Uveitis-Associated Rheumatic Disease: For Non-Ophthalmologists (Eng)
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Abstract
Uveitis is a leading cause of vision loss worldwide. Its etiology is classified into infectious, non-infectious, and idiopathic categories. Among non-infectious cases, uveitis associated with rheumatic diseases is common. Effective management of uveitis and identification of underlying rheumatic conditions are crucial. Therefore, interdisciplinary collaboration between ophthalmologists and internists or rheumatologists is essential. To achieve this, non-ophthalmologists need a solid understanding of uveitis, including ocular anatomy, classification, clinical features, rheumatic disease associations, and current treatment strategies. These aspects will be addressed in this review.
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References
Riordan-Eva P. Anatomy & Embryology of the Eye. In: Riordan-Eva P, Augsburger JJ, editors. Vaughan & Asbury's General Ophthalmology, 19e. New York, NY: McGraw-Hill Education; 2017.
Hochberg MC GE, Smolen JS, Van der Heijde D, Weinblatt ME, Weisman MH. . Rheumatology:2023.
Mescher AL. Junqueira's Basic Histology: Text and Atlas, Sixteenth Edition: McGraw Hill LLC; 2021.
Riordan-Eva P. Chapter 1. Anatomy & Embryology of the Eye. In: Riordan-Eva P, Cunningham ET, editors. Vaughan & Asbury's General Ophthalmology, 18e. New York, NY: The McGraw-Hill Companies; 2011.
Ophthalmology AAo, Sen HN, Smith WM, Armbrust KR, Dahr SS, Dodds EM, et al. 2023-2024 Basic and Clinical Science Course(tm), Section 9: Uveitis and Ocular Inflammation: American Academy of Ophthalmology; 2023.
Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, Koretzky G. Firestein & Kelley's Textbook of Rheumatology - E-Book: Elsevier; 2020.
Taylor AW. Ocular immune privilege. Eye (Lond) 2009;23(10):1885-9.
Streilein JW. Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation. J Leukoc Biol 2003;74(2):179-85.
Maghsoudlou P, Epps SJ, Guly CM, Dick AD. Uveitis in Adults: A Review. JAMA 2025;334(5):419-34.
Acharya NR, Tham VM, Esterberg E, Borkar DS, Parker JV, Vinoya AC, et al. Incidence and prevalence of uveitis: results from the Pacific Ocular Inflammation Study. JAMA Ophthalmol 2013;131(11):1405-12.
Gritz DC, Wong IG. Incidence and prevalence of uveitis in Northern California; the Northern California Epidemiology of Uveitis Study. Ophthalmology 2004;111(3):491-500; discussion
Thorne JE, Suhler E, Skup M, Tari S, Macaulay D, Chao J, et al. Prevalence of Noninfectious Uveitis in the United States: A Claims-Based Analysis. JAMA Ophthalmol 2016;134(11):1237-45.
Rim TH, Kim SS, Ham DI, Yu SY, Chung EJ, Lee SC. Incidence and prevalence of uveitis in South Korea: a nationwide cohort study. Br J Ophthalmol 2018;102(1):79-83.
Rathinam SR, Krishnadas R, Ramakrishnan R, Thulasiraj RD, Tielsch JM, Katz J, et al. Population-based prevalence of uveitis in Southern India. Br J Ophthalmol 2011;95(4):463-7.
Hsu YR, Huang JC, Tao Y, Kaburaki T, Lee CS, Lin TC, et al. Noninfectious uveitis in the Asia-Pacific region. Eye (Lond) 2019;33(1):66-77.
Durrani OM, Meads CA, Murray PI. Uveitis: a potentially blinding disease. Ophthalmologica 2004;218(4):223-36.
Sukavatcharin S, Kijdaoroong O, Lekhanont K, Arj-Ong Vallipakorn S. Pattern of Uveitis in a Tertiary Ophthalmology Center in Thailand. Ocul Immunol Inflamm 2017;25(sup1):S94-s9.
Pathanapitoon K, Kunavisarut P, Ausayakhun S, Sirirungsi W, Rothova A. Uveitis in a tertiary ophthalmology centre in Thailand. Br J Ophthalmol 2008;92(4):474-8.
Silpa-Archa S, Noonpradej S, Amphornphruet A. Pattern of Uveitis in a Referral Ophthalmology Center in the Central District of Thailand. Ocul Immunol Inflamm 2015;23(4):320-8.
Sittivarakul W, Bhurayanontachai P, Ratanasukon M. Pattern of uveitis in a university-based referral center in southern Thailand. Ocul Immunol Inflamm 2013;21(1):53-60.
