Comparison of Relapsing Polychondritis Patients with and Without Respiratory Involvement Based on Chest Computed Tomography: A Retrospective Cohort Study

Background Relapsing polychondritis (RP) patients with tracheal cartilage involvement are different from other patients. The objectives of this study were to compare the clinical features and disease patterns between respiratory involvement subgroup and non-respiratory involvement subgroup according to chest computed tomography. Method We performed a retrospective cohort study collected RP patients hospitalized at the Beijing Chao-Yang Hospital between January 2012 - August 2021. Results The incident of costochondritis was more frequent in RP patients with respiratory involvement(p=0.03), the incidence of inflammatory eye disease(p=0.001) and auricular chondritis(p=0.001) was less frequent in RP respiratory involvement patients, compared with those of RP patients without respiratory involvement. Correlation analysis showed that a negative correlation between respiratory involvement and auricular chondritis (r=-0.58, p < 0.01), and between respiratory involvement and inflammatory eye disease (r=-0.45, P < 0.01). Auricular chondritis was positively correlated with inflammatory eye disease (r=0.49, P < 0.01). Compared with non-respiratory involvement subgroup, the incidence of pulmonary infection marginally increased in respiratory involvement subgroup(p=0.06). Inflammatory indexes except for CAR were significantly higher in respiratory involvement subgroup, subgroup analysis found that there was no significant relationship between inflammatory indexes and pulmonary infection. Conclusion RP patients with respiratory involvement was characterized by higher rate of costochondritis and pulmonary infection, fewer inflammatory eye disease and auricular chondritis compared to non-respiratory involvement. Increase inflammatory indexes may suggested that patients with respiratory involvement had a higher disease activity index of RP. The probability of survival was not significant between two subgroups.

Adhesion Molecule Targeted Therapy for Non-Infectious Uveitis

Non-infectious uveitis (NIU) is an inflammatory eye disease initiated via CD4+ T-cell activation and transmigration, resulting in focal retinal tissue damage and visual acuity disturbance. Cell adhesion molecules (CAMs) are activated during the inflammatory process to facilitate the leukocyte recruitment cascade. Our review focused on CAM-targeted therapies in experimental autoimmune uveitis (EAU) and NIU. We concluded that CAM-based therapies have demonstrated benefits for controlling EAU severity with decreases in immune cell migration, especially via ICAM-1/LFA-1 and VCAM-1/VLA-4 (integrin) pathways. P-selectin and E-selectin are more involved specifically in uveitis related to vasculitis. These therapies have potential clinical applications for the development of a more personalized and specific treatment. Localized therapies are the future direction to avoid serious systemic side effects.

Analysis of the Assortability of Ophthalmologists Using a Therapy as Part of Routine Medical Care for Patients with Inflammatory Eye Diseases

The problem of diagnosis and treatment of inflammatory eye diseases takes a leading place in Russia and in the world, but the most important thing is the correct choice of treatment methods. Purpose of the work: collection and analysis of data on doctors’ preferences under prescribing therapy in patients with inflammatory eye pathology in routine clinical practice. As a result, 5960 clinical cases from 47 Russian cities were analyzed. This article compiles data from October to November 2020. 151 medical researchers were taken part in the participation of the recruitment. Doctors made different diagnoses for referring patients, but significantly more often diagnosis H10.3 was detected — 17.99 % (in 1072 patients). Ophthalmologists preferred to prescribe the following combination of drugs: 1 — antibacterial local, 2 — local antiseptics, 3 — non-steroidal anti-inflammatory local, a combination (antibiotic and glucocorticosteroid), antiallergic in the form of drops of local action. The choice of drugs for inflammatory eye disease is determined by their high efficiency of use for a given disease: antibiotic Signicef® (levofloxacin 0,5 %), nonsteroidal anti-inflammatory drug Broxinac® (bromphenac 0,09 %), fixed combination Kombinil® (ciprofloxacin 0,3 % + dexamethasone 0,1 %), Visallergol® (olopatadine 0,2 %) in the form of topical eye drops.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

Background Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory eye disease, affecting the inner choroid and the outer retina. Recent advances in multimodal imaging have been important in the understanding of the pathophysiology of the disease, allowing a better characterization of the morphology of this condition. Methods Narrative review. Results In this review, a comprehensive overview of clinical features, imaging findings, treatment management, and long-term outcomes of patients with APMPPE will be provided. Conclusions Although APMPPE was originally believed to be a self-limited condition with a good prognosis, the disease can be recurrent and result in significant loss of vision function. Fundus imaging plays an important role in the diagnosis and management of the disease, allowing to evaluate response to treatment and onset of complications.

