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葡萄膜炎——系统性炎症性疾病的一扇“窗口”

Uveitis as an Open Window to Systemic Inflammatory Diseases.

作者信息

El Jammal Thomas, Loria Olivier, Jamilloux Yvan, Gerfaud-Valentin Mathieu, Kodjikian Laurent, Sève Pascal

机构信息

Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France.

Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France.

出版信息

J Clin Med. 2021 Jan 14;10(2):281. doi: 10.3390/jcm10020281.

Abstract

Spondyloarthritis (Spa), Behçet's disease (BD) and sarcoidosis are major systemic inflammatory diseases worldwide. They are all multisystem pathologies and share a possible ocular involvement, especially uveitis. We hereby describe selected cases who were referred by ophthalmologists to our internal medicine department for unexplained uveitis. Physical examination and/or the use of laboratory and imaging investigations allowed to make a diagnosis of a systemic inflammatory disease in a large proportion of patients. In our tertiary referral center, 75 patients have been diagnosed with Spa ( = 20), BD ( = 9), or sarcoidosis ( = 46) in the last two years. There was a significant delay in the diagnosis of Spa-associated uveitis. Screening strategies using Human Leukocyte Antigen (HLA)-B27 determination and sacroiliac magnetic resonance imaging in patients suffering from chronic low back pain and/or psoriasis helped in the diagnosis. BD's uveitis affects young people from both sexes and all origins and usually presents with panuveitis and retinal vasculitis. The high proportion of sarcoidosis in our population is explained by the use of chest computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography CT that helped to identify smaller hilar or mediastinal involvement and allowed to further investigate those patients, especially in the elderly. Our results confirm how in these sight- and potentially life-threatening diseases a prompt diagnosis is mandatory and benefits from a multidisciplinary approach.

摘要

脊柱关节炎(SpA)、白塞病(BD)和结节病是全球主要的系统性炎症性疾病。它们均为多系统病变,且都可能累及眼部,尤其是葡萄膜炎。在此,我们描述一些眼科医生转诊至我们内科的不明原因葡萄膜炎病例。体格检查和/或实验室及影像学检查使大部分患者得以诊断出系统性炎症性疾病。在我们的三级转诊中心,过去两年中有75例患者被诊断为SpA(n = 20)、BD(n = 9)或结节病(n = 46)。SpA相关葡萄膜炎的诊断存在显著延迟。对患有慢性下背痛和/或银屑病的患者采用人类白细胞抗原(HLA)-B27检测和骶髂关节磁共振成像的筛查策略有助于诊断。BD的葡萄膜炎影响来自不同性别和所有种族的年轻人,通常表现为全葡萄膜炎和视网膜血管炎。我们研究人群中结节病比例较高的原因是采用了胸部计算机断层扫描(CT)和18F-氟脱氧葡萄糖正电子发射断层扫描CT,这有助于识别较小的肺门或纵隔受累情况,并能对这些患者,尤其是老年患者进行进一步检查。我们的结果证实,在这些威胁视力甚至可能危及生命的疾病中,及时诊断是必不可少的,且多学科方法有助于诊断。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8d4/7828680/b2ec9f72a82b/jcm-10-00281-g001.jpg

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