Keorochana N. Pattern and Outcome of Uveitis in a Tertiary Military Hospital in Thailand. Ocul Immunol Inflamm 2020;28(3):424-32.
Tesavibul N, Boonsopon S, Choopong P, Tanterdtham S. Uveitis in Siriraj Hospital: pattern differences between immune-related uveitis and infectious uveitis in a university-based tertiary care hospital. Int Ophthalmol 2018;38(2):673-8.
Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005;140(3):509-16.
Rosenbaum JT, Dick AD. The Eyes Have it: A Rheumatologist's View of Uveitis. Arthritis Rheumatol 2018;70(10):1533-43.
Sève P, Cacoub P, Bodaghi B, Trad S, Sellam J, Bellocq D, et al. Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee. Autoimmun Rev 2017;16(12):1254-64.
El Jammal T, Loria O, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Sève P. Uveitis as an Open Window to Systemic Inflammatory Diseases J Clin Med 2021;10(2).
Clinical overview: Uveitis: Elsevier 2025 [cited 2025 20 October]. Available from: https://www-clinicalkey-com.ejournal.mahidol.ac.th/#!/content/clinical_overview/67-s2.0-9e71b7c5-a4f0-438c-b1ee-5028093e9786#causes-and-risk-factors-heading-12.
Rosenzweig HL, Martin TM, Planck SR, Jann MM, Smith JR, Glant TT, et al. Anterior uveitis accompanies joint disease in a murine model resembling ankylosing spondylitis. Ophthalmic Res 2008;40(3-4):189-92.
Pathanapitoon K, Dodds EM, Cunningham ET, Jr., Rothova A. Clinical Spectrum of HLA-B27-associated Ocular Inflammation. Ocul Immunol Inflamm 2017;25(4):569-76.
Wakefield D, Chang JH, Amjadi S, Maconochie Z, Abu El-Asrar A, McCluskey P. What is new HLA-B27 acute anterior uveitis? Ocul Immunol Inflamm 2011;19(2):139-44.
Ríhová E, Havlíková M, Michalová K, Strasmajer V, Poch T. [Acute anterior uveitis, systemic diseases and HLA-B27]. Cesk Slov Oftalmol 1997;53(2):80-7.
Rademacher J, Poddubnyy D, Pleyer U. Uveitis in spondyloarthritis. Ther Adv Musculoskelet Dis 2020;12:1759720X20951733.
Bolletta E, Crescentini F, Gentile P, Citriniti G, Macchioni P, Marchesoni A, et al. A review on anterior uveitis and spondyloarthritis with a focus on the interdisciplinary approach between ophthalmologists and rheumatologists. Saudi J Ophthalmol 2025;39(1):20-30.
Stolwijk C, van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis 2015;74(1):65-73.
de Winter JJ, van Mens LJ, van der Heijde D, Landewé R, Baeten DL. Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: a meta-analysis. Arthritis Res Ther 2016;18(1):196.
Limsakul N, Chiowchanwisawakit P, Permpikul P, Thanaketpaisarn Y. Younger age of onset and uveitis associated with HLA-B27 and delayed diagnosis in Thai patients with axial spondyloarthritis. Sci Rep 2021;11(1):13536.
Lozada CJ, Carpintero MF, Schwartz RA. Reactive Arthritis Clinical Presentation2025 25 October 2025 [cited 2025 25 October]. Available from: https://emedicine.medscape.com/article/331347-clinical#b2.
De Vicente Delmás A, Sanchez-Bilbao L, Calvo-Río V, Martínez-López D, Herrero-Morant A, Galíndez-Agirregoikoa E, et al. Uveitis in psoriatic arthritis: study of 406 patients in a single university center and literature review. RMD Open 2023;9(1).
Paiva ES, Macaluso DC, Edwards A, Rosenbaum JT. Characterisation of uveitis in patients with psoriatic arthritis. Ann Rheum Dis 2000;59(1):67-70.
Lyons JL, Rosenbaum JT. Uveitis associated with inflammatory bowel disease compared with uveitis associated with spondyloarthropathy. Arch Ophthalmol 1997;115(1):61-4.
Pan J, Kapur M, McCallum R. Noninfectious immune-mediated uveitis and ocular inflammation. Curr Allergy Asthma Rep 2014;14(1):409.
Cassidy J, Kivlin J, Lindsley C, Nocton J. Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics 2006;117(5):1843-5.
Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken) 2019;71(6):703-16.
Rosenbaum JT, Pasadhika S. Ocular Sarcoidosis. Clin Chest Med 2024;45(1):59-70.
Yazici H, Seyahi E, Hatemi G, Yazici Y. Behçet syndrome: a contemporary view. Nat Rev Rheumatol 2018;14(2):107-19.
