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Abstract
Sarcoidosis frequently affects the eye and can do so in many different ways. Sarcoidosis causing uveitis can have distinctive features that facilitate identifying sarcoidosis as the cause of the uveitis. Progress is being made in elucidating ocular sarcoidosis, as for example, by transcriptomics, genetics, therapy, and imaging.
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Affiliation(s)
- James T Rosenbaum
- Legacy Devers Eye Institute, 1040 NW 22nd Avenue, Portland, OR 97210, USA; Corvus Pharmaceuticals, 863 Mitten Road Street 102, Burlingame, CA 94010, USA.
| | - Sirichai Pasadhika
- Legacy Devers Eye Institute, 1040 NW 22nd Avenue, Portland, OR 97210, USA
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Gangaputra S, Newcomb C, Armour R, Choi D, Ying GS, Groth S, Begum H, Fitzgerald T, Artornsombudh P, Daniel E, Bhatt N, Foster S, Jabs D, Levy-Clarke G, Nussenblatt R, Rosenbaum JT, Sen HN, Suhler E, Thorne J, Dreger K, Buchanich J, Kempen JH. Long-term visual acuity outcomes following cataract surgery in eyes with ocular inflammatory disease. Br J Ophthalmol 2024; 108:380-385. [PMID: 36810151 DOI: 10.1136/bjo-2022-322236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To evaluate the long-term visual acuity (VA) outcome of cataract surgery in inflammatory eye disease. SETTING Tertiary care academic centres. DESIGN Multicentre retrospective cohort study. METHODS A total of 1741 patients with non-infectious inflammatory eye disease (2382 eyes) who underwent cataract surgery while under tertiary uveitis management were included. Standardised chart review was used to gather clinical data. Multivariable logistic regression models with adjustment for intereye correlations were performed to evaluate the prognostic factors for VA outcomes. Main outcome measure was VA after cataract surgery. RESULTS Uveitic eyes independent of anatomical location showed improved VA from baseline (mean 20/200) to within 3 months (mean 20/63) of cataract surgery and maintained through at least 5 years of follow-up (mean 20/63). Eyes that achieved 20/40 or better VA at 1 year were more likely to have scleritis (OR=1.34, p<0.0001) or anterior uveitis (OR=2.2, p<0.0001), VA 20/50 to 20/80 (OR 4.76 as compared with worse than 20/200, p<0.0001) preoperatively, inactive uveitis (OR=1.49, p=0.03), have undergone phacoemulsification (OR=1.45 as compared with extracapsular cataract extraction, p=0.04) or have had intraocular lens placement (OR=2.13, p=0.01). Adults had better VA immediately after surgery, with only 39% (57/146) paediatric eyes at 20/40 or better at 1 year. CONCLUSIONS Our results suggest that adult and paediatric eyes with uveitis typically have improved VA following cataract surgery and remain stable thereafter for at least 5 years.
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Affiliation(s)
| | - Craig Newcomb
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rebecca Armour
- Department of Ophthalmology, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Dongseok Choi
- Public Health and Preventive Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Gui-Shuang Ying
- Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sylvia Groth
- Vanderbilt Eye Institute, Nashville, Tennessee, USA
| | - Hosne Begum
- Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
| | - Tonetta Fitzgerald
- Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pichaporn Artornsombudh
- Ophthalmology, Somdech Phra Pinklao Hospital, Bangkok, Thailand
- Chulalongkorn University, Bangkok, Thailand
| | - Ebenezer Daniel
- Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nirali Bhatt
- Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA
- Sight for Souls, Fort Myers, Florida, USA
| | - Douglas Jabs
- Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
- The Tampa Bay Uveitis Center, St Petersburg, Florida, USA
| | - Robert Nussenblatt
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Legacy Devers Eye Institute at Good Samaritan Medical Center, Portland, Oregon, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
| | - Eric Suhler
- Department of Ophthalmology, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
- Ophthalmology, Veterans Health Administration, Portland, Oregon, USA
| | - Jennifer Thorne
- Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kurt Dreger
- Wilmer Eye Institute, Johns Hopkins Medicine School of Medicine, Baltimore, Maryland, USA
- Ophthalmology, Somdech Phra Pinklao Hospital, Bangkok, Thailand
- Center for Occupational Biostatistics and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeanine Buchanich
- Center for Occupational Biostatistics and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - John H Kempen
- Sight for Souls, Fort Myers, Florida, USA
- Departments of Ophthalmology and Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
- MCM Eye Unit, MyungSung Christian Medical Center General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
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3
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Zaki AM, Pasadhika S, Huang JC, Thomas AS, Burkholder BM, Lim LL, Llop SM, Suhler EB, Adamus G, Rosenbaum JT. Characterization of autoimmune eye disease in association with Down's syndrome. Eye (Lond) 2024; 38:386-392. [PMID: 37598261 PMCID: PMC10810817 DOI: 10.1038/s41433-023-02706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Autoimmunity and deficiency of the transcription factor autoimmune regulator protein (AIRE) are known associations with Down syndrome (DS). Lack of AIRE abrogates thymic tolerance. The autoimmune eye disease associated with DS has not been characterized. We identified a series of subjects with DS (n = 8) and uveitis. In three consecutive subjects, we tested the hypothesis that autoimmunity to retinal antigens might be a contributing factor. SUBJECTS/METHODS This was a multicentred, retrospective case series. Deidentified clinical data of subjects with both DS and uveitis were collected via questionnaire by uveitis-trained ophthalmologists. Anti-retinal autoantibodies (AAbs) were detected using an Autoimmune Retinopathy Panel tested in the OHSU Ocular Immunology Laboratory. RESULTS We characterized eight subjects (mean age 29 [range, 19-37] years). The mean age of detected uveitis onset was 23.5 [range, 11-33] years. All eight subjects had bilateral uveitis (p < 0.001 based on comparison to published university referral patterns), with anterior and intermediate uveitis found in six and five subjects respectively. Each of three subjects tested for anti-retinal AAbs was positive. Detected AAbs included anti-carbonic anhydrase II, anti-enolase, anti-arrestin, and anti-aldolase. DISCUSSION A partial deficiency in the AIRE on chromosome 21 has been described in DS. The similarities in the uveitis presentations within this patient group, the known autoimmune disease predisposition in DS, the recognized association of DS and AIRE deficiency, the reported detection of anti-retinal antibodies in patients with DS in general, and the presence of anti-retinal AAbs in three subjects in our series supports a causal association between DS and autoimmune eye disease.
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Affiliation(s)
- Amr M Zaki
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Jerry C Huang
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | - Bryn M Burkholder
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne, Parkville, VIC, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Stephanie M Llop
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric B Suhler
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
- Portland Veterans Administration Health Care System, Portland, OR, USA
| | - Grazyna Adamus
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA.
- Legacy Devers Eye Institute, Portland, OR, USA.
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Corvus Pharmaceuticals, Burlingame, CA, USA.
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4
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Morrison T, Gottman M, Do T, Rosenbaum JT, Ghetie D, Friedman M. Scleritis and development of immune-mediated disease: A retrospective chart review. J Rheumatol 2024:jrheum.2023-0788. [PMID: 38302174 DOI: 10.3899/jrheum.2023-0788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Scleritis may be idiopathic or caused by trauma, infections, or an immune-mediated condition. Our study aimed to understand the relationship between scleritis and immune-mediated disease, including presenting characteristics, serologies, and treatment course. Understanding these associations may allow clinicians to risk-stratify patients and predict their clinical and treatment course. METHODS We conducted a retrospective chart review of 341 scleritis patients seen at a tertiary care center between January 1, 2005, and December 31, 2020. Demographics, scleritis characteristics, treatment response, recurrence, and serologic data were compared among patients with idiopathic and immune-mediated disease-associated scleritis. RESULTS Among scleritis patients seen, 145 patients (43%) had an associated immune-mediated disease, most commonly rheumatoid arthritis (39%), vasculitis (21%), or inflammatory bowel disease (14%). In most cases, the immune-mediated disease diagnosis predated the scleritis presentation (65%), though vasculitis cases were more likely to develop during or after scleritis episodes. There were no significant differences in demographics or treatment failures among scleritis patients with and without associated immune-mediated conditions. Patients with immune-mediated diseases were more likely to have a recurrence of scleritis (62% vs 49%, p=0.02). CONCLUSION At our ophthalmology center, 43% of patients with scleritis had an associated immunemediated disease, and most patients with immune-mediated disease were symptomatic from this disease prior to scleritis presentation. Rheumatoid arthritis was the most commonly associated condition and typically predated the scleritis, while vasculitis was more likely diagnosed during or after the scleritis episode. Scleritis among immune-mediated disease patients is more likely to recur compared to scleritis that is idiopathic.
