Max R, Lorenz H M, Mackensen F
Interdisziplinäres Uveitiszentrum, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany.
Z Rheumatol. 2010 Jul;69(5):397-402. doi: 10.1007/s00393-009-0576-6.
The most frequent extraarticular manifestation in spondyloarthropathies (SpA) is eye involvement, which is found in 30%-50% of patients. HLA B27 positive patients in particular--mostly those in the subgroup with ankylosing spondylitis--are affected. Prevalence of uveitis increases with duration of disease. Typical eye involvement is sudden-onset unilateral anterior uveitis (iridocyclitis). Most cases respond well to topical corticosteroids. Frequently relapsing or chronic cases may require oral corticosteroids in addition to classical immunosuppressive drugs and, to an increasing extent, also TNF-alpha inhibitors. In the case of the latter, monoclonal antibodies are preferred over receptor antagonists. Acute anterior uveitis may occur as a minimal variation or initial symptom of SpA. These patients should also be seen by a rheumatologist since undiagnosed SpA may be present in a significant percentage and should be included in therapeutic considerations.
脊柱关节炎（SpA）最常见的关节外表现是眼部受累，30%-50%的患者会出现这种情况。尤其是 HLA B27 阳性患者——主要是强直性脊柱炎亚组中的患者——会受到影响。葡萄膜炎的患病率随病程延长而增加。典型的眼部受累是突发性单侧前葡萄膜炎（虹膜睫状体炎）。大多数病例对局部使用皮质类固醇反应良好。频繁复发或慢性病例除了使用传统免疫抑制药物外，可能还需要口服皮质类固醇，并且越来越多地还需要使用肿瘤坏死因子-α抑制剂。对于后者，单克隆抗体比受体拮抗剂更受青睐。急性前葡萄膜炎可能作为 SpA 的轻微变异或初始症状出现。这些患者也应由风湿病学家诊治，因为相当比例的患者可能存在未确诊的 SpA，应将其纳入治疗考虑范围。
