Augenerkrankungen und entzündlichrheumatische Erkrankungen im Kindes- und Erwachsenenalter

Zusammenfassung

Entzündlich-rheumatische Erkrankungen gehen häufig mit einer Augenbeteiligung einher. Zu den typischen Befunden zählen Sjögren-Syndrom, Konjunktivitis, Episkleritis, Skleritis, Keratitis und Uveitis. Die unterschiedlichen System-erkrankungen sind mit einem typischen Spektrum von Augenveränderungen und -komplikationen verbunden. Von besonderer Bedeutung ist, dass die Augenerkrankung das erste klinische Zeichen der systemischen entzündlich-rheumatischen Erkrankung sein kann. Die Diagnostik und The-rapie von schweren Augenentzündungen bei Patienten mit entzündlich-rheumatischen Systemerkrankungen setzt eine besondere Erfahrung mit diesen komplexen Krankheitsbildern voraus. In die Therapieentscheidungen müssen die Befunde von allen betroffenen Organen einbezogen wer-den. Die Betreuung sollte möglichst in spezialisierten Zen-tren und in enger interdisziplinärer Kooperation erfolgen. Unter Beachtung von publizierten Studien und Behandlungsleitlinien können die Patienten oft vor einem drohen-den Visusverlust bewahrt werden.

Summary

Systemic rheumatic diseases frequently occur with ocular manifestations, and these include Sjögrenś syndrome, conjunctivitis, episcleritis, scleritis, keratitis, and uveitis. The different systemic diseases are combined with a typical spectrum of eye changes and complications. It is of particular importance that diseases of the eye may be the first clinical sign of the systemic rheumatic disease. The diagnosis and therapy of severe eye inflammations in patients with systemic rheumatic disease requires a particular experience with these complex clinical entities. The therapeutic decisions should consider the abnormalities of all involved organs. Patient care may preferentially take place in specialized centers, and with close interdisciplinary cooperation. With the consideration of published studies and treatment guidelines, the patients can often be prevented from visual loss.

