Pineda-Sierra Juan Sebastián, Cifuentes-González Carlos, Rojas-Carabali William, Muñoz-Vargas Paula Tatiana, Henao-Posada Alejandro, de-la-Torre Alejandra
Neuroscience (NEUROS) Research Group, Institute of Translational Medicine (IMT), Neurovitae Research Center, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia.
Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Institute of Translational Medicine (IMT), Neurovitae Research Center, Escuela de Medicina Y Ciencias de La Salud, Universidad del Rosario, Carrera 24 # 63C - 69, Bogotá, Colombia.
J Ophthalmic Inflamm Infect. 2023 Aug 30;13(1):38. doi: 10.1186/s12348-023-00352-3.
Despite HLA-B27-associated uveitis is one of the most frequent etiologies of uveitis worldwide, there are scarce studies on the clinical spectrum of this disease and the implications of therapeutic strategies used in the Latin-American population, with none conducted in Colombia. Thus, this study aimed to describe the clinical characteristics of a cohort of patients with positive HLA-B27-associated uveitis in Colombia and evaluate the impact of systemic treatment on the recurrence rate.
We retrospectively reviewed 490 clinical charts of patients with uveitis, searching for those with positive HLA-B27-associated uveitis over eight years in a referral center in Bogotá, Colombia. We used descriptive statistics to summarize demographic and clinical characteristics and conducted a Chi-square test, Fisher Exact test, Spearman correlation, and Mann-Whitney test to assess associations between treatment strategies and the recurrences rate.
We analyzed 39 patients (59% females) with positive HLA-B27-associated uveitis, with a median age at the first consultation of 44.5 years (Range: 2-80) and a mean follow-up time of 86.4 weeks (1.65 years). Most patients had unilateral uveitis (53.8%) and an anterior anatomical diagnosis (76.6%); two had anterior chamber fibrinous reaction, and only one had hypopyon. Most patients did not show associated systemic symptoms (66.7%). Topical corticosteroids, NSAIDs, methotrexate, mydriatics, and adalimumab were the most used treatments. The most common complications included cataracts, posterior synechiae, and macular edema. We identified that the rate of recurrences decreases over time (r = -0.6361, P = 0.002571), and this decrease seems to be associated with the initiation of disease-modifying antirheumatic drugs (DMARDs) in chronic and recurrent cases.
The clinical spectrum of HLA-B27-associated uveitis in Colombian patients is distinct from other latitudes. Notably, we found a female predominance, older age at presentation, higher frequency of bilateral and vitreous involvement, and lower frequency of concomitant systemic diseases. Additionally, our results suggest that DMARDs such as methotrexate and biologic agents are good therapeutic options to avoid recurrences in chronic and recurrent cases.
尽管HLA - B27相关葡萄膜炎是全球葡萄膜炎最常见的病因之一，但关于该疾病临床谱以及拉丁美洲人群所采用治疗策略的影响的研究却很少，在哥伦比亚尚无此类研究。因此，本研究旨在描述哥伦比亚一组HLA - B27相关葡萄膜炎阳性患者的临床特征，并评估全身治疗对复发率的影响。
我们回顾性分析了490例葡萄膜炎患者的临床病历，在哥伦比亚波哥大的一家转诊中心查找8年间HLA - B27相关葡萄膜炎阳性的患者。我们使用描述性统计来总结人口统计学和临床特征，并进行卡方检验、Fisher精确检验、Spearman相关性分析和Mann - Whitney检验，以评估治疗策略与复发率之间的关联。
我们分析了39例HLA - B27相关葡萄膜炎阳性患者（59%为女性），首次就诊时的中位年龄为44.5岁（范围：2 - 80岁），平均随访时间为86.4周（1.65年）。大多数患者为单眼葡萄膜炎（53.8%）且解剖学诊断为前部葡萄膜炎（76.6%）；2例有前房纤维素样反应，仅1例有前房积脓。大多数患者未表现出相关全身症状（66.7%）。局部用皮质类固醇、非甾体抗炎药、甲氨蝶呤、散瞳剂和阿达木单抗是最常用的治疗方法。最常见的并发症包括白内障、虹膜后粘连和黄斑水肿。我们发现复发率随时间下降（r = -0.6361，P = 0.002571），这种下降似乎与慢性和复发性病例中启动改善病情抗风湿药物（DMARDs）有关。
哥伦比亚患者中HLA - B27相关葡萄膜炎的临床谱与其他地区不同。值得注意的是，我们发现女性占优势、就诊年龄较大、双侧和玻璃体受累频率较高以及合并全身疾病的频率较低。此外，我们的结果表明，甲氨蝶呤和生物制剂等DMARDs是避免慢性和复发性病例复发的良好治疗选择。