Gallagher K, Viswanathan A, Okhravi N. Association of systemic lupus erythematosus with uveitis. JAMA Ophthalmol 2015;133(10):1190-3.
Liu S, Xu M, Zhao X, Yang J, Zhang W, Chen Y. Ocular manifestations in ANCA-associated vasculitis: a comprehensive analysis from Chinese medical centers. Clin Rheumatol 2024;43(9):2899-910.
Junek ML, Zhao L, Garner S, Cuthbertson D, Pagnoux C, Koening CL, et al. Ocular manifestations of ANCA-associated vasculitis. Rheumatology (Oxford) 2023;62(7):2517-24.
Leffler CT, Brar VS, Wallace M. Randomized Controlled Trial Evaluating a Standardized Strategy for Uveitis Etiologic Diagnosis (ULISSE). Am J Ophthalmol 2017;179:207-8.
Grumet P, Kodjikian L, de Parisot A, Errera MH, Sedira N, Heron E, et al. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis). Autoimmun Rev 2018;17(4):331-43.
Quartier P, Saadoun D, Belot A, Errera MH, Kaplanski G, Kodjikian L, et al. French recommendations for the management of non-infectious chronic uveitis. Rev Med Interne 2023;44(5):227-52.
Balasubramaniam B, Chong YJ, Azzopardi M, Logeswaran A, Denniston AK. Topical Anti-Inflammatory Agents for Non-Infectious Uveitis: Current Treatment and Perspectives. J Inflamm Res 2022;15:6439-51.
Writing Committee for the Multicenter Uveitis Steroid Treatment T, Follow-up Study Research G, Kempen JH, Altaweel MM, Holbrook JT, Sugar EA, et al. Association Between Long-Lasting Intravitreous Fluocinolone Acetonide Implant vs Systemic Anti-inflammatory Therapy and Visual Acuity at 7 Years Among Patients With Intermediate, Posterior, or Panuveitis. JAMA 2017;317(19):1993-2005.
Rosenbaum JT, Bodaghi B, Couto C, Zierhut M, Acharya N, Pavesio C, et al. New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Semin Arthritis Rheum 2019;49(3):438-45.
Hatemi G, Christensen R, Bang D, Bodaghi B, Celik AF, Fortune F, et al. 2018 update of the EULAR recommendations for the management of Behcet's syndrome. Ann Rheum Dis 2018;77(6):808-18.
Jabs DA, Rosenbaum JT, Foster CS, Holland GN, Jaffe GJ, Louie JS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol 2000;130(4):492-513.
Wu X, Tao M, Zhu L, Zhang T, Zhang M. Pathogenesis and current therapies for non-infectious uveitis. Clin Exp Med 2023;23(4):1089-106.
Leclercq M, Seve P, Biard L, Vautier M, Maalouf G, Leroux G, et al. Methotrexate versus conventional disease-modifying antirheumatic drugs in the treatment of non-anterior sarcoidosis-associated uveitis. Br J Ophthalmol 2024;109(1):34-40.
Saadoun D, Wechsler B, Terrada C, Hajage D, Le Thi Huong D, Resche-Rigon M, et al. Azathioprine in severe uveitis of Behcet's disease. Arthritis Care Res (Hoboken) 2010;62(12):1733-8.
Pasadhika S, Kempen JH, Newcomb CW, Liesegang TL, Pujari SS, Rosenbaum JT, et al. Azathioprine for ocular inflammatory diseases. Am J Ophthalmol 2009;148(4):500-9 e2.
Daniel E, Thorne JE, Newcomb CW, Pujari SS, Kaçmaz RO, Levy-Clarke GA, et al. Mycophenolate mofetil for ocular inflammation. Am J Ophthalmol 2010;149(3):423-32.e1-2.
Pujari SS, Kempen JH, Newcomb CW, Gangaputra S, Daniel E, Suhler EB, et al. Cyclophosphamide for ocular inflammatory diseases. Ophthalmology 2010;117(2):356-65.
Kaçmaz RO, Kempen JH, Newcomb C, Daniel E, Gangaputra S, Nussenblatt RB, et al. Cyclosporine for ocular inflammatory diseases. Ophthalmology 2010;117(3):576-84.
Murphy CC, Greiner K, Plskova J, Duncan L, Frost NA, Forrester JV, et al. Cyclosporine vs tacrolimus therapy for posterior and intermediate uveitis. Arch Ophthalmol 2005;123(5):634-41.
Jaffe GJ, Dick AD, Brézin AP, Nguyen QD, Thorne JE, Kestelyn P, et al. Adalimumab in Patients with Active Noninfectious Uveitis. N Engl J Med 2016;375(10):932-43.
