Inflamed eye linked to arthritis

[Guest guest]

Inflamed eye linked to arthritis

By DR. YONG H. TSAI

MANAGING PAIN

Last update: June 13, 2005

Like rheumatoid arthritis, uveitis is an inflammatory process. But

rather than affecting joints, uveitis causes inflammation of one or

more areas of the eye.

Tom, for example, is a 45-year-old man with recurrent episodes of eye

redness and pain. He was diagnosed with anterior uveitis after slip

lamp examination, a simple and painless test in which a light is shone

into the eye while looking through a microscope.

Tom's ophthalmologist referred him to me. I found him also to have

ankylosing spondylitis associated with his acute anterior uveitis.

Another common case is illustrated by , a 10-year-old with

frequent joint pain and swelling, diagnosed with juvenile idiopathic

arthritis. Even though she had no eye symptoms, she was referred to an

ophthalmologist, who confirmed associated chronic uveitis after slit

lamp exam.

As you see, the symptoms of uveitis depend on the site of involvement.

Acute anterior uveitis develops suddenly and causes eye redness, pain

and sensitivity to light.

Commonly associated with ankylosing spondylitis, more so in males than

in females, the HLA B27-specific gene marker has been seen in about

half of the patients.

On the other hand, persistent uveitis, as with juvenile idiopathic

arthritis, may show no symptoms despite inflammation and intra-ocular

damage, until scarring, loss of vision or cataracts develop.

Topical corticosteroids are usually effective in treating mild to

moderate anterior uveitis, but are not recommended for posterior

uveitis due to limited efficacy.

Immunosuppressive drugs such as methotrexate, azathioprine,

cyclosporine, cyclophasmide and new biologic agents are a good choice

for patients with a poor response to corticosteroids or on high doses

over a prolonged period.

The best plan of action is to have your uveitis managed by an

ophthalmologist and rheumatologist and internist if systemic disease is

involved.

In general, dosing and toxicity of immunosuppressive agents are managed

by your rheumatologist, while disease activity and ocular damage falls

under an ophthalmologist.

Dr. Yong H. Tsai is board-certified in rheumatology, allergy and

clinical immunology. Send questions to Dr. Tsai in care of

accent@....