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Zeitschrift für Rheumatologie

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20.06.2018 | Originalien

Relationship of ocular presentation in granulomatosis with polyangiitis to autoantibodies and disease activity

verfasst von: Prof. T. A. Gheita, MD, E. M. Abd El Latif

Erschienen in: Zeitschrift für Rheumatologie | Ausgabe 3/2019

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Abstract

Objective

The aim of this study was to assess disease characteristics, autoantibodies, and disease activity in granulomatosis with polyangiitis (GPA) patients with ocular manifestations.

Methods

The cohort included 46 GPA patients visiting the ophthalmology clinic. Ocular manifestations were recorded, clinical and slit lamp examinations were performed. The Birmingham Vasculitis Activity Score (BVAS) was recorded. Laboratory investigations and the antineutrophil cytoplasmic antibody (ANCA) assay were performed.

Results

Median age of the 22 male and 24 female patients was 44.5 (32–63) years, median disease duration 6.5 (1–16) years. Ocular manifestations were present in all patients: 12 (26.1%) had proptosis; 40 (87%) had scleritis/episcleritis, with perforation in 3 (6.5%); 33 (71.7%) had keratoconjunctivitis (KC), with acute infiltrative stromal keratitis in 11, peripheral ulcerative keratitis in 15, and sclerosing keratitis in 11 patients. Uveitis was present in 11 (23.9%) and retinal changes including vasculitis, exudates, and hemorrhage were present in 7 (15.2%). Blurred vision was present in 43 (93.5%) patients and 2 (4.3%) had vision loss. Glaucoma was present in 4 (8.7%) and hypotony in 2 (4.3%) patients. Involvement was bilateral in 32 (69.6%) patients. Rheumatoid factor (RF) was positive in 56.5% and significantly associated with uveitis (p = 0.04), while antinuclear antibody (ANA) was positive in 45.7% and significantly associated with KC (p = 0.04). BVAS tended to be higher in patients with uveitis (p = 0.49).

Conclusion

Ocular involvement must be considered in all GPA patients and referral to an experienced ophthalmologist is mandatory for proper management and improved outcome of such a rare systemic disease. ANA and RF positivity may raise suspicion for KC or uveitis, respectively. There was a remarkable association between uveitis and disease activity.

Kubaisi B, Samra AK, Foster CS (2016) Granulomatosis with polyangiitis (Wegener’s disease): an updated review of ocular disease manifestations. Intractable Rare Dis Res 5(2):61–69CrossRef

Ntatsaki E, Watts RA, Scott DG (2010) Epidemiology of ANCA-associated vasculitis. Rheum Dis Clin North Am 36:447–461CrossRef

Andrews M, Edmunds M, Campbell A et al (1990) Systemic vasculitis in the 1980s ? is there an increasing incidence of Wegener’s granulomatosis and microscopic polyarteritis? J R Coll Physicians Lond 24:284–288PubMedPubMedCentral

Chung S, Monach PA (2017) Anti-neutrophil cutoplasmic antibody-associated vasculitis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR (eds) Kelley and Firestein’s textbook of rheumatology. Elsevier, Philadelphia, pp 1541–1558 (Chapter 89)CrossRef

Cisternas M, Soto L, Jacobelli S et al (2005) Clinical features of Wegener granulomatosis and microscopic polyangiitis in Chilean patients. Rev Med Chil 133(3):273–278CrossRef

Rothschild PR, Pagnoux C, Seror R et al (2013) Ophthalmologic manifestations of systemic necrotizing vasculitides at diagnosis: a retrospective study of 1286 patients and review of the literature. Semin Arthritis Rheum 42(5):507–514CrossRef

Gheita TA, Samad HM, Mahdy MA (2014) Pattern of primary vasculitis with peripheral ischemic manifestations: report of a case series and role of vascular surgery. Curr Rheumatol Rev 10(2):126–130CrossRef

Niederkorn JY (2006) See no evil, hear no evil, do no evil: the lessons of immune privilege. Nat Immunol 7:353–359CrossRef

Rosenbaum JT (2017) The eye and rheumatic diseases. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR (eds) Kelley and Firestein’s textbook of rheumatology. Elsevier, Philadelphia, pp 645–653 (Chapter 44)CrossRef

10.

Leavitt RY, Fauci AS, Bloch DA et al (1990) The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 33:1101–1107CrossRef

11.

Luqmani RA, Bacon PA, Moots RJ et al (1994) Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. QJM 87:671–678PubMed

12.

Wang T, Shi W, Fan T, Wan X, Chen YH, Ruan Q (2016) c‑Rel is required for the induction of pTregs in the eye but not in the Gut Mucosa. Immunol Invest 45(8):776–786CrossRef

13.

Aldasoro-Cáceres V, Aldasoro-Cáceres I, Pérez-Moreiras JV et al (2014) C‑ANCA positive necrotising scleritis and multiple sclerosis compatible with ocular Wegener: treatment with rituximab. Arch Soc Esp Oftalmol 89(1):31–34CrossRef

14.

Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW et al (1992) Wegener’s granulomatosis: an analysis of 158 patients. Ann Intern Med 116:488–498CrossRef

15.

Torres RM, Herreras JM, Becerra E et al (2004) Ocular presentation in Wegener granulomatosis. Arch Soc Esp Oftalmol 79(3):135–138CrossRef

16.

