Augenbeteiligung bei ausgewählten rheumatischen Erkrankungen – Klinik im Erwachsenenalter

Zusammenfassung

Okuläre Manifestationen rheumatischer Erkrankungen sind häufig und tragen wesentlich zur Morbidität und Reduktion der Lebensqualität der betroffenen Patienten bei. Die Kenntnis über typische Manifestationsformen ist bedeutsam für den Rheumatologen, um Patienten mit entsprechender Symptomatik frühzeitig ophthalmologisch vorstellen zu können oder auch regelmäßige Screeninguntersuchungen zu veranlassen (z. B. bei Behçet-Syndrom). Umgekehrt ist eine (ggf. auch dringliche) rheumatologische Mitbeurteilung bei bestimmten ophthalmologischen Krankheitsbildern entscheidend, um eine (u. U. letale) systemische assoziierte Erkrankung nicht zu übersehen. Patienten mit rheumatischen bzw. entzündlichen okulären Erkrankungen sollten immer durch den behandelnden Arzt über mögliche Symptome anderweitiger Organmanifestationen aufgeklärt werden, um eine verzögerte Diagnosestellung zu vermeiden. „Klassische“ Assoziationen für Uveitiden sind die (HLA-B27-assoziierten) Spondyloarthritiden und die akute anteriore Uveitis sowie die retinale Vaskulitis mit oder ohne Panuveitis und das Behçet-Syndrom. Bei Patienten mit rheumatoider Arthritis oder ANCA-assoziierten Vaskulitiden hingegen treten typischerweise Skleritiden (mit oder ohne periphere ulzerative Keratitis) auf, aber auch eine Vielzahl weiterer Befunde ist möglich. Die enge interdisziplinäre Zusammenarbeit insbesondere in der Therapiegestaltung ist entscheidend, um eine gute Prognose für den Patienten zu sichern.

Schlüsselwörter

rheumatische Erkrankungen - Uveitis - Skleritis - rheumatoide Arthritis - Spondyloarthritis - Vaskulitis

