Juvenile chronic arthritis in India: is it different from that seen in Western countries?

Medical records of 89 children with juvenile chronic arthritis attending the clinical immunology outpatient department of a tertiary care hospital were analysed. Polyarticular type of juvenile chronic arthritis was the most common, followed by pauciarticular and systemic onset types. No patient with the early onset pauciarticular disease subset, which is associated with iridocyclitis and antinuclear antibody (ANA) positivity was seen. Uveitis was observed in only one patient with late onset pauciarticular disease. The ANA positivity rate (1/89) was very low. Polyarticular onset type disease had a higher incidence of deformities.     

Unusual presentation of non-Hodgkin lymphoma: polyarthritis and uveitis mimicking a rheumatologic disease

We report a case of 45-year-old male who presented with polyarthritis and posterior uveitis. He was given azathioprine (AZA) 150 mg day⁻¹ and methyl-prednisolone 48 mg day⁻¹ for his uveitis and polyarthritis. Eye and joint complaints improved with these medications within 1 month. Three months later, while he was on AZA, the patient presented with pain on his anterior chest wall associated with diffuse hyperemic and warm mass lesion. A wedge biopsy of the lesion was reported as diffuse large B-cell NHL. Here, we briefly discuss the relationship between arthritis, uveitis and lymphoproliferative disease.     

强直性脊柱炎伴发葡萄膜炎82例临床分析

目的探讨强直性脊柱炎（As）伴发葡萄膜炎的临床特点及药物治疗疗效。方法回顾性分析82例AS伴葡萄膜炎患者的临床资料。结果82例AS伴葡萄膜炎患者平均年龄（34．994±8．28）岁,其中男性占85．37％,HLA-B27阳性率为87．80％,葡萄膜炎评分（5．56±2．04）分。经非甾体类抗炎药、改善病情药物及眼科局部用药后,患者葡萄膜炎症状缓解,视力提高,眼部炎症消失,腰痛改善,血沉、C反应蛋白（CRP）、强直性脊柱炎疾病活动性指数（BASDAI）和强直性脊柱炎功能指数（BASFI）与治疗前比较差异均有统计学意义（P〈0．05）。结论AS伴发葡萄膜炎多见于青壮年男性,单侧受累为主,大部分患者HLA-B27阳性,及时有效治疗疗效确切,一般预后良好。     

UVEITIS: A STRATEGY FOR DIAGNOSIS

Uveitis may be the first presentation of a wide variety of underlying ocular and systemic diseases. It is important for the ophthalmologist to make a specific diagnosis in order to instigate specific therapy and give an accurate prognosis .
The ability to recognise the clinical patterns of uveitis and to initiate appropriate investigations should form the basis of the ophthalmologist's management of the condition. To this end, we have considered uveitis under four major patterns of presentation—anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis—with subclasses within each of these four groups. We have outlined both the investigations which facilitate diagnosis of the possible underlying causes of inflammation and the interpretation of the results of such investigations .     

合并角膜带状变性的并发性白内障手术探讨

目的：探讨合并角膜带状变性的葡萄膜炎并发白内障的手术方法。方法：对16例（26眼）施行光学虹膜切除及现代白内障囊外摘出术，利用上方透明角膜提高视力。结果：23眼（92％）术后矫正视力≥0．2，随访3月－3年，平均8月，视力稳定，未见葡萄膜炎复 发。结论：葡萄膜炎并发白内障，即使合并角膜带状变性，也不应轻易放弃手术治疗，对该类病人施行光学虹膜切除及现代白内障囊外摘出术，不失为一种简便，经济，有效的方法。     

Multifocal posterior uveitis in Crohn’s disease

Purpose To report a case of rare posterior eye manifestation of Crohn’s disease preceding recurrence of inflammatory bowel disease. Methods Case report with ophthalmoscopic findings, fluorescein/indocyanin green angiograms, automated perimetry and multifocal-ERG. Results The perimetry revealed absolute and relative scotomas corresponding to multifocal inflammatory lesions in the retina and choroid, reduced a/b amplitudes in multifocal-ERG and hypofluorescent dots in angiography. Under oral prednisolone visual defects, ophthalmoscopic and angiographic findings resolved, while a/b amplitudes remained mildly reduced. The ocular changes occurred without systemic hypertension and were followed by a new episode of intestinal symptoms. Conclusion Multifocal inflammatory lesions in the retina and choroid in patients with Crohn’s disease may occur and may precede a recurrent intestinal episode. Crohn’s patients should be carefully followed up in collaboration with internal medicine specialists.     