García C, Voorduin S, Pedroza-Seres M (2006) Diagnosis of Wegener’s granulomatosis in patients with ocular inflamatory disease. Gac Med Mex 142(6):477–482PubMed

17.

Cogan D (1995) Corneoscleral lesions in periarteritis nodosa and Wegener’s granulomatosis. Trans Am Ophthalmol Soc 53:321–342

18.

Spalton DJ, Graham EM, Page NG et al (1981) Ocular changes in limited forms of Wegener’s granulomatosis. Br J Ophthalmol 1981(65):553–563CrossRef

19.

Sadiq SA, Jennings CR, Jones NS et al (2000) Wegener’s granulomatosis: the ocular manifestations revisited. Orbit 19(4):253–261CrossRef

20.

Holle JU, Voigt C, Both M et al (2013) Orbital masses in granulomatosis with polyangiitis are associated with a refractory course and a high burden of local damage. Rheumatology (Oxford) 52:875–882CrossRef

21.

Jinnah HA, Dixon A, Brat DJ, Hellmann DB (1997) Review chronic meningitis with cranial neuropathies in Wegener’s granulomatosis. Case report and review of the literature. Arthritis Rheum 40(3):573–577CrossRef

22.

Akpek EK, Thorne JE, Qazi FA et al (2004) Evaluation of patients with scleritis for systemic disease. Ophthalmology 111(3):501–506CrossRef

23.

Cocho L, Gonzalez-Gonzalez LA, Molina-Prat N et al (2016) Scleritis in patients with granulomatosis with polyangiitis (Wegener). Br J Ophthalmol 100(8):1062–1065CrossRef

24.

Sainz de la Maza M, Foster CS, Jabbur NS (1995) Scleritis associated with systemic vasculitic diseases. Ophthalmology 102:687–692CrossRef

25.

Wieringa WG, Wieringa JE, ten Dam-van Loon NH et al (2013) Visual outcome, treatment results, and prognostic factors in patients with scleritis. Ophthalmology 120:379–386CrossRef

26.

Fortney AC, Chodosh J (2002) Conjunctival ulceration in recurrent Wegener granulomatosis. Cornea 21(6):623–624CrossRef

27.

Messmer EM, Foster CS (1999) Vasculitic peripheral ulcerative keratitis. Surv Ophthalmol 43:379–396CrossRef

28.

Palmowski AM, Hille K, Ruprecht KW (1994) Non-syphilitic interstitial keratitis and inner ear deafness in the initial phase of Wegener’s granulomatosis. Klin Monbl Augenheilkd 205:364–367CrossRef

29.

Cassan SM, Coles DT, Harrison EG Jr. (1970) The concept of limited forms of Wegener’s granulomatosis. Am J Med 49:366–379CrossRef

30.

Straatsma BR (1957) Ocular manifestations of Wegener’s granulomatosis. Am J Ophthalmol 144:789–799CrossRef

31.

Watkins AS, Kempen JH, Choi D et al (2009) Ocular disease in patients with ANCA-positive vasculitis. J Ocul Biol Dis Infor 3:12–19CrossRef

32.

du Huong LT, Tran TH, Piette JC (2006) Granulomatous uveitis revealing Wegener’s granulomatosis. J Rheumatol 33:1209–1210

33.

Woo TL, Francis IC, Wilcsek GA et al (2001) Australasian orbital and adnexal Wegener’s granulomatosis. Ophthalmology 108:1535–1543CrossRef

34.

Harper SL, Letko E, Samson CM et al (2001) Wegener’s granulomatosis: the relationship between ocular and systemic disease. J Rheumatol 28:1025–1032PubMed

35.

Schonermarck U, Lamprecht P, Csernok E et al (2001) Prevalence and spectrum of rheumatic diseases associated with proteinase 3‑antineutrophil cytoplasmic antibodies (ANCA) and myeloperoxidase-ANCA. Rheumatology 40:178–184CrossRef

36.

Falk RJ, Hogan S, Carey TS et al (1990) Clinical course of anti-neutrophil cytoplasmic autoantibodyassociated glomerulonephritis and systemic vasculitis. The glomerular disease collaborative network. Ann Intern Med 113:656–663CrossRef

37.

Power WJ, Rodriguez A, Neves RA et al (1995) Disease relapse in patients with ocular manifestations of Wegener granulomatosis. Ophthalmology 102(1):154–160CrossRef

38.

Pagnoux C, Hogan SL, Chin H et al (2008) Predictors of treatment resistance and relapse in antineutrophil cytoplasmic antibody associated small-vessel vasculitis: comparison of two independent cohorts. Arthritis Rheum 58:2908–2918CrossRef

39.

Savige JA, Chang L, Wilson D et al (1996) Autoantibodies and target antigens in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Rheumatol Int 16(3):109–114CrossRef

Titel: Relationship of ocular presentation in granulomatosis with polyangiitis to autoantibodies and disease activity
verfasst von: Prof. T. A. Gheita, MD
E. M. Abd El Latif
Publikationsdatum: 20.06.2018
Verlag: Springer Medizin
Erschienen in: Zeitschrift für Rheumatologie / Ausgabe 3/2019
Print ISSN: 0340-1855
Elektronische ISSN: 1435-1250
DOI: https://doi.org/10.1007/s00393-018-0495-5

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Relationship of ocular presentation in granulomatosis with polyangiitis to autoantibodies and disease activity

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