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Uveitis bei Spondyloarthritiden

Uveitis in spondyloarthritis

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Zusammenfassung

Die akute anteriore Uveitis (AAU) ist die häufigste Uveitisform. Sie ist häufig assoziiert mit dem HLA-B27-Antigen und mit entzündlich rheumatischen Systemerkrankungen, insbesondere mit einer Spondyloarthritis (SpA), die ebenfalls mit HLA-B27 assoziiert ist. Eine zugrundeliegende SpA findet sich bei 40–60 % der AAU-Patienten, eine Uveitis bei 20–50 % aller SpA-Patienten, wobei die Uveitisinzidenz mit der Krankheitsdauer der SpA zunimmt. Die AAU tritt typischer akut und unilateral auf und neigt zu Rezidiven. Eine frühe und konsequente Therapie der akuten Uveitisattacken mit topischen Kortikosteroiden ist wichtig. Die Schübe müssen mindestens 6 bis 8 Wochen behandelt werden, um das Risiko für eine frühe Reaktivierung zu senken. Die Komplikationsrate korreliert mit der Zahl der Uveitisschübe. Bei adäquater Behandlung ist die Visusprognose meist gut. Bei schwerem Uveitisverlauf und hoher Rezidivrate kann der Langzeitverlauf mit konventionellen DMARDs („disease modifying antirheumatic drugs“; Sulfasalazin, Methotrexat) und biologischen DMARDs (TNF[Tumor-Nekrose-Faktor]-α-Inhibitoren) verbessert werden. Die vom Augenarzt erstmalig diagnostizierte AAU sollte Anlass sein, eine mögliche SpA rheumatologisch weiter abzuklären, insbesondere bei bestehenden Rückenschmerzen oder Gelenkschmerzen.

Abstract

Acute anterior uveitis (AAU) is the most frequent uveitis subtype. It is often associated with HLA-B27 and with inflammatory rheumatic diseases, in particular with spondyloarthritis (SpA), which itself is strongly associated with HLA-B27. About 40–60% of patients with AAU have an associated spondyloarthritis, and 20–40% of patients with spondyloarthritis also have uveitis. The incidence of AAU in patients with SpA clearly correlates with disease duration. The AAU has an acute onset, usually affects only one eye at a time, and shows a tendency for recurrence. Early therapy of AAU with topical steroids is relevant for good visual outcomes. Minimum duration of therapy of flares of AAU is 6–8 weeks in order to prevent early recurrency. The rate of local complications correlates with the rate of AAU flares and the visual outcome is often good. Refractory uveitis and frequent recurrencies of AAU may be treated with conventional disease-modifying antirheumatic drugs (DMARDs, such as sulfasalazine and methotrexate) and biologicals (e.g. TNF-alpha inhibitors). Any first episode of AAU diagnosed by an ophthalmologist should prompt referral to rheumatology for suspected SpA, particularly if rheumatic symptoms are present.

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Authors and Affiliations

  1. Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland

    M. Rudwaleit

  2. Augenabteilung und Ophtha Lab, St. Franziskus Hospital, Münster, Deutschland

    K. Walscheid & A. Heiligenhaus

  3. Universität Duisburg-Essen, Essen, Deutschland

    A. Heiligenhaus

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Correspondence to M. Rudwaleit.

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Interessenkonflikt

A. Heiligenhaus hat Studienunterstützungen von BMBF, Pfizer und Novartis und Honorare von AbbVie, Alimera Sciences, Allergan, MSD Sharp und Dohme, Pfizer, Santen und Xoma erhalten. M. Rudwaleit hat Honorare für Beratungen und/oder wissenschaftliche Vorträge erhalten von Abbvie, BMS, Celgene, Chugai, Janssen, MSD, Novartis, Pfizer, Roche, UCB. K. Walscheid gibt keine Interessenkonflikte an.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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I. Kötter, Hamburg

H.-I. Huppertz, Bremen

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Rudwaleit, M., Walscheid, K. & Heiligenhaus, A. Uveitis bei Spondyloarthritiden. Z Rheumatol 76, 682–692 (2017). https://doi.org/10.1007/s00393-017-0357-6

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