Anxiety and depression in inflammatory eye disease: exploring the potential impact of topical treatment frequency as a putative psychometric item

ObjectiveTo evaluate whether topical therapy is linked to scores related to anxiety, depression and quality of life (QoL) in inflammatory eye disease (IED).Methods and analysisPatients with ocular surface disease (OSD, N=100) and Uveitis (N=100) completed self-administered validated questions on ocular symptoms and well-being, with supplemental questions on eye drop frequency.ResultsForty (20%) patients had scores consistent with depression and 33 (17%) anxiety. Anxiety, depression, QoL and OSD index (OSDI) scores did not differ significantly between OSD and Uveitis groups. In those with anxiety or depression, QoL was significantly reduced in all WHO Quality Of Life-BREF domains (all p<0.001). Multivariable analysis considering demographic and disease-related factors found daily topical drop frequency to be independently associated with anxiety (p=0.009) but not depression (p=0.300).ConclusionA high proportion of patients with IED demonstrated scores indicative of anxiety and depression. Preliminary evidence suggests that the frequency of topical eye drops potentially plays a significant role in the psychological health status of patients with IED .

AB0389 A COMBINED RHEUMATOLOGY-OPHTHALMOLOGY CLINIC IMPROVED DIAGNOSIS AND TREATMENT OF IMMUNE-MEDIATED AND INFLAMMATORY DISEASES AMONG PATIENTS PRESENTING WITH INFLAMMATORY EYE DISEASES

Background:Patients presenting with an inflammatory eye disease may have underlying immune-mediated and inflammatory diseases (IMIDs). However, IMIDs are challenging to diagnose. A combined rheumatology-ophthalmology evaluation could enhance detection of IMIDs in this group.Objectives:To investigate whether the implementation of a combined rheumatology-ophthalmology clinic could increase the sensibility of IMIDs diagnosis.Methods:A combined rheumatology-ophthalmology clinic started in January 2020. A rheumatologist with expertise in IMIDs assessed outpatients of a tertiary care ophthalmologic clinic specialised in inflammatory eye disease consecutively referred between 01/01/20 and 31/12/20. Two separate visits confirmed both ophthalmology and rheumatology diagnoses. The same period of the year 2019 was used as a comparator.Results:We noticed a three-fold increase in the number of ophthalmology patients who underwent an evaluation with a rheumatologist in 2020 compared to 2019 (41 vs 13, +315%; Table). There were no differences in sex distribution or age between the two years. However, the median time before rheumatology assessment was shorter in 2020 than 2019 (median days 0 [range 0-6] vs 12 [range 0-91]). IMIDs diagnoses increased by 27% in 2020 compared to 2019 (29/41 vs 7/13, 71% vs 54%), mainly driven by new diagnoses of systemic vasculitis and Behcet’s disease (Figure 1). There was also an increase in diagnoses of non-IMIDs systemic conditions (3 cancers and one infection in 2020 vs none in 2019). After rheumatology evaluation, immune-modulating therapy was initiated in 18/41 (44%) vs 3/13 (23%).Ophthalmology assessment and referrals to rheumatologyReferrals2019(n=13)Referrals2020(n=41)Inflammatory eye disease, n (%)6 (46)36 (88)Uveitis, n621Vasculitis, n24AION, n35Conjunctivitis, n10Scleritis, episcleritis, n01Other, n15Conclusion:An integrated approach with rheumatologist appeared to remarkably increase the likelihood to detect IMIDs among patients presenting with inflammatory eye diseases.Disclosure of Interests:None declared

Ocular Sarcoidosis

Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.

Multiple Evanescent White Dot Syndrome: A Case Report and Experience with Corticosteroid Therapy

Multiple evanescent white dot syndrome (MEWDS) is an inflammatory eye disease of the outer retina, retinal pigmented epithelium, choroid presenting with photopsia, loss of vision, and temporal scotoma. The patient was a 31-year-old female with a history of vision loss since 11 days ago (left eye). At presentation, best-corrected Snellen visual acuity was 20/140 in the Snellen chart. We decided to treat her with short time corticosteroid therapy (0.75 mg/kg/day prednisolone which was tapered in 3 weeks) for any possible rapid recovery of vision. The visual acuity of the involved eye was improved to 20/25 and 20/20, one week and three weeks after starting treatment respectively. Thus, it seems that short-term oral steroids might be an alternative method of management for patients with MEWDS.