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Affiliation(s)
- Tessalyn Morrison
- Tessalyn Morrison, MD, MPH, Department of Medicine, University of Vermont Medical Center, Burlington, Vermont
| | - Moriah Gottman
- Moriah Gottman, MS, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Toan Do
- Toan Do, MD, Department of Allergy and Immunology, University of California San Diego, San Diego, California
| | - James T Rosenbaum
- James T. Rosenbaum, MD, Department of Ophthalmology, Devers Eye Institute, Legacy Health Systems, Portland, Oregon
| | - Daniela Ghetie
- Daniela Ghetie, MD, Department of Medicine, Division of Rheumatology, Oregon Health and Science University, Portland, Oregon
| | - Marcia Friedman
- Marcia Friedman, MD, Department of Medicine, Division of Rheumatology, Oregon Health and Science University, Portland, Oregon
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Thng ZX, Putera I, Testi I, Chan K, Westcott M, Chee SP, Dick AD, Kempen JH, Bodaghi B, Thorne JE, Barisani-Asenbauer T, de Smet MD, Smith JR, McCluskey P, La Distia Nora R, Jabs DA, de Boer JH, Sen HN, Goldstein DA, Khairallah M, Davis JL, Rosenbaum JT, Jones NP, Nguyen QD, Pavesio C, Agrawal R, Gupta V. The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 2-global current practice patterns for the management of Cytomegalovirus anterior uveitis. Eye (Lond) 2024; 38:68-75. [PMID: 37419958 PMCID: PMC10764804 DOI: 10.1038/s41433-023-02631-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023] Open
Abstract
AIMS To present current practice patterns in the diagnosis and management of Cytomegalovirus anterior uveitis (CMV AU) by uveitis experts worldwide. METHODS A two-round modified Delphi survey with masking of the study team was performed. Based on experience and expertise, 100 international uveitis specialists from 21 countries were invited to participate in the survey. Variation in the diagnostic approaches and preferred management of CMV AU was captured using an online survey platform. RESULTS Seventy-five experts completed both surveys. Fifty-five of the 75 experts (73.3%) would always perform diagnostic aqueous tap in suspected CMV AU cases. Consensus was achieved for starting topical antiviral treatment (85% of experts). About half of the experts (48%) would only commence systemic antiviral treatment for severe, prolonged, or atypical presentation. The preferred specific route was ganciclovir gel 0.15% for topical treatment (selected by 70% of experts) and oral valganciclovir for systemic treatment (78% of experts). The majority of experts (77%) would commence treatment with topical corticosteroid four times daily for one to two weeks along with antiviral coverage, with subsequent adjustment depending on the clinical response. Prednisolone acetate 1% was the drug of choice (opted by 70% of experts). Long-term maintenance treatment (up to 12 months) can be considered for chronic course of inflammation (88% of experts) and those with at least 2 episodes of CMV AU within a year (75-88% of experts). CONCLUSIONS Preferred management practices for CMV AU vary widely. Further research is necessary to refine diagnosis and management and provide higher-level evidence.
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Affiliation(s)
- Zheng Xian Thng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilaria Testi
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Kevin Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mark Westcott
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew D Dick
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
- UCL-Institute of Ophthalmology, London, UK
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School; and Schepens Eye Research Institute, Boston, MA, USA
- Sight for Souls, Fort Myers, FL, USA
- Addis Ababa University Department of Ophthalmology, Addis Ababa, Ethiopia
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Bahram Bodaghi
- Dept of Ophthalmology, IHU FOReSIGHT, Sorbonne-APHP, 47-83 bd de l'Hopital, 75013, Paris, France
| | - Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Talin Barisani-Asenbauer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Marc D de Smet
- Dept of Ophthalmology, Leiden University, Leiden, Netherlands
- MIOS sa, Lausanne, Switzerland
| | - Justine R Smith
- Flinders University College of Medicine & Public Health, Adelaide, Australia and Queensland Eye Institute, Brisbane, QLD, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Director Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joke H de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra A Goldstein
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James T Rosenbaum
- Oregon Health and Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Portland, OR, USA
| | - Nicholas P Jones
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford Medical School, Palo Alto, CA, USA
| | - Carlos Pavesio
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- UCL-Institute of Ophthalmology, London, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Duke NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
| | - Vishali Gupta
- Advanced Eye Centre, Post-graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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6
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Thng ZX, Putera I, Testi I, Chan K, Westcott M, Chee SP, Dick AD, Kempen JH, Bodaghi B, Thorne JE, Barisani-Asenbauer T, de Smet MD, Smith JR, McCluskey P, La Distia Nora R, Jabs DA, de Boer JH, Sen HN, Goldstein DA, Khairallah M, Davis JL, Rosenbaum JT, Jones NP, Nguyen QD, Pavesio C, Agrawal R, Gupta V. The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis. Eye (Lond) 2024; 38:61-67. [PMID: 37419957 PMCID: PMC10764303 DOI: 10.1038/s41433-023-02630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023] Open
Abstract
AIMS To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide. METHODS A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used. RESULTS Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints. CONCLUSIONS Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.
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Affiliation(s)
- Zheng Xian Thng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilaria Testi
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Kevin Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mark Westcott
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Soon-Phaik Chee
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew D Dick
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
- UCL Institute of Ophthalmology, London, UK
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, and Schepens Eye Research Institute, Boston, MA, USA
- Sight for Souls, Fort Myers, FL, USA
- Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne-APHP, 47-83 bd de l'Hopital, 75013, Paris, France
| | - Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Talin Barisani-Asenbauer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Marc D de Smet
- Department of Ophthalmology, Leiden University, Leiden, The Netherlands
- MIOS sa, Lausanne, Switzerland
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Adelaide, SA, Australia
- Queensland Eye Institute, Brisbane, QLD, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Rina La Distia Nora
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joke H de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Debra A Goldstein
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James T Rosenbaum
- Oregon Health and Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Portland, OR, USA
| | - Nicholas P Jones
- School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Carlos Pavesio
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK
- University of Bristol, Bristol, UK
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.