Publikationsverlauf

Eingereicht: 08. Dezember 2023

Angenommen: 19. Dezember 2023

Artikel online veröffentlicht:
04. April 2024

• Literatur/References

• 1 Listing J, Kekow J, Manger B. et al. Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNFalpha inhibitors and rituximab. Ann Rheum Dis 2015; 74: 415-421
• 2 Symmons D. . Epidemiology and the rheumatic diseases. In Watts RA (Hrsg.): Oxford textbook of rheumatology. Oxford: Oxford University Press; 2013: 203-211
• 3 Feist E, Pleyer U. . Diseases of the outer eye in Rheumatoid arthritis. Z Rheumatol 2010; 69: 403-410
• 4 Turk MA, Hayworth JL, Nevskaya T. et al. Ocular Manifestations in Rheumatoid Arthritis, Connective Tissue Disease, and Vasculitis: A Systematic Review and Metaanalysis. J Rheumatol 2021; 48: 25-34 DOI: 10.3899/jrheum.190768.
• 5 Reddy SC, Rao UR. Ocular complications of adult rheumatoid arthritis. Rheumatol Int 1996; 16: 49-52 DOI: 10.1007/BF01816435.
• 6 Reddy AK, Kolfenbach JR, Palestine AG. Ocular manifestations of rheumatoid arthritis. Curr Opin Ophthalmol 2022; 33: 551-556 DOI: 10.1097/ICU.0000000000000890.
• 7 Artifoni M, Rothschild PR, Brezin A. et al. Ocular inflammatory diseases associated with rheumatoid arthritis. Nat Rev Rheumatol 2014; 10: 108-116 DOI: 10.1038/nrrheum.2013.185.
• 8 Timlin HM, Hall HN, Foot B. et al. Corneal perforation from peripheral ulcerative keratopathy in patients with rheumatoid arthritis: epidemiological findings of the British Ophthalmological Surveillance Unit. Br J Ophthalmol 2018; 102: 1298-1302 DOI: 10.1136/bjophthalmol-2017-310671.
• 9 Watanabe R, Ishii T, Yoshida M. et al. Ulcerative keratitis in patients with rheumatoid arthritis in the modern biologic era: a series of eight cases and literature review. Int J Rheum Dis 2017; 20: 225-230 DOI: 10.1111/1756-185X.12688.
• 10 Dutta Majumder P, Agarwal S, Shah M. et al. Necrotizing Scleritis: A Review. Ocul Immunol Inflamm 2023; DOI: 10.1080/09273948.2023.2206898.
• 11 Erhardt CC, Mumford PA, Venables PJ. et al. Factors predicting a poor life prognosis in rheumatoid arthritis: an eight year prospective study. Ann Rheum Dis 1989; 48: 7-13 DOI: 10.1136/ard.48.1.7.
• 12 Busnelo Moreno C, Goncalves Cruz JC, Zotarelli-Filho IJ. et al. Necrotizing Scleritis and Rheumatoid Arthritis: A Clinical Case Report Supported by A Brief Review with Risk of Bias Analysis. Curr Rheumatol Rev 2023; 19: 367-372 DOI: 10.2174/1573397119666230222093007.
• 13 Caimmi C, Crowson CS, Smith WM. et al. Clinical Correlates, Outcomes, and Predictors of Inflammatory Ocular Disease Associated with Rheumatoid Arthritis in the Biologic Era. J Rheumatol 2018; 45: 595-603 DOI: 10.3899/jrheum.170437.
• 14 Yan F, Liu Y, Zhang T. et al. Identifying TNF and IL6 as potential hub genes and targeted drugs associated with scleritis: A bio-informative report. Front Immunol 2023; 14: 1098140 DOI: 10.3389/fimmu.2023.1098140.
• 15 Dominguez-Casas LC, Sanchez-Bilbao L, Calvo-Rio V. et al. Biologic therapy in severe and refractory peripheral ulcerative keratitis (PUK). Multicenter study of 34 patients. Semin Arthritis Rheum 2020; 50: 608-615 DOI: 10.1016/j.semarthrit.2020.03.023.
• 16 Hardy S, Hashemi K, Catanese M. et al. Necrotising Scleritis and Peripheral Ulcerative Keratitis Associated with Rheumatoid Arthritis Treated with Rituximab. Klin Monbl Augenheilkd 2017; 234: 567-570 DOI: 10.1055/s-0042-121315.
• 17 Sieper J. . Axial spondyloarthropathies. In Watts RA (Hrsg): Oxford textbook of rheumatology. Oxford: Oxford University Press; 2013: 879-889
• 18 Zeboulon N, Dougados M, Gossec L. . Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis 2008; 67: 955-959
• 19 Walscheid K, Glandorf K, Rothaus K. et al. Enthesitis-related arthritis: prevalence and complications of associated uveitis in children and adolescents from a population-based nation-wide study in Germany. J Rheumatol 2021; 48: 262-269 DOI: 10.3899/jrheum.191085.
• 20 Rothova A, van Veenedaal WG, Linssen A. et al. Clinical features of acute anterior uveitis. Am J Ophthalmol 1987; 103: 137-145 DOI: 10.1016/s0002-9394(14)74218-7.
• 21 Linssen A, Meenken C. Outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis. Am J Ophthalmol 1995; 120: 351-361 DOI: 10.1016/s0002-9394(14)72165-8.
• 22 Muñoz-Fernández S, García-Aparicio AM, Hidalgo MV. et al. Methotrexate: an option for preventing the recurrence of acute anterior uveitis. Eye (Lond) 2009; 23: 1130-1133 DOI: 10.1038/eye.2008.198.
• 23 Meyer zu Hoerste M, Walscheid K, Tappeiner C. et al. The effect of methotrexate and sulfasalazine on the course of HLA-B27-positive anterior uveitis: results from a retrospective cohort study. Graefes Arch Clin Exp Ophthalmol 2018; 256: 1985-1992 DOI: 10.1007/s00417-018-4082-x.
• 24 Rudwaleit M, Rodevand E, Holck P. et al. Adalimumab effectively reduces the rate of anterior uveitis flares in patients with active ankylosing spondylitis: results of a prospective open-label study. Ann Rheum Dis 2009; 68: 696-701 DOI: 10.1136/ard.2008.092585.
• 25 Rudwaleit M, Rosenbaum JT, Landewe R. et al. Observed Incidence of Uveitis Following Certolizumab Pegol Treatment in Patients With Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2016; 68: 838-844 DOI: 10.1002/acr.22848.
