Background/Purpose: Uveitis represents a diagnostic and therapeutic challenge, as well as an economic one, due to its heterogeneous presentation, multiple underlying causes and lack of well-codified diagnostic procedures. Furthermore, a third of uveitis is considered idiopathic. The aim of this study was to evaluate the contribution of diagnostic investigations in the management of uveitis in a specialized centre.

Methods: Single-centre retrospective study including patients referred from the Ophthalmology department to Internal Medicine practitioners for etiological diagnosis of uveitis. Uveitis related to pure ophthalmological diseases or occurring during the course of an already diagnosed pathology were excluded. All patients had a complete ophthalmologic examination followed by clinical and paraclinical exams. All diagnoses were established according to recent international diagnostic criteria.

Results: Three hundred consecutive patients were included (mean age 48 ± 30 years, men 49%). The main features of uveitis were: bilateral 56%, anterior 33%, posterior 8%, panuveitis 30%, granulomatous 44%, chronic 39%. Forty-three percent of patients had at least one clinical extra-ophthalmologic manifestation, such as arthralgia (17%) or general symptoms (15%). Regarding paraclinical exams, chest CT scan was performed in 94% of cases, and showed abnormal findings suggestive of pulmonary or mediastinal sarcoidosis in 39%. Factors associated with having an abnormal CT scan were blood lymphocytopenia (p=0.002) and increased angiotensin-converting enzyme (ACE) over 1.5 the upper limit of normal (ULN) (p=0.007). Salivary gland biopsy, performed in 76% of cases, led to the identification of granuloma in only 6%. Bronchoscopy was performed in 61% of cases, with bronchial biopsies showing granuloma in only 8% whereas bronchoalveolar lavage fluid (BALF) analysis revealed alveolar lymphocytosis suggestive of sarcoidosis (lymphocytes >15% and/or CD4/CD8 ratio >3.5) in 27%. Patients with granuloma on biopsies always had abnormalities on CT scan whereas 37% of patients with alveolar lymphocytosis had normal CT scan. Factors associated with having contributive BALF were vitreous snowballs (p=0.003), peripheral multifocal choroiditis (p=0.002), lymphocytopenia (p=0.03), and a >1.5 ULN ACE titer (p<0.0001). Cerebral MRI was performed in 56% of cases and was abnormal in 14%. Factors associated with abnormal MRI were retinal vasculitis (p=0.03) and a >1.5 ULN ACE titer. Lumbar puncture was performed in 44% but mainly showed non relevant abnormalities in 31%. Finally, at the end of the diagnostic workup, the main causes identified were uveitis associated with latent tuberculosis in 25%, sarcoidosis in 18% or Behçet’s disease in 5%. However, 37% of uveitis remained of undetermined origin. Baseline features from the latter did not differ from those in which a specific diagnosis was retained.

Conclusion: Despite an extensive clinical and paraclinical workup, an important proportion of uveitis remains of undetermined origin. Identification of factors associated with abnormal investigations might improve the optimal diagnostic workup adapted to each patient’s characteristics.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/contribution-of-diagnostic-investigations-in-the-management-of-uveitis-retrospective-analysis-of-300-patients/