- National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Duke NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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7
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Kempen JH, Newcomb CW, Washington TL, Foster CS, Sobrin L, Thorne JE, Jabs DA, Suhler EB, Rosenbaum JT, Sen HN, Levy-Clarke GA, Nussenblatt RB, Bhatt NP, Lowder CY, Goldstein DA, Leiderman YI, Acharya NR, Holland GN, Read RW, Dunn JP, Dreger KA, Artornsombudh P, Begum HA, Fitzgerald TD, Kothari S, Payal AR, Daniel E, Gangaputra SS, Kaçmaz RO, Liesegang TL, Pujari SS, Khachatryan N, Maghsoudlou A, Suga HK, Pak CM, Helzlsouer KJ, Buchanich JM. Use of Immunosuppression and the Risk of Subsequent Overall or Cancer Mortality. Ophthalmology 2023; 130:1258-1268. [PMID: 37499954 PMCID: PMC10811288 DOI: 10.1016/j.ophtha.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
PURPOSE To determine the incidence of all-cause and cancer mortality (CM) in association with immunosuppression. DESIGN Retrospective cohort study at ocular inflammatory disease (OID) subspecialty centers. We harvested exposure and covariate data retrospectively from clinic inception (earliest in 1979) through 2010 inclusive. Then we ascertained overall and cancer-specific mortalities by National Death Index linkage. We constructed separate Cox models to evaluate overall and CM for each class of immunosuppressant and for each individual immunosuppressant compared with person-time unexposed to any immunosuppression. PARTICIPANTS Patients with noninfectious OID, excluding those with human immunodeficiency infection or preexisting cancer. METHODS Tumor necrosis factor (TNF) inhibitors (mostly infliximab, adalimumab, and etanercept); antimetabolites (methotrexate, mycophenolate mofetil, azathioprine); calcineurin inhibitors (cyclosporine); and alkylating agents (cyclophosphamide) were given when clinically indicated in this noninterventional cohort study. MAIN OUTCOME MEASURES Overall mortality and CM. RESULTS Over 187 151 person-years (median follow-up 10.0 years), during which 15 938 patients were at risk for mortality, we observed 1970 deaths, 435 due to cancer. Both patients unexposed to immunosuppressants (standardized mortality ratio [SMR] = 0.95, 95% confidence interval [CI], 0.90-1.01) and those exposed to immunosuppressants but free of systemic inflammatory diseases (SIDs) (SMR = 1.04, 95% CI, 0.95-1.14) had similar mortality risk to the US population. Comparing patients exposed to TNF inhibitors, antimetabolites, calcineurin inhibitors, and alkylating agents with patients not exposed to any of these, we found that overall mortality (adjusted hazard ratio [aHR] = 0.88, 0.89, 0.90, 1.11) and CM (aHR = 1.25, 0.89, 0.86, 1.23) were not significantly increased. These results were stable in sensitivity analyses whether excluding or including patients with SID, across 0-, 3-, or 5-year lags and across quartiles of immunosuppressant dose and duration. CONCLUSIONS Our results, in a cohort where the indication for treatment was proven unassociated with mortality risk, found that commonly used immunosuppressants-especially the antimetabolites methotrexate, mycophenolate mofetil, and azathioprine; the TNF inhibitors adalimumab and infliximab, and cyclosporine-were not associated with increased overall and CM over a median cohort follow-up of 10.0 years. These results suggest the safety of these agents with respect to overall and CM for patients treated with immunosuppression for a wide range of inflammatory diseases. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- John H Kempen
- Department of Ophthalmology and Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Sight for Souls, Bellevue, Washington; MCM Eye Unit, MyungSung Christian Medical Center General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
| | - Craig W Newcomb
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Terri L Washington
- Center for Occupational Biostatistics and Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts
| | - Lucia Sobrin
- Department of Ophthalmology and Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jennifer E Thorne
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Douglas A Jabs
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Portland Veteran's Affairs Medical Center, Portland, Oregon
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; Legacy Devers Eye Institute, Portland, Oregon
| | - H Nida Sen
- Department of Ophthalmology, George Washington University, Washington, District of Columbia; Janssen Retina Global Clinical Development, Princeton, New Jersey
| | - Grace A Levy-Clarke
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, West Virginia
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Nirali P Bhatt
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Careen Y Lowder
- Cole Eye Institute, Department of Ophthalmology, Cleveland Clinic, Cleveland, Ohio
| | - Debra A Goldstein
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yannek I Leiderman
- Illinois Eye & Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Nisha R Acharya
- F.I. Proctor Foundation, Department of Ophthalmology, University of California San Francisco School of Medicine, San Francisco, California
| | - Gary N Holland
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Russell W Read
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - James P Dunn
- Mid-Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Kurt A Dreger
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pichaporn Artornsombudh
- Department of Ophthalmology, Somdech Phra Pinkloa Hospital, Royal Thai Navy, Bangkok, Thailand; Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | - Hosne A Begum
- Wilmer Eye Institute, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tonetta D Fitzgerald
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Srishti Kothari
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ebenezer Daniel
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sapna S Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Teresa L Liesegang
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon
| | - Siddharth S Pujari
- Siddharth Netralaya Superspecialty Eye Hospital, Belgaum, Karnataka, India
| | - Naira Khachatryan
- Department of Ophthalmology, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hilkiah K Suga
- MCM Eye Unit, MyungSung Christian Medical Center General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
| | - Clara M Pak
- MCM Eye Unit, MyungSung Christian Medical Center General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia; University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Kathy J Helzlsouer
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanine M Buchanich
- Center for Occupational Biostatistics and Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
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8
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Desmarais J, Rosenbaum JT, Link M, Kovacs R. Risk of arrhythmia among new users of hydroxychloroquine: comment on the article by Hoque et al. Arthritis Rheumatol 2023; 75:2065. [PMID: 37229793 DOI: 10.1002/art.42618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Affiliation(s)
| | | | - Mark Link
- University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Richard Kovacs
- Indiana University School of Medicine, Indianapolis, Indiana
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9
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Verma R, Chen AJ, Choi D, Wilson DJ, Grossniklaus HE, Dailey RA, Ng JD, Steele EA, Planck SR, Czyz CN, Korn BS, Kikkawa DO, Foster JA, Kazim M, Harris GJ, Edward DP, Al Maktabi A, Rosenbaum JT. Inflammation and Fibrosis in Orbital Inflammatory Disease: A Histopathologic Analysis. Ophthalmic Plast Reconstr Surg 2023; 39:588-593. [PMID: 37279012 PMCID: PMC10698206 DOI: 10.1097/iop.0000000000002410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the histopathologic inflammation and fibrosis of orbital adipose tissue in orbital inflammatory disease (OID) specimens. METHODS In this retrospective cohort study, inflammation, and fibrosis in orbital adipose tissue from patients with thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis, nonspecific orbital inflammation (NSOI), and healthy controls were scored by 2 masked ocular pathologists. Both categories were scored on a scale of 0 to 3 with scoring criteria based on the percentage of specimens containing inflammation or fibrosis, respectively. Tissue specimens were collected from oculoplastic surgeons at 8 international centers representing 4 countries. Seventy-four specimens were included: 25 with TAO, 6 with orbital GPA, 7 with orbital sarcoidosis, 24 with NSOI, and 12 healthy controls. RESULTS The mean inflammation and fibrosis scores for healthy controls were 0.0 and 1.1, respectively. Orbital inflammatory disease groups' inflammation (I) and fibrosis (F) scores, formatted [I, F] with respective p -values when compared to controls, were: TAO [0.2, 1.4] ( p = 1, 1), GPA [1.9, 2.6] ( p = 0.003, 0.009), sarcoidosis [2.4, 1.9] ( p = 0.001, 0.023), and NSOI [1.3, 1.8] ( p ≤ 0.001, 0.018). Sarcoidosis had the highest mean inflammation score. The pairwise analysis demonstrated that sarcoidosis had a significantly higher mean inflammation score than NSOI ( p = 0.036) and TAO ( p < 0.0001), but no difference when compared to GPA. GPA had the highest mean fibrosis score, with pairwise analysis demonstrating a significantly higher mean fibrosis score than TAO ( p = 0.048). CONCLUSIONS Mean inflammation and fibrosis scores in TAO orbital adipose tissue samples did not differ from healthy controls. In contrast, the more "intense" inflammatory diseases such as GPA, sarcoidosis, and NSOI did demonstrate higher histopathologic inflammation and fibrosis. This has implications in prognosis, therapeutic selection, and response monitoring in orbital inflammatory disease.
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Affiliation(s)
- Rohan Verma
- Oculofacial Plastic and Reconstructive Surgery, Casey Aesthetic Facial Surgery Center, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Allison J. Chen
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
| | - Dongseok Choi
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Wilson
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Roger A Dailey
- Oculofacial Plastic and Reconstructive Surgery, Casey Aesthetic Facial Surgery Center, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - John D. Ng
- Oculofacial Plastic and Reconstructive Surgery, Casey Aesthetic Facial Surgery Center, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric A. Steele
- Oculofacial Plastic and Reconstructive Surgery, Casey Aesthetic Facial Surgery Center, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephen R. Planck
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA
| | - Craig N. Czyz
- Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth, Columbus, Ohio, USA
| | - Bobby S. Korn
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
- Plastic Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Don O. Kikkawa
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
- Plastic Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Jill A. Foster
- Oculofacial Plastic and Reconstructive Surgery, Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio, USA
| | - Michael Kazim
- Oculofacial Plastic and Reconstructive Surgery, Edward S Harkness Eye Institute, Columbia University, New York, New York, USA
| | - Gerald J. Harris
- Oculofacial Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Deepak P. Edward
- Ophthalmology, University of Illinois College of Medicine, Chicago, Illinois, USA
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - James T. Rosenbaum
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA
- Corvus Pharmaceuticals Inc., Burlingame, CA 94010, USA
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10
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Papaliodis GN, Rosner BA, Dreger KA, Fitzgerald TD, Artornsombudh P, Kothari S, Gangaputra SS, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Jabs DA, Pak CM, Ying GS, Kempen JH. Incidence of and Risk Factors for Cataract in Anterior Uveitis. Am J Ophthalmol 2023; 254:221-232. [PMID: 37414328 PMCID: PMC10528977 DOI: 10.1016/j.ajo.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To estimate the incidence/risk factors for cataract in noninfectious anterior uveitis. DESIGN Retrospective multicenter cohort study (6 US tertiary uveitis sites, 1978-2010). METHODS Data were harvested by trained expert reviewers, using protocol-driven review of experts' charts. We studied cataract incidence-newly reduced visual acuity worse than 20/40 attributed to cataract; or incident cataract surgery-in 3923 eyes of 2567 patients with anterior uveitis. RESULTS Cataract developed in 507 eyes (54/1000 eye-years, 95% CI 49-59). Time-updated risk factors associated with cataract included older age (≥65 vs <18 years: adjusted hazard ratio [aHR] 5.04, 95% CI 3.04-8.33), higher anterior chamber cell grade (P(trend)=0.001), prior incisional glaucoma surgery (aHR 1.86, 95% CI 1.10-3.14), band keratopathy (aHR 2.23, 95% CI 1.47-3.37), posterior synechiae (aHR 3.71, 95% CI 2.83-4.87), and elevated intraocular pressure ≥30 vs 6-20 mm Hg (aHR 2.57, 95% CI 1.38-4.77). Primary acute (aHR 0.59, 95% CI 0.30-1.15) and recurrent acute (aHR 0.74, 95% CI 0.55-0.98) had lower cataract risk than chronic anterior uveitis. Higher-dose prednisolone acetate 1%-equivalent use (≥2 drops/day) was associated with >2-fold higher cataract risk in eyes with anterior chamber cell grades 0.5+ or lower but was not associated with higher cataract risk in the presence of anterior chamber cells of grade 1+ or higher. CONCLUSIONS Cataract complicates anterior uveitis in ∼5.4/100 eye-years. Several fixed and modifiable risk factors were identified, yielding a point system to guide cataract risk minimization. Topical corticosteroids only were associated with increased cataract risk when anterior chamber cells were absent or minimally present, suggesting their use to treat active inflammation (which itself is cataractogenic) does not cause a net increase in cataract incidence.