The role of histopathology in the diagnosis and management of uveitis

Summary Intraocular inflammation/uveitis is one of the more poorly understood areas in the field of ophthalmology. We hope to improve this understanding by first reviewing the classic histopathologic approach to intraocular inflammation, and then by integrating that with the current role of histopathology in the diagnosis and management of uveitis. Herein, we will present a systematic approach, beginning with the most accessible conjunctival, lacrimal gland and lymph node biopsy sites; extending through anterior chamber tap, iris biopsy, and vitrectomy and ending with retinal or chorioretinal biopsy of distant organ sites. We will show how a combination of these histopathologic elements can aid in the diagnosis, and thereby the management, of intraocular inflammations and uveitis.     

幼年型慢性关节炎伴发葡萄膜炎患者的临床特征和诊断及治疗

目的　探讨幼年型慢性关节炎(JCA)伴发葡萄膜炎的临床特征、诊断及治疗。方法对1996至2002年间于中山大学中山眼科中心葡萄膜炎专科就诊的26例JCA伴发葡萄膜炎患者采集病史,进行常规裂隙灯显微镜、检眼镜、抗核抗体(ANA)、红细胞沉降率(ESR)、类风湿因子(RF)、C反应蛋白(CRP)及抗链球菌溶血素“O”(ASO)等检查。根据临床需要,部分患者进行人类白细胞相关抗原B27(HLA B27)检测和骶髂关节及脊柱X线检查,并分析患者的治疗、预后及并发症等情况。结果　26例患者中男性11例,女性15例;JCA和葡萄膜炎的中位发病年龄分别为(8±7)岁和(9±5)岁;其中慢性前葡萄膜炎21例,急性前葡萄膜炎3例,慢性全葡萄膜炎2例; 22例患者双眼患病, 4例单眼患病,患眼共有48只;其中33只眼有轻至中度前房闪辉, 24只眼有少至中等量房水细胞, 39只眼发生虹膜后粘连; 30只眼并发白内障, 20只眼并发角膜带状变性, 12只眼继发青光眼。实验室检查发现18例患者呈ANA阳性,ASO均为阴性,RF仅1例为阳性。炎性反应急性期给予睫状肌麻痹剂、糖皮质激素滴眼治疗。病情较顽固的6例患者中, 3例加用环孢霉素A口服治疗, 3例加用苯丁酸氮芥口服治疗,炎性反应均良好控制。16只眼由于治疗前已合并严重的并发症,视力无显著提高;余32只眼视力均有不同程度提高。     

Ciclosporin-Monitoring bei Patienten mit chronischer Uveitis

ZusammenfassungHintergrund Ciclosporin (CsA) ist ein häufig verwendetes Medikament in der Behandlung der posterioren Uveitis. Während sich die Visusprognose der Uveitispatienten unter Therapie mit CsA deutlich gebessert hat, steht dem therapeutischen Nutzen das Auftreten von Nebenwirkungen, u.a. Nephrotoxitität und Entwicklung einer Hypertonie, gegenüber. Neuerdings wurde das C₂-Monitoring (CsA-Blutspiegel 2 h nach oraler Einnahme) als neuer sensitiver Parameter in der Transplantationsmedizin eingeführt.Patienten und Methode In die prospektiv angelegte Studie wurden bisher 15 Patienten mit posteriorer Uveitis eingeschlossen. Sie erhielten oral CsA (5 mg/kg KG 2-mal/Tag). Die Abhängigkeit zwischen C₂- und C₀-Blutspiegel wurde analysiert und mit der klinischen Sicherheit und Effektivität korreliert.Ergebnisse Eine große intra und interindividuelle Variabilität der C₀-Spiegel wurde wie erwartet in Abhängigkeit von Faktoren wie Comedikation und intestinaler Resorption beobachtet. Die C₂-Messungen korrelierten gut mit der klinischen Kontrolle der intraokularen Entzündung.Zusammenfassung Das C₂-Monitoring ist eine einfache und akkurate Alternative für das klinische Monitoring von CsA. Es ermöglicht eine Individualisierung der CsA-Dosierung für jeden Patienten und somit eine Verringerung der Nebenwirkungsrate.Der Inhalt des Beitrags wurde auf der 101. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft, 2004 vorgetragen.