Nguyen QD, Merrill PT, Jaffe GJ, Dick AD, Kurup SK, Sheppard J, et al. Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial. Lancet 2016;388(10050):1183-92.
Sener H, Evereklioglu C, Horozoglu F, Gunay Sener AB. Efficacy and Safety of Adalimumab in Patients with Behcet Uveitis: A Systematic Review and Meta-Analysis. Ocul Immunol Inflamm 2024;32(1):89-97.
Liu W, Bai D, Kou L. Comparison of infliximab with adalimumab for the treatment of non-infectious uveitis: a systematic review and meta-analysis. BMC Ophthalmol 2023;23(1):240.
Vallet H, Seve P, Biard L, Baptiste Fraison J, Bielefeld P, Perard L, et al. Infliximab Versus Adalimumab in the Treatment of Refractory Inflammatory Uveitis: A Multicenter Study From the French Uveitis Network. Arthritis Rheumatol 2016;68(6):1522-30.
Tungsattayathitthan U, Tesavibul N, Choopong P, Treeratsakulchai C, Ngathaweesuk Y, Sanphan W, et al. Efficacy of golimumab in patients with refractory non-infectious panuveitis. Sci Rep 2024;14(1):2179.
Brito-Zeron P, Perez-Alvarez R, Ramos-Casals M, Group BS. Etanercept and uveitis: friends or foes? Curr Med Res Opin 2015;31(2):251-2.
Gangaputra SS, Newcomb CW, Ying GS, Dreger KA, Fitzgerald T, Artornsombudh P, et al. Effectiveness of Frequently Used TNF Inhibitors vs. Conventional Immunosuppressive Therapies for Noninfectious Uveitis. Ocul Immunol Inflamm 2025;33(6):948-56.
Ng CC, Sy A, Cunningham ET, Jr. Rituximab for non-infectious Uveitis and Scleritis. J Ophthalmic Inflamm Infect 2021;11(1):23.
Uludag G, Karaca I, Akhavanrezayat A, Yasar C, Matsumiya W, Pham BH, et al. Efficacy and Safety of Tocilizumab in the Management of Non-Infectious Uveitis Failed with Conventional Immunomodulatory and Anti-TNFalpha Therapies. Ocul Immunol Inflamm 2024;32(6):891-7.
Bodaghi B, Gendron G, Wechsler B, Terrada C, Cassoux N, Huong du LT, et al. Efficacy of interferon alpha in the treatment of refractory and sight threatening uveitis: a retrospective monocentric study of 45 patients. Br J Ophthalmol 2007;91(3):335-9.
Pyare R, Shaikh N, Sen A, Kene R, Bagri N, Janarthanan M, et al. JAK-STAT inhibitors in noninfectious uveitis - A review. Indian J Ophthalmol 2025;73(6):807-15.
The Comptroller General’s Department. Criteria for reimbursement of medical expenses for patients with uveitis who require high-cost medications. In: Department TCGs, editor 2021.
Contreras-Salinas H, Orozco-Ceja V, Romero-Lopez MS, Barajas-Virgen MY, Baiza-Duran LM, Rodriguez-Herrera LY. Ocular Cyclopentolate: A Mini Review Concerning Its Benefits and Risks. Clin Ophthalmol 2022;16:3753-62.
Charatcharoenwitthaya N, Jaisamrarn U, Songpatanasilp T, Kuptniratsaikul V, Unnanuntana A, Sritara C, et al. Summary of the Thai Osteoporosis Foundation (TOPF) Clinical Practice Guideline on the diagnosis and management of osteoporosis 2021. Osteoporos Sarcopenia 2023;9(2):45-52.
Thai Rheumatism Association. 2014 Clinical practice guidelines for the diagnosis and management of rheumatoid arthritis 2014 [cited 2014. Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://thairheumatology.org/phocadownload/73/Guideline_007.pdf.
Ali FS, Nguyen MH, Hernaez R, Huang DQ, Wilder J, Piscoya A, et al. AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals. Gastroenterology 2025;168(2):267-84.
Allen KB, Keating RM. Immunosuppressive agents: cyclosporine, cyclophosphamide, azathioprine, mycophenolate mofetil, and tacrolimus. Philadelphia: Elsevier 2023 [cited 2025 31 October].
Shahab MA, Mir TA, Zafar S. Optimising drug therapy for non-infectious uveitis. Int Ophthalmol 2019;39(7):1633-50.
Quartier P, Saadoun D, Belot A, Errera MH, Kaplanski G, Kodjikian L, et al. French recommendations for the management of non-infectious chronic uveitis. Rev Med Interne 2023;44(5):227-52.