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Affiliation(s)
- George N Papaliodis
- From the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (G.N.P., J.H.K.), Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School (G.N.P., C.S.F., J.H.K.), Boston, Massachusetts, USA.
| | - Bernard A Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School (B.A.R.), Boston, Massachusetts, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health (B.A.R.), Boston, Massachusetts, USA
| | - Kurt A Dreger
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health (K.A.D.), Baltimore, Maryland, USA; Department of Ophthalmology, Johns Hopkins School of Medicine (K.A.D., J.E.T., D.A.J.), Baltimore, Maryland, USA
| | - Tonetta D Fitzgerald
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine (T.D.F., N.P.B., G.-s.Y., s.k.), Philadelphia, Pennsylvania, USA
| | - Pichaporn Artornsombudh
- Massachusetts Eye Research and Surgery Institution (P.A., S.K., C.S.F.), Waltham, Massachusetts, USA; Department of Ophthalmology, Somdech Phra Pinklao Hospital, Royal Thai Navy (P.A.), Bangkok, Thailand;; Department of Ophthalmology, King Chulalongkorn Memorial Hospital (P.A.), Bangkok, Thailand
| | - Srishti Kothari
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine (T.D.F., N.P.B., G.-s.Y., s.k.), Philadelphia, Pennsylvania, USA; Massachusetts Eye Research and Surgery Institution (P.A., S.K., C.S.F.), Waltham, Massachusetts, USA
| | - Sapna S Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University Medical Center (S.S.G.), Nashville, Tennessee, USA
| | - Grace A Levy-Clarke
- Department of Ophthalmology and Visual Sciences, West Virginia University (G.A.L.-C.), Morgantown, West Virginia, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health (R.B.N., H.N.S.), Bethesda, Maryland, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University (J.T.R., E.B.S.), Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University (J.T.R.), Portland, Oregon, USA; Legacy Devers Eye Institute (J.T.R.), Portland, Oregon, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health (R.B.N., H.N.S.), Bethesda, Maryland, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University (J.T.R., E.B.S.), Portland, Oregon, USA; Portland Veteran's Affairs Medical Center (E.B.S.), Portland, Oregon, USA
| | - Jennifer E Thorne
- Department of Ophthalmology, Johns Hopkins School of Medicine (K.A.D., J.E.T., D.A.J.), Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (J.E.T., D.A.J.), Baltimore, Maryland, USA
| | - Nirali P Bhatt
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine (T.D.F., N.P.B., G.-s.Y., s.k.), Philadelphia, Pennsylvania, USA
| | - C Stephen Foster
- Department of Ophthalmology, Harvard Medical School (G.N.P., C.S.F., J.H.K.), Boston, Massachusetts, USA; Massachusetts Eye Research and Surgery Institution (P.A., S.K., C.S.F.), Waltham, Massachusetts, USA
| | - Douglas A Jabs
- Department of Ophthalmology, Johns Hopkins School of Medicine (K.A.D., J.E.T., D.A.J.), Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (J.E.T., D.A.J.), Baltimore, Maryland, USA
| | - Clara M Pak
- University of Rochester School of Medicine & Dentistry (C.M.P.), Rochester, New York, USA; MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical School (J.H.K., C.M.P.), Addis Ababa, Ethiopia
| | - Gui-Shuang Ying
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine (T.D.F., N.P.B., G.-s.Y., s.k.), Philadelphia, Pennsylvania, USA
| | - John H Kempen
- From the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (G.N.P., J.H.K.), Boston, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School (G.N.P., C.S.F., J.H.K.), Boston, Massachusetts, USA; MCM Eye Unit, MyungSung Christian Medical Center (MCM) General Hospital and MyungSung Medical School (J.H.K., C.M.P.), Addis Ababa, Ethiopia; Department of Ophthalmology, Addis Ababa University School of Medicine (J.H.K.), Addis Ababa, Ethiopia.
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Johnson KB, Rosenbaum JT, Yarter JT, Broadbent T, Michels KS. A 10-Year Review of the Management of Ocular Mucous Membrane Pemphigoid: A Private Practice Experience. Cornea 2023; 42:565-571. [PMID: 37000702 DOI: 10.1097/ico.0000000000003071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Ocular mucous membrane pemphigoid (OcMMP) is a rare and potentially blinding condition for which consensus treatment guidelines do not exist. The purpose of this study was to assess the effectiveness and safety of various immunomodulatory agents in the treatment of OcMMP in a private practice setting. METHODS We conducted a 10-year retrospective chart review of patients managed with OcMMP (n = 22). The median age at diagnosis was 73 (range: 35-91) years, and 59% (13/22) of patients were female. Visual acuity, Foster stage, and adverse effects (AEs) were documented. Treatment outcomes for each treatment episode were qualified at 3 months as complete response (CR), response (R), or failure (F). After 3 months, CR was then further subqualified as sustained CR, reactivation after initial CR, or AE after initial CR. The Fisher exact test P values were calculated for each outcome in comparison with mycophenolate. RESULTS Twenty patients were treated with an immunomodulatory agent for a total of 55 treatment episodes. In comparison to dapsone, mycophenolate was more likely to achieve sustained CR (50% vs. 0%, P = 0.022) and R (100% vs. 50%, P = 0.007), and less likely to fail (0% vs. 50%, P = 0.007). Dapsone was also more likely to be discontinued because of AEs than mycophenolate (40% vs. 6%, P = 0.041). CONCLUSIONS Mycophenolate is a superior first-line agent to dapsone in the treatment of OcMMP. Although not statistically significant, mycophenolate trends toward superiority over methotrexate as well. Mycophenolate is very effective when used in combination with rituximab. Azathioprine remains a reasonable second-line agent.
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Affiliation(s)
- Kasey B Johnson
- Washington State University, Elson S. Floyd College of Medicine, Spokane, WA
| | - James T Rosenbaum
- Oregon Health and Science University, Casey Eye Institute, School of Medicine, Portland, OR
- Legacy Health System, Devers Eye Institute, Portland, OR
| | - Jason T Yarter
- University of Washington, School of Medicine, Spokane, WA; and
| | | | - Kevin S Michels
- Washington State University, Elson S. Floyd College of Medicine, Spokane, WA
- Northwest Eyelid and Orbital Specialists, Spokane, WA
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12
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Jadon DR, Corp N, van der Windt DA, Coates LC, Soriano ER, Kavanaugh A, Raine T, Rieder F, Siebert S, Zummer M, Schwartzman S, Rosenbaum JT, Michelsen B, Laxminarayan R, Wu D, Gupta L, Ng B, Jethwa H, De Windt N, Gudu T, Hutton J, O'Sullivan D, Luchetti MM, Stoll M, Singh JA, Peluso R, Rademacher J, Husni ME. Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients with Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol 2023; 50:438-450. [PMID: 36455946 PMCID: PMC10921838 DOI: 10.3899/jrheum.220317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Several advanced therapies have been licensed across the related conditions of psoriatic arthritis (PsA), Crohn disease (CD), ulcerative colitis (UC), and noninfectious uveitis. We sought to summarize results from randomized controlled trials (RCTs) investigating the efficacy and safety of advanced therapies for these related conditions in patients with PsA. METHODS We updated the previous systematic search conducted in 2013 with literature reviews of MEDLINE, Embase, and the Cochrane Library (from February 2013 to August 2020) on this subject; only those new studies are presented here. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. RESULTS The number of RCTs meeting eligibility criteria were 12 for CD, 15 for UC, and 5 for uveitis. The tumor necrosis factor inhibitor (TNFi) class appears to be efficacious and safe across CD, UC, and uveitis, with the exception of etanercept. Interleukin 12/23 inhibitors (IL-12/23i) are efficacious for CD and UC. Phase II and III RCTs of Janus kinase inhibitors (JAKi) and IL-23i in CD and UC are promising in terms of efficacy and safety. IL-17i must be used with great caution in patients with PsA at high risk of inflammatory bowel disease (IBD). RCTs in uveitis have mainly studied adalimumab. CONCLUSION We have identified 32 recent RCTs in IBD and uveitis and updated recommendations for managing patients with PsA and these related conditions. A multispecialty approach is essential to effectively, safely, and holistically manage such patients. Advanced therapies are not equally efficacious across these related conditions, with dosing regimens and safety varying.
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Affiliation(s)
- Deepak R Jadon
- D.R. Jadon, MBBCh, PhD, Department of Rheumatology, University of Cambridge, Cambridge, UK;
| | - Nadia Corp
- N. Corp, PhD, D.A. van der Windt, PhD, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Danielle A van der Windt
- N. Corp, PhD, D.A. van der Windt, PhD, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Laura C Coates
- L.C. Coates, MBChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Enrique R Soriano
- E.R. Soriano, MD, MSc, Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Arthur Kavanaugh
- A. Kavanaugh, MD, Division of Rheumatology Allergy and Immunology, University of California, San Diego, California, USA
| | - Tim Raine
- T. Raine, MB, BChir, PhD, Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Florian Rieder
- F. Rieder, MD, Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stefan Siebert
- S. Siebert, MD, Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Michel Zummer
- M. Zummer, MD, Division of Rheumatology, CH Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Sergio Schwartzman
- S. Schwartzman, MD, Hospital for Special Surgery, Weill Cornell Medical Center, New York City, New York, USA
| | - James T Rosenbaum
- J.T. Rosenbaum, MD, Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health and Science University, and the Legacy Devers Eye Institute, Portland, Oregon, USA
| | - Brigitte Michelsen
- B. Michelsen, MD, PhD, Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Ramasharan Laxminarayan
- R. Laxminarayan, MD, University Hospitals of Derby and Burton NHS Foundation Trust, Burton-on-Trent, UK
| | - Dongze Wu
- D. Wu, PhD, Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Latika Gupta
- L. Gupta, MD, DM, Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, and Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Beverly Ng
- B. Ng, MBBS, MSc, Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hannah Jethwa
- H. Jethwa, MBChB, PhD, Department of Rheumatology, Royal Free London NHS Foundation Trust, Imperial College Healthcare NHS Trust, London, UK
| | - Nick De Windt
- N. De Windt, BS, Department of Rheumatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tania Gudu
- T. Gudu, MD, PhD, Rheumatology Department, Cambridge University Hospitals NHS FT, Cambridge, UK
| | - Joseph Hutton
- J. Hutton, MBChB, University of Cambridge, Cambridge, UK
| | - Denis O'Sullivan
- D. O'Sullivan, BE, Rheumatic & Musculoskeletal Disease Unit, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Michele M Luchetti
- M.M. Luchetti, MD, Clinica Medica, Dipartimento Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Matthew Stoll
- M. Stoll, MD, PhD, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jasvinder A Singh
- J.A. Singh, MBBS, MPH, Medicine Service, VA Medical Center, and Department of Medicine, School of Medicine, University of Alabama at Birmingham, and Department of Epidemiology at the UAB School of Public Health, Birmingham, Alabama, USA
| | - Rosario Peluso
- R. Peluso, MD, PhD, Department of Clinical Medicine and Surgery, Rheumatology Research Unit, School of Medicine, University Federico II of Naples, Naples, Italy
| | - Judith Rademacher
- J. Rademacher, MD, Department of Gastroenterology, Infection, and Rheumatology, Universitätsmedizin Berlin, and Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - M Elaine Husni
- M.E. Husni, MD, MPH, Department of Rheumatologic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, USA
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Mathapathi S, Guendsechadze SN, Halfpenny A, Pasadhika S, Rosenbaum JT, Desmarais J. Occam's Razor Dulled: A Curious Case of Dyspnea in a 70-Year-Old. Arthritis Care Res (Hoboken) 2023. [PMID: 36762542 DOI: 10.1002/acr.25102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/21/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Affiliation(s)
| | | | | | | | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
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14
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Rosenbaum JT, Gill T, Martin TM. The NLRP3 Conundrum. Arthritis Rheumatol 2022; 75:661-663. [PMID: 36575775 DOI: 10.1002/art.42430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Affiliation(s)
- James T Rosenbaum
- Corvus Pharmaceuticals, Burlingame, California, and Legacy Devers Eye Institute, Legacy Health System, Portland, Oregon
| | - Tejpal Gill
- Department of Medicine, Oregon Health & Science University, Portland
| | - Tammy M Martin
- Departments of Ophthalmology and Molecular Microbiology & Immunology, Oregon Health & Science University, Portland
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15
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Gill T, Stauffer P, Asquith M, Laderas T, Martin TM, Davin S, Schleisman M, Ramirez C, Ogle K, Lindquist I, Nguyen J, Planck SR, Shaut C, Diamond S, Rosenbaum JT, Karstens L. Axial spondyloarthritis patients have altered mucosal IgA response to oral and fecal microbiota. Front Immunol 2022; 13:965634. [PMID: 36248884 PMCID: PMC9556278 DOI: 10.3389/fimmu.2022.965634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Axial spondyloarthritis (axSpA) is an inflammatory arthritis involving the spine and the sacroiliac joint with extra-articular manifestations in the eye, gut, and skin. The intestinal microbiota has been implicated as a central environmental component in the pathogenesis of various types of spondyloarthritis including axSpA. Additionally, alterations in the oral microbiota have been shown in various rheumatological conditions, such as rheumatoid arthritis (RA). Therefore, the aim of this study was to investigate whether axSpA patients have an altered immunoglobulin A (IgA) response in the gut and oral microbial communities. We performed 16S rRNA gene (16S) sequencing on IgA positive (IgA+) and IgA negative (IgA-) fractions (IgA-SEQ) from feces (n=17 axSpA; n=14 healthy) and saliva (n=14 axSpA; n=12 healthy), as well as on IgA-unsorted fecal and salivary samples. PICRUSt2 was used to predict microbial metabolic potential in axSpA patients and healthy controls (HCs). IgA-SEQ analyses revealed enrichment of several microbes in the fecal (Akkermansia, Ruminococcaceae, Lachnospira) and salivary (Prevotellaceae, Actinobacillus) microbiome in axSpA patients as compared with HCs. Fecal microbiome from axSpA patients showed a tendency towards increased alpha diversity in IgA+ fraction and decreased diversity in IgA- fraction in comparison with HCs, while the salivary microbiome exhibits a significant decrease in alpha diversity in both IgA+ and IgA- fractions. Increased IgA coating of Clostridiales Family XIII in feces correlated with disease severity. Inferred metagenomic analysis suggests perturbation of metabolites and metabolic pathways for inflammation (oxidative stress, amino acid degradation) and metabolism (propanoate and butanoate) in axSpA patients. Analyses of fecal and salivary microbes from axSpA patients reveal distinct populations of immunoreactive microbes compared to HCs using the IgA-SEQ approach. These bacteria were not identified by comparing their relative abundance alone. Predictive metagenomic analysis revealed perturbation of metabolites/metabolic pathways in axSpA patients. Future studies on these immunoreactive microbes may lead to better understanding of the functional role of IgA in maintaining microbial structure and human health.
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Affiliation(s)
- Tejpal Gill
- Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- *Correspondence: Tejpal Gill,
| | - Patrick Stauffer
- Casey Eye Institute/Department of Ophthalmology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Mark Asquith
- Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Ted Laderas
- Division of Bioinformatics and Computational Biomedicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Tammy M. Martin
- Casey Eye Institute/Department of Ophthalmology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
- Department of Molecular Microbiology & Immunology, Oregon Health & Science University, Portland, OR, United States
| | - Sean Davin
- Casey Eye Institute/Department of Ophthalmology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Matthew Schleisman
- Casey Eye Institute/Department of Ophthalmology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Claire Ramirez
- Casey Eye Institute/Department of Ophthalmology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Kimberly Ogle
- Casey Eye Institute/Department of Ophthalmology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Ingrid Lindquist
- Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Department of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Justine Nguyen
- Division of Bioinformatics and Computational Biomedicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Stephen R. Planck
- Casey Eye Institute/Department of Ophthalmology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Carley Shaut
- Laboratory of Immunogenetics, Oregon Health & Science University, Portland, OR, United States
| | - Sarah Diamond
- Department of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - James T. Rosenbaum
- Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
- Casey Eye Institute/Department of Ophthalmology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
- Department of Cell Biology, Oregon Health & Science University, Portland, OR, United States
- Legacy Devers Eye Institute, Portland, OR, United States
| | - Lisa Karstens
- Division of Bioinformatics and Computational Biomedicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
- Division of Urogynecology, Department of Obstetrics and Gynecology Oregon Health & Science University, Portland, OR, United States
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16
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Desmarais J, Fett N, Rosenbaum JT, Costenbader KH, Ginzler EM, Goodman S, O'Dell J, Pineau CA, Schmajuk G, Werth VP, Link MS, Kovacs R. Reply. Arthritis Rheumatol 2022; 74:1301. [PMID: 35212179 DOI: 10.1002/art.42102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Affiliation(s)
| | - Nicole Fett
- Oregon Health & Science University, Portland, OR
| | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland, OR
| | | | - Ellen M Ginzler
- State University of New York, Downstate Health Sciences University, Brooklyn, NY
| | - Susan Goodman
- Hospital for Special Surgery at New York-Presbyterian Weill Cornell Medicine, New York, NY
| | - James O'Dell
- University of Nebraska Medical Center and Omaha VA Hospital, Omaha, NE
| | | | - Gabriela Schmajuk
- University of California San Francisco, San Francisco VA Medical Center and Philip R. Lee Institute for Health Policy, San Francisco, CA
| | - Victoria P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, PA
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, TX
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17
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Ng CC, Suresh S, Rosenbaum JT, McDonald HR, Cunningham ET. Occlusive retinal vasculitis associated with systemic sclerosis and antiphospholipid antibodies. Am J Ophthalmol Case Rep 2021; 24:101206. [PMID: 34568641 PMCID: PMC8449073 DOI: 10.1016/j.ajoc.2021.101206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/18/2021] [Accepted: 09/10/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To report a series of patients with occlusive retinal vasculitis associated with systemic sclerosis (SSc) and elevated antiphospholipid antibody titers. METHOD Case series. Main outcome measures included clinical and fluorescein angiographic findings at presentation and over time. OBSERVATIONS Case 1 - A 61-year-old woman initially diagnosed with idiopathic, bilateral panuveitis and retinal vasculitis causing peripheral nonperfusion was subsequently diagnosed with limited cutaneous systemic sclerosis (lcSSc). Her ocular inflammation and retinal vasculitis were controlled with topical and periocular corticosteroids, but she eventually developed peripheral retinal vascular occlusion that progressed to macular ischemia 11 years after presentation. Repeat serologic evaluation detected interval development of antiphospholipid antibodies. Case 2 - A 58-year-old woman was found to have bilateral peripheral nonperfusion and retinal neovascularization in her right eye. Given her elevated hemoglobin A1c of 8.5%, she was diagnosed with presumed proliferative diabetic retinopathy. Three years after initial presentation, she was diagnosed with lcSSc. Subsequent serum workup detected elevated B2-glycoprotein antibody titers. Her peripheral nonperfusion progressed despite adequate glycemic control, resulting in further neovascularization in each eye. Case 3 - A 40-year-old woman with diffuse cutaneous systemic sclerosis (dcSSc) and elevated titers of anti-cardiolipin antibodies developed multiple branch retinal artery occlusions with subsequent neovascularization of the retina, optic disc, and angle in the right eye. CONCLUSION AND IMPORTANCE Vision-threatening occlusive retinal vasculitis may develop in select patients with SSc. The presence of elevated anti-phospholipid antibody titers may confer increased risk for this vision-threatening complication.
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Affiliation(s)
- Caleb C. Ng
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Sandip Suresh
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
| | - James T. Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
- Legacy Devers Eye Institute, Portland, OR, USA
| | - H. Richard McDonald
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
| | - Emmett T. Cunningham
- West Coast Retina Medical Group, San Francisco, CA, USA
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
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18
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Desmarais J, Rosenbaum JT, Costenbader KH, Ginzler EM, Fett N, Goodman S, O'Dell J, Pineau CA, Schmajuk G, Werth VP, Link MS, Kovacs R. American College of Rheumatology White Paper on Antimalarial Cardiac Toxicity. Arthritis Rheumatol 2021; 73:2151-2160. [PMID: 34697918 DOI: 10.1002/art.41934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022]
Abstract
Hydroxychloroquine (HCQ) and chloroquine (CQ) are well-established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)-prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID-19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus-based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long-term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk-benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases.
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Affiliation(s)
| | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
| | | | - Ellen M Ginzler
- State University of New York Downstate Health Sciences University, Brooklyn
| | - Nicole Fett
- Oregon Health & Science University, Portland
| | - Susan Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - James O'Dell
- University of Nebraska Medical Center and Omaha VA Hospital, Omaha, Nebraska
| | | | - Gabriela Schmajuk
- University of California San Francisco, San Francisco VA Medical Center, and Philip R. Lee Institute for Health Policy, San Francisco, California
| | - Victoria P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas
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Khazaei H, Khazaei D, Verma R, Ng J, Wilmarth PA, David LL, Rosenbaum JT. The potential of tear proteomics for diagnosis and management of orbital inflammatory disorders including Graves' ophthalmopathy. Exp Eye Res 2021; 213:108813. [PMID: 34742692 DOI: 10.1016/j.exer.2021.108813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/10/2021] [Accepted: 10/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Orbital compartments harbor a variety of tissues that can be independently targeted in a plethora of disorders resulting in sight-threatening risks. Orbital inflammatory disorders (OID) including Graves' ophthalmopathy, sarcoidosis, IgG4 disease, granulomatosis with polyangiitis, and nonspecific orbital inflammation constitute an important cause of pain, diplopia and vision loss. Physical examination, laboratory tests, imaging, and even biopsy are not always adequate to classify orbital inflammation which is frequently deemed "nonspecific". Tear sampling and testing provide a potential "window" to the orbital disease process through a non-invasive technique that allows longitudinal sampling as the disease evolves. Using PubMed/Medline, we identified potentially relevant articles on tear proteomics published in the English language between 1988 and 2021. Of 303 citations obtained, 225 contained empirical data on tear proteins, including 33 publications on inflammatory conditions, 15 in glaucoma, 15 in thyroid eye disease, 1 in sarcoidosis (75) and 2 in uveitis (77,78). Review articles were used to identify an additional 56 relevant articles through citation search. In this review, we provide a short introduction to the potential use of tears as a diagnostic fluid and tool to investigate the mechanism of ocular diseases. A general review of previous tear proteomics studies is also provided, with a focus on Graves' ophthalmopathy (GO), and a discussion of unmet needs in the diagnosis and treatment of orbital inflammatory disease (OID). The review concludes by pointing out current limitations of mass spectrometric analysis of tear proteins and summarizes future needs in the field.
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20
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Rosenbaum JT, Weisman MH, Hamilton H, Shafer C, Aslanyan E, Howard RA, Ogle K, Reveille JD, Winthrop KL, Choi D. The Interplay Between COVID-19 and Spondyloarthritis or Its Treatment. J Rheumatol 2021; 49:225-229. [PMID: 34599048 DOI: 10.3899/jrheum.210742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has created multiple uncertainties regarding rheumatic diseases or their treatment, with regard to the susceptibility to or severity of the viral disease. We aimed to address these questions as they relate to spondyloarthritis (SpA). METHODS We created a longitudinal survey from April 10, 2020, to April 26, 2021. There were 4723 subjects with SpA and 450 household contacts who participated worldwide. Of these, 3064 respondents were from the US and 70.4% of them provided longitudinal data. To control for the duration of potential risk of COVID-19, the rate of contracting the disease was normalized for person-months of exposure. RESULTS In an analysis of US subjects who provided longitudinal data, the incident rate ratio for the 159 (out of 2157) subjects who tested positive for COVID-19 was 1.16 compared to the US population as adjusted for age and sex (range 0.997-1.361, P = 0.06). A paired evaluation using patients and household members did not show a statistically significant effect to indicate a predisposition for developing COVID-19 as a result of SpA or its treatment. Our data failed to show that any class of medication commonly used to treat SpA significantly affected the risk of developing COVID-19 or increasing the severity of COVID-19. CONCLUSION These data do not exclude a small increased risk of developing COVID-19 as a result of SpA, but the risk, if it exists, is low and not consistently demonstrated. The data should provide reassurance to patients and to rheumatologists about the risk that COVID-19 poses to patients with SpA.
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Affiliation(s)
- James T Rosenbaum
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Michael H Weisman
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Hedley Hamilton
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Cassie Shafer
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Elin Aslanyan
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Richard A Howard
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Kimberly Ogle
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - John D Reveille
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Kevin L Winthrop
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
| | - Dongseok Choi
- This work was supported by the Spondylitis Association of America and Any-3. The Spondylitis Association of America receives support from AbbVie for this project. AbbVie played no role in the study design, data interpretation, or writing of the results. JTR receives support from the Grandmaison Fund for Autoimmunity Research, the William and Mary Bauman Foundation, the Stan and Madelle Rosenfeld Family Trust, and Research to Prevent Blindness. J.T. Rosenbaum, MD, Departments of Medicine, Ophthalmology, and Cell Biology Oregon Health & Science University, and Legacy Devers Eye Institute, Portland, Oregon, USA; M.H. Weisman, MD, Cedars Sinai Medical Center, Los Angeles, California, USA; H. Hamilton, BSc, Any-3, London, UK; C. Shafer, BS, E. Aslanyan, BA, R.A. Howard, BA, Spondylitis Association of America, Los Angeles, California, USA; K. Ogle, BA, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; J.D. Reveille, MD, Department of Medicine, University of Texas, Houston, Texas, USA; K.L Winthrop, MD, MPH, D. Choi, PhD, OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA. JTR consults for AbbVie, Gilead, UCB, Novartis, Roche, Horizon, Santen, Eyevensys, Corvus, Affibody, Revolo, Roivant, and Neoleukin; receives royalties from UpToDate; and receives grant support from Pfizer and Horizon. JTR serves on a data monitoring committee for Celgene (BMS). HH owns Any-3, the website that hosted the survey and donated its services. RAH owns stock in AbbVie, Amgen, BMS, GSK, Johnson and Johnson, Lilly, Merck, Novartis, Pfizer, and Teva. MHW consults for Novartis, UCB, Gilead, and GSK. JDR consults for UCB; and receives research support from Lilly and Janssen. KLW consults for Pfizer, AbbVie, UCB, Lilly, Galapagos, GSK, Roche, and Gilead; and receives research support from BMS and Pfizer. CS, EA, and RAH are employed by the Spondylitis Association of America. DC and KO report no conflicts of interest relevant to this article. Address correspondence to Dr. J.T. Rosenbaum, Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L467Ad Portland, OR 97239, USA. . Accepted for publication September 23, 2021
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Ortega-Loayza AG, Friedman MA, Reese AM, Liu Y, Greiling TM, Cassidy PB, Marzano AV, Gao L, Fei SS, Rosenbaum JT. Molecular and cellular characterization of pyoderma gangrenosum: Implications for the use of gene expression. J Invest Dermatol 2021; 142:1217-1220.e14. [PMID: 34536481 DOI: 10.1016/j.jid.2021.08.431] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA.
| | - Marcia A Friedman
- Department of Medicine, Division of Arthritis and Rheumatic Disease, Oregon Health & Science University, Portland, Oregon, USA
| | - Ashley M Reese
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Yuangang Liu
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Pamela B Cassidy
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Portland, Oregon, USA
| | - Lina Gao
- Oregon National Primate Research Center Bioinformatics & Biostatistics Core, Portland, Oregon, USA
| | - Suzanne S Fei
- Oregon National Primate Research Center Bioinformatics & Biostatistics Core, Portland, Oregon, USA
| | - James T Rosenbaum
- Department of Medicine, Division of Arthritis and Rheumatic Disease, Oregon Health & Science University, Portland, Oregon, USA
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22
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Rosenbaum JT, Gill T, Martin TM. EnRAPtured: Is Endoplasmic Reticulum Aminopeptidase a New Clue to the Pathogenesis and ThERAPy of Uveitis? Ophthalmology Science 2021; 1:100056. [PMID: 36247819 PMCID: PMC9559087 DOI: 10.1016/j.xops.2021.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rosenbaum JT, Friedman M. Seasoning to Perfection: How to Optimize Anti-TNF Therapy. Ocul Immunol Inflamm 2021; 30:767-768. [PMID: 34424794 DOI: 10.1080/09273948.2021.1964032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- James T Rosenbaum
- Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health & Science University, Casey Eye Institute, Portland, Oregon, USA.,Legacy Devers Eye Institute, Legacy Health System, Portland, Oregon, USA.,Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Marcia Friedman
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Rosenbaum JT, Harrington CA, Searles RP, Fei SS, Zaki A, Arepalli S, Paley MA, Hassman LM, Vitale AT, Conrady CD, Keath P, Mitchell C, Watson L, Planck SR, Martin TM, Choi D. Identifying RNA Biomarkers and Molecular Pathways Involved in Multiple Subtypes of Uveitis. Am J Ophthalmol 2021; 226:226-234. [PMID: 33503442 DOI: 10.1016/j.ajo.2021.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Uveitis is a heterogeneous collection of diseases. We tested the hypothesis that despite the diversity of uveitides, there could be common mechanisms shared by multiple subtypes, and that evidence of these common mechanisms may be detected as gene expression profiles in whole blood. DESIGN Cohort study. METHODS Ninety subjects with uveitis including axial spondyloarthritis (n = 17), sarcoidosis (n = 13), inflammatory bowel disease (n = 12), tubulointerstitial nephritis with uveitis (n = 10), or idiopathic uveitis (n = 38) as well as 18 healthy controls were enrolled, predominantly at Oregon Health & Science University. RNA-Seq data generated from peripheral, whole blood identified 19,859 unique transcripts. We analyzed gene expression pathways via Kyoto Encyclopedia of Genes and Genomes and Gene Ontology (GO). We validated our list of upregulated genes by comparison to a previously published study on peripheral blood gene expression among 50 subjects with diverse forms of uveitis. RESULTS Both the Kyoto Encyclopedia of Genes and Genomes and GO analysis identified multiple shared pathways or GO terms with a P value of <.0001. Almost all pathways related to the immune response and/or response to an infection. A total of 119 individual transcripts were upregulated by at least 1.5-fold and false discovery rate <.05, and 61 were downregulated by similar criteria. Comparing mRNA from our study with a false discovery rate <.05 and the prior report, we identified 10 common gene transcripts: ICAM1, IL15RA, IL15, IRF1, IL10RB, GSK3A, TYK2, MEF2A, MEF2B, and MEF2D. CONCLUSIONS Many forms of uveitis share overlapping mechanisms. These data support the concept that a single therapeutic approach could benefit diverse forms of this disease.
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Carbonell D, Mahajan S, Chee SP, Sobolewska B, Agrawal R, Bülow T, Gupta V, Jones NP, Accorinti M, Agarwal M, Batchelor T, Biswas J, Cimino L, tenDam-van Loon NH, de-la-Torre A, Frenkel S, Pe'er J, Kramer M, Miserocchi E, Mochizuki M, Ness T, Rosenbaum JT, Sen HN, Simion M, Sitter H, Vasconcelos-Santos DV, Habot-Wilner Z, Coupland SE, Pulido JS, Smith J, Thorne JE, Zierhut M. Consensus Recommendations for the Diagnosis of Vitreoretinal Lymphoma. Ocul Immunol Inflamm 2021; 29:507-520. [PMID: 34009095 DOI: 10.1080/09273948.2021.1878233] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To provide recommendations for diagnosis of vitreoretinal lymphoma (VRL). METHODS Literature was reviewed for reports supporting the diagnosis of VRL. A questionnaire (Delphi 1 round) was distributed to 28 participants. In the second round (Delphi 2), items of the questionnaire not reaching consensus (75% agreement) were discussed to finalize the recommendations. RESULTS Presenting symptoms include floaters and painless loss of vision, vitreous cells organized into sheets or clumps. Retinal lesions are usually multifocal creamy/white in the outer retina. Other findings include retinal lesions with "leopard-skin" appearance and retinal pigment epithelium atrophy. Severe vitreous infiltration without macular edema is the most likely presentation. Diagnostic vitrectomy should be performed. Systemic corticosteroid should be discontinued at least 2 weeks before surgery. An interleukin (IL)-10:IL-6 ratio > 1, positive mutation for the myeloid differentiation primary response 88 gene and monoclonality are indicators of VRL. Multi-modal imaging (optical coherence tomography, fundus autofluorescence) are recommended. CONCLUSIONS A consensus meeting allowed the establishment of recommendations important for the diagnosis of VRL.
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Affiliation(s)
- Denise Carbonell
- Ocular Inflammation and Immunology section, Singapore National Eye Centre, Singapore
| | | | - Soon-Phaik Chee
- Ocular Inflammation and Immunology section, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Singapore Eye Research Institute, The Academia, Singapore.,Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Bianka Sobolewska
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore
| | - Tanja Bülow
- Department of Medical Statistics, RWTH Aachen University, Aachen, Germany
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nicholas P Jones
- Uveitis service, Manchester Royal Eye Hospital, Manchester; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | | | - Tracy Batchelor
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts , United States
| | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS, Di Reggio Emilia, Italy
| | | | - Alejandra de-la-Torre
- NeURos Research Group, Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Shahar Frenkel
- Department Division of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Pe'er
- Department Division of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Kramer
- Uveitis service, Department of Ophthamology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Elisabetta Miserocchi
- Ocular Immunology and Uveitis Service, University Hospital San Raffaele Milan, Milan, Italy
| | - Manabu Mochizuki
- Department of Ophthalmology & Visual Science Tokyo Medical and Dental University Graduate School, Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan
| | - Thomas Ness
- Department of Ophthalmology, University Eye Clinic Freiburg, Freiburg, Germany
| | - James T Rosenbaum
- Uveitis Section, Oregon Health & Science and University Casey Eye Institute, Portland, Oregon, USA
| | - H Nida Sen
- Uveitis Clinic, National Eye Institute, Bethesda, Maryland, USA
| | | | - Helmut Sitter
- Institute of Surgical Research, Dept. Of Medicine, Philipps-University Marburg, Marburg, Germany
| | | | - Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Sarah E Coupland
- Pathology Department, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - José S Pulido
- Departments of Ophthalmology and Molecular Medicine, Mayo Clinic, Philadelphia, Pennsylvania, USA
| | - Justine Smith
- Eye and Vision Health section, Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Jennifer E Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manfred Zierhut
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
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- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
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Cunningham ET, Pichi F, Mahajan VB, Rosenbaum JT, Zierhut M. Genetics of Uveitis. Ocul Immunol Inflamm 2021; 29:215-218. [PMID: 33950774 DOI: 10.1080/09273948.2021.1910430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Vinit B Mahajan
- Omics Laboratory, Stanford University, Palo Alto, California, USA.,The Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - James T Rosenbaum
- The Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,The Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,Legacy Devers Eye Institute, Portland, Oregon, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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Rosenbaum JT, Costenbader KH, Desmarais J, Ginzler EM, Fett N, Goodman SM, O'Dell JR, Schmajuk G, Werth VP, Melles RB, Marmor MF. American College of Rheumatology, American Academy of Dermatology, Rheumatologic Dermatology Society, and American Academy of Ophthalmology 2020 Joint Statement on Hydroxychloroquine Use With Respect to Retinal Toxicity. Arthritis Rheumatol 2021; 73:908-911. [PMID: 33559327 DOI: 10.1002/art.41683] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022]
Abstract
Four major medical societies involved with hydroxychloroquine (HCQ) therapy concur on the need for common principles and cooperation to minimize the risk of ocular toxicity. At a daily dosage of ≤5 mg/kg/day actual body weight, the risk of retinal toxicity from HCQ is <2% for usage up to 10 years. Widespread adoption of more sensitive testing techniques, such as optical coherence tomography and automated visual fields, by eye care providers will allow the detection of early toxicity and thus preserve the patient's visual function. Baseline testing is advised to rule out confounding disease when a patient is started on HCQ. Annual screening with sensitive tests should begin no more than 5 years after treatment initiation. Providers should be sensitive to the medical value of HCQ, and not stop the drug for uncertain indications. It is important to note that effective communication among prescribing physicians, patients, and eye care providers will optimize the utility and safety of HCQ.
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Affiliation(s)
- James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland
| | | | | | - Ellen M Ginzler
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Nicole Fett
- Oregon Health & Science University, Portland
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - James R O'Dell
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
| | | | - Victoria P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia
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van der Horst-Bruinsma I, van Bentum R, Verbraak FD, Rath T, Rosenbaum JT, Misterska-Skora M, Hoepken B, Irvin-Sellers O, VanLunen B, Bauer L, Rudwaleit M. The impact of certolizumab pegol treatment on the incidence of anterior uveitis flares in patients with axial spondyloarthritis: 48-week interim results from C-VIEW. RMD Open 2021; 6:rmdopen-2019-001161. [PMID: 32371433 PMCID: PMC7299504 DOI: 10.1136/rmdopen-2019-001161] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/10/2020] [Accepted: 03/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background Acute anterior uveitis (AAU) is the most common extra-articular manifestation in patients with axial spondyloarthritis (axSpA). C-VIEW investigates the impact of the Fc-free TNF inhibitor certolizumab pegol (CZP) on AAU flares in patients with active axSpA at high risk of recurrent AAU. Methods C-VIEW (NCT03020992) is a 96-week ongoing, multicentre, open-label, phase 4 study. Included patients had an axSpA diagnosis, a history of recurrent AAU (≥2 AAU flares, ≥1 flare in the year prior to study entry), HLA-B27 positivity, active disease, and failure of ≥2 non-steroidal anti-inflammatory drugs. Patients received CZP 400 mg at Weeks 0/2/4, then 200 mg every 2 weeks up to 96 weeks. This 48-week pre-planned interim analysis compares AAU flare incidence in the 48 weeks before and after initiation of CZP treatment, using Poisson regression to account for possible within-patient correlations. Results In total, 89 patients were included (male: 63%; radiographic/non-radiographic axSpA: 85%/15%; mean axSpA disease duration: 8.6 years). During 48 weeks’ CZP treatment, 13 (15%) patients experienced 15 AAU flares, representing an 87% reduction in AAU incidence rate (146.6 per 100 patient-years (PY) in the 48 weeks pre-baseline to 18.7 per 100 PY during CZP treatment). Poisson regression analysis showed that the incidence rate of AAU per patient reduced from 1.5 to 0.2 (p<0.001). No new safety signals were identified. Conclusions There was a significant reduction in the AAU flare rate during 48 weeks of CZP treatment, indicating that CZP is a suitable treatment option for patients with active axSpA and a history of recurrent AAU.
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Affiliation(s)
- Irene van der Horst-Bruinsma
- Department of Rheumatology, Amsterdam University Medical Center, Location VU Medical Center, Amsterdam, The Netherlands
| | - Rianne van Bentum
- Department of Rheumatology, Amsterdam University Medical Center, Location VU Medical Center, Amsterdam, The Netherlands
| | - Frank D Verbraak
- Department of Ophthalmology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | | | - James T Rosenbaum
- Devers Eye Institute, Legacy Health System, Portland, Oregon, USA.,Oregon Health and Science University, Portland, Oregon, USA
| | - Maria Misterska-Skora
- Department of Rheumatology and Internal Medicine, Wrocław Medical University, Wrocław, Poland
| | | | | | | | | | - Martin Rudwaleit
- Klinikum Bielefeld and Charité Berlin, Berlin, Germany.,Ghent University, Ghent, Belgium
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Huang JCC, Schleisman M, Choi D, Mitchell C, