingdom.

Best Practice & Research. Clinical Rheumatology
|December 5, 2018
PubMed
Summary

Uveitis is common in spondyloarthropathies (SpAs). Research explores genetic, microbiome, and immune cell factors, with biologics like infliximab and adalimumab showing promise for managing this eye condition.

Keywords:
Acute anterior uveitisHLA-B27IL23Intermediate uveitisMicrobiomeSpondyloarthritisSpondyloarthropathyTNF-α

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Area of Science:

  • Ophthalmology
  • Rheumatology
  • Immunology

Background:

  • Uveitis is a frequent extra-articular manifestation in spondyloarthropathies (SpAs), affecting adults and children.
  • Occurrence varies by SpA subtype, HLA-B27 status, and disease duration, with acute anterior uveitis being most common.
  • Posterior segment uveitis, though less common, carries higher risks of cystoid macular edema and vision loss.

Purpose of the Study:

  • To investigate the underlying mechanisms of tissue specificity in SpA-related uveitis.
  • To explore novel therapeutic targets and evaluate current treatment efficacy.

Main Methods:

  • High-throughput genomics to identify uveitis susceptibility alleles.
  • Investigating the role of the intestinal microbiome in innate immune signaling.
  • Studying IL23R-bearing cells in entheseal sites, including the eye.

Main Results:

  • Topical corticosteroids are standard for acute episodes.
  • Systemic anti-TNF agents (infliximab, adalimumab, certolizumab) reduce uveitis frequency; etanercept is ineffective.
  • IL-17A inhibition (secukinumab) has not proven effective for uveitis.

Conclusions:

  • Future treatments may involve JAK and tyrosine kinase inhibitors.
  • Understanding SpA uveitis requires integrated approaches, from genomics to immunology.
  • Targeting the IL23/IL17 axis shows differential efficacy, highlighting the need for specific therapeutic strategies.