• 26 Read RW. Clinical mini-review: systemic lupus erythematosus and the eye. Ocul Immunol Inflamm 2004; 12: 87-99 DOI: 10.1080/09273940490895308.
• 27 Jawahar N, Walker JK, Murray PI. et al. Epidemiology of disease-activity related ophthalmological manifestations in Systemic Lupus Erythematosus: A systematic review. Lupus 2021; 30: 2191-2203 DOI: 10.1177/09612033211050337.
• 28 Luboń W, Luboń M, Kotyla P. et al. Understanding Ocular Findings and Manifestations of Systemic Lupus Erythematosus: Update Review of the Literature. Int J Mol Sci 2022; 23: 12264 DOI: 10.3390/ijms232012264.
• 29 Ramos-Casals M, Tzioufas AG, Stone JH. et al. Treatment of primary Sjogren syndrome: a systematic review. JAMA 2010; 304: 452-460 DOI: 10.1001/jama.2010.1014.
• 30 Pan Q, Angelina A, Marrone M. et al. Autologous serum eye drops for dry eye. Cochrane Database Syst Rev 2017; (02) CD009327 DOI: 10.1002/14651858.CD009327.pub3.
• 31 Schwartz LM, Woloshin S. A Clear-eyed View of Restasis and Chronic Dry Eye Disease. JAMA Intern Med 2018; 178: 181-182 DOI: 10.1001/jamainternmed.2017.7904.
• 32 Qiu W, Liu Z, Ao M. et al. Punctal plugs versus artificial tears for treating primary Sjogrenʼs syndrome with keratoconjunctivitis SICCA: a comparative observation of their effects on visual function. Rheumatol Int 2013; 33: 2543-2548 DOI: 10.1007/s00296-013-2769-1.
• 33 Ervin AM, Law A, Pucker AD. Punctal occlusion for dry eye syndrome. Cochrane Database Syst Rev 2017; (06) CD006775 DOI: 10.1002/14651858.CD006775.pub3.
• 34 Brito-Zerón P, Retamozo S, Kostov B. et al. Efficacy and safety of topical and systemic medications: a systematic literature review informing the EULAR recommendations for the management of Sjögrenʼs syndrome. RMD Open 2019; 5: e001064 DOI: 10.1136/rmdopen-2019-001064.
• 35 Ramos-Casals M, Brito-Zerón P, Sisó-Almirall A. et al. Topical and systemic medications for the treatment of primary Sjögrenʼs syndrome. Nat Rev Rheumatol 2012; 8: 399-411 DOI: 10.1038/nrrheum.2012.53.
• 36 Ozdal PC, Tugal-Tutkun I. Choroidal involvement in systemic vasculitis: a systematic review. J Ophthalmic Inflamm Infect 2022; 12: 14 DOI: 10.1186/s12348-022-00292-4.
• 37 Dammacco R, Cimino L, De Simone L. et al. Ocular Manifestations in an Italian Cohort of Patients with Takayasu Arteritis. Ocul Immunol Inflamm 2023; 31: 945-954 DOI: 10.1080/09273948.2022.2072348.
• 38 Peter J, David S, Joseph G. et al. Hypoperfusive and hypertensive ocular manifestations in Takayasu arteritis. Clin Ophthalmol 2010; 4: 1173-1176 DOI: 10.2147/OPTH.S12331.
• 39 Rothschild PR, Pagnoux C, Seror R. et al. Ophthalmologic manifestations of systemic necrotizing vasculitides at diagnosis: a retrospective study of 1286 patients and review of the literature. Semin Arthritis Rheum 2013; 42: 507-514 DOI: 10.1016/j.semarthrit.2012.08.003.
• 40 Hočevar A, Tomšič M, Perdan Pirkmajer K. Clinical Approach to Diagnosis and Therapy of Polyarteritis Nodosa. Curr Rheumatol Rep 2021; 23: 14 DOI: 10.1007/s11926-021-00983-2.
• 41 Ohno S, Miyajima T, Higuchi M. et al. Ocular manifestations of Kawasakiʼs disease (mucocutaneous lymph node syndrome). Am J Ophthalmol 1982; 93: 713-717 DOI: 10.1016/0002-9394(82)90465-2.
• 42 Corral-Gudino L, González-Vázquez E, Calero-Paniagua I. et al. The complexity of classifying ANCA-associated small-vessel vasculitis in actual clinical practice: data from a multicenter retrospective survey. Rheumatol Int 2020; 40: 303-311 DOI: 10.1007/s00296-019-04406-5.
• 43 Junek ML, Zhao L, Garner S. et al. Ocular manifestations of ANCA-associated vasculitis. Rheumatology (Oxford) 2023; 62: 2517-2524 DOI: 10.1093/rheumatology/keac663.
• 44 Cunningham jr. ET, Tugal-Tutkun I, Khairallah M. et al. Behcet Uveitis. Ocul Immunol Inflamm 2017; 25: 2-6 DOI: 10.1080/09273948.2017.1279840.
• 45 Tugal-Tutkun I. Uveitis in Behcet disease – an update. Curr Opin Rheumatol 2023; 35: 17-24 DOI: 10.1097/BOR.0000000000000911.
• 46 Fabiani C, Vitale A, Emmi G. et al. Efficacy and safety of adalimumab in Behcetʼs disease-related uveitis: a multicenter retrospective observational study. Clin Rheumatol 2017; 36: 183-189 DOI: 10.1007/s10067-016-3480-x.
• 47 Tugal-Tutkun I, Güney-Tefekli E, Urgancioglu M. Results of interferon-alfa therapy in patients with Behçet uveitis. Graefes Arch Clin Exp Ophthalmol 2006; 244: 1692-1695 DOI: 10.1007/s00417-006-0346-y.
• 48 De Simone L, Gentile P, Aldigeri R. et al. Effectiveness of Pegylated Interferon Alpha-2a in Post-Uveitic Macular Edema Previously Responding to Non-Pegylated Interferon. Ocul Immunol Inflamm 2023; DOI: 10.1080/09273948.2023.2195494.
• 49 Espinoza GM, Wheeler J, Temprano KK. et al. Coganʼs Syndrome: Clinical Presentations and Update on Treatment. Curr Allergy Asthma Rep 2020; 20: 46 DOI: 10.1007/s11882-020-00945-1.
• 50 Shiboski CH, Shiboski SC, Seror R. et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjogrenʼs syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis 2017; 76: 9-16 DOI: 10.1136/annrheumdis-2016-210571.