Schlüsselwörter

Sjögren-Syndrom - Skleritis - Uveitis - Keratitis

Keywords

Sjögren’s syndrome - scleritis - uveitis - keratitis

• Literatur

• 1 Afshari NA.. et al. Inflammatory conditions of the eye associated with rheumatic diseases. Curr Rheumatol Rep 2001; 3: 453-458.
• 2 Bonfioli AA., Orefice F.. Behçet’s disease. Semin Ophthalmol 2005; 20: 199-206.
• 3 Dana MR., Qian Y., Hamrah P.. Twenty-five-year panorama of corneal immunology: emerging concepts in the immunopathogenesis of microbial keratitis, peripheral ulcerative keratitis, and corneal transplant rejection. Cornea 2000; 19: 625-643.
• 4 El-Shabrawi Y., Hermann J.. Anti-TNF alpha therapy in chronic necrotizing scleritis resistant to standard immunomodulatory therapy in a patient with wegener’s granulomatosis. Eye 2005; 19: 1017-1018.
• 5 Foeldvari I., Wierk A.. Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis. J Rheumatol 2005; 32: 362-365.
• 6 Foster CS.. et al. Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or ulcerative keratitis. Ophthalmology 1984; 91: 1253-1263.
• 7 Foster CS., Sainz de la Maza M.. The sclera. New York, Berlin: Springer; 1994
• 8 Garcia-Carrasco M.. et al. Pathophysiology of Sjogren&quote;s syndrome. Arch Med Res. 2006; 37 (08) 921-932.
• 9 Geggel HS., Mensher JH.. Cicatricial conjunctivitis in sarcoidosis: recognition and treatment. Ann Ophthalmol 1989; 21: 92-94.
• 10 Gold DH.. et al. Ocular findings in systemic lupus erythematosus. Br J Ophthalmol 1972; 56: 800-804.
• 11 Haimovici R., Foster CS.. Sarcoidosis. In Pepose JS.. et al. Hrsg. Ocular infection and immunity. St. Louis: Mosby; 1996: 754-776.
• 12 Harper SL.. et al. Wegener’s granulomatosis: the relationship between ocular and systemic disease. J Rheumatol 2001; 28: 1025-1032.
• 13 Heiligenhaus A.. et al. Histology and immuno-pathology of systemic lupus erythematosus affecting the conjunctiva. Eye 1996; 10: 425-32.
• 14 Heiligenhaus A., Steuhl KP.. Skleritis. Differential-diagnostik und Therapie. Bücherei Augenarzt 1996; 137: 136-144.
• 15 Heiligenhaus A.. et al. Indikation und Wirksamkeit einer Immunsuppression bei Patienten mit Skleritis. Klin Monatsbl Augenheilk 2003; 220: 471-480.
• 16 Heiligenhaus A.. et al. Juvenile idiopathic arthritis and uveitis: screening and anti-inflammatory therapy. Klin Monatsbl Augenheilk 2003; 220: 738-753.
• 17 Heiligenhaus A.. et al. Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology 2007; 46: 1015-1019.
• 18 Heiligenhaus A.. et al. Methotrexate for uveitis associates with juvenile idiopathic arthritis: value and requirement for additional anti-inflammatory medication. Eur J Ophthalmol 2007; 17: 743-748.
• 19 Hodge WG., Maurer TA., Nozik RA.. Reiter’s syndrome. In Mannis MJ., Macsai MS., Huntley AC.. Hrsg. Eye and skin disease. Philadelphia: Lippincott-Raven Publishers; 1996: 311-316.
• 20 Ibanez HE.. et al. Exuberant conjunctival pseudo-polyposis in a patient with dermatomyositis. Ann Ophthalmol 1993; 25: 326-327.
• 21 Jabs DA., Johns CJ.. Ocular involvement in chronic sarcoidosis. Am J Ophthalmol 1986; 102: 297-301.
• 22 Jabs DA., Mudun A., Dunn JP., Marsh MJ.. Episcleritis and scleritis: clinical features and treatment results. Am J Ophthalmol 2000; 130: 469-476.
• 23 Jabs DA.. et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005; 140: 509-516.
• 24 Jordan DR., Addison DA.. Wegner’s granulomatosis. Eyelid and conjunctival manifestations as the presenting feature in two individuals. Ophthalmology 1994; 101: 602-607.
• 25 Kötter I., Zierhut M., Eckstein AK.. et al. Human recombinant interferon alfa-2a for the treatment of Behçet’s disease with sight threatening posterior or panuveiits. Br J Ophthalmol 2003; 87: 423-431.
• 26 Krzystolik M., Power WJ., Foster CS.. Diagnostic and therapeutic challenges of sarcoidosis. Int Ophthalmol Clin 1998; 38: 61-76.
• 27 Larche MJ.. A short review of the pathogenesis of Sjögren’s syndrome. Autoimun Rev 2006; 5: 132-135.
• 28 Lemp MA.. et al. The definition and classification of dry eye disease: report of the definition and classification subcommittee of the international dry eye workshop. Ocul Surf 2007; 5: 75-92.
• 29 Messmer EM., Foster CS.. Vasculitic peripheral ulcerative keratitis. Surv Ophthalmol 1999; 43: 379-396.
• 30 Minden K., Mingels A., Niewerth M.. et al. Juvenile idiopahic arthritis and uveitis: epidemiology including data from the national database. Klin Monatsbl Augenheilk 2007; 224: 469-472.
• 31 Niehues T.. et al. EBM analysis: classic DMARs and immunosuppressants in arthritis and uveitis. Klin Monatsbl Augenheilk 2007; 224: 520-525.
• 32 Nussenblatt RB., Palastine AG., Rook AH.. et al. Treatment of intraocular inflammatory disease with cyclosporin A. Lancet 1983; 2: 235-238.
• 33 Ozyazgan Y.. et al. Low dose cyclosporin A versus pulsed cyclophosphamide in Behcet’s syndrome: a single masked trial. Br J Ophthalmol 1992; 76: 241-243.
• 34 Pakrou N.. et al. Wegener’s granulomatoris: ophthalmi manifestation and management. Semin Ar-thritis Rheum 2006; 35: 284-292.
• 35 Pflugfelder SC.. et al. Management and therapy of dry eye disease: report of the management and therapy subcommittee of the international dry eye workshop. Ocul Surf 2007; 5: 163-178.
• 36 Pleyer U.. et al. Autoimmunerkrankungen der peripheren Hornhaut. Immunpathologie, Klinik und Therapie. Klin Monatsbl Augenheildk 1996; 208: 73-81.
• 37 Purcell Jr. JJ.. et al. Conjunctival lesions in periarteriitis nodosa. Arch Ophthalmol 1984; 102: 736-738.
• 38 Rothova A.. et al. Risk factors for ocular sarcoidosis. Doc Ophthalmol 1989; 72: 287-296.
• 39 Sainz de la Maza M., Jabbur NS., Foster CS.. An analysis of therapeutic decision for scleritis. Ophthalmology 1993; 100: 1372-1376.
• 40 Sainz de la Maza M.. et al. Severity of scleritis and episcleritis. Ophthalmology 1994; 101: 389-396.
• 41 Schirra F., Rubrecht KW.. Das trockene Auge. Ophthalmologe 2004; 101: 10-18.
• 42 Sfikakis PP.. et al. Anti-TNF therapy in the management of Behcet&quote;s disease – review and basis for recommendations. Rheumatology 2007; 46: 736-741.
• 43 Stavrou P.. et al. Clinical diagnosis of ocular sarcoidosis. Eye 1997; 11: 365-370.
• 44 Tu EY.. et al. Therapy of nonnecrotizing anterior scleritis with subconjunctival corticosteroid injection. Ophthalmology 1995; 102: 718-724.
• 45 Watson PG., Hayreh SS.. Scleritis and episcleritis. Br J Ophthalmol 1976; 60: 163-191.
• 46 Watson PG.. The diagnosis and management of scleritis. Ophthalmology 1980; 87: 716-720.
• 47 Watson PG.. The nature and treatment of scleral inflammation. Trans Ophthalmol Soc UK 1982; 102: 257-281.
• 48 Watson PG.. et al. The sclera and systemic disorders. 2nd Edition. Edinburgh, London: BH; 2004
• 49 West RH., Barnett AJ.. Ocular involvement in scleroderma. Br J Ophthalmol 1979; 63: 845-847.
• 50 Yazici H.. et al. A controlled trial of azathioprine in behcet’s syndrome. N Engl J Med 1990; 322: 281-285.
• 51 Yazici H.. et al. Behçet’s syndrome: disease manifestations, management, and advances in treatment. Nat Clin Pract Rheumatol 2007; 3: 148-155.