The eye, shaped much like a tennis ball, has three different layers of tissue surrounding a central gel-filled cavity. The middle layer of the eye is the uvea which contains many blood vessels, the veins and arteries that carry blood flow to the eye. Uveitis is inflammation of the uvea, and that inflammation can damage one's sight. In fact, chronic uveitis is the third leading cause of preventable, irreversible blindness in developed countries.

     An underlying systemic autoimmune disorder may be present in a significant proportion of patients with uveitis. Familiarity with its symptoms can help facilitate prompt diagnosis and treatment which, in turn, could be sight- and life-saving. In patients with an established diagnosis of autoimmune disease, ocular inflammation can mark the severity of the systemic condition.    

     Are some autoimmune diseases associated with a higher risk for the condition than others? According to George N. Papaliodis, M.D., of Harvard Medical School and the Massachusetts Eye and Ear Infirmary in Boston, "Patients who develop bilateral uveitis or recurrent uveitis or who have involvement of posterior ocular structures (retina, optic nerve, or vitreous) are more likely to have a diagnosis of an underlying systemic inflammatory disease.

     "Even if we use these criteria, approximately a third of patients have idiopathic [without recognizable cause] disease. In the United States, the most common autoimmune entry to cause uveitis is associated with human leukocyte antigen (HLA)-B27. Other common autoimmune diseases that lead to ocular inflammation include rheumatoid arthritis, psoriasis, psoriatic arthritis, sarcoidosis, and the inflammatory bowel diseases."

     What is the role of the rheumatologist in diagnosing uveitis? Dr. Papaliodis says that a thorough history and examination are critical. "The rheumatologist should perform a detailed review of systems in patients with autoimmune disease and refer those with visual symptoms--such as blurry vision, ocular pain, ocular erythema [diffused redness], or light sensitivity--to an ophthalmologist."

     Concerning the rheumatologist's management of patients with uveitis, Dr. Papaliodis advises that there be a collaboration with an ophthalmologist who is familiar with the diagnosis and treatment of these diseases. He says that while rheumatologists are familiar with the agents used to manage uveitis, they are not equipped to evaluate the ocular impact of therapy.

--Source: Adapted from "Ask the Expert; Uveitis in the Rheumatology Clinic," George N. Papaliodis, M.D., Rheumatology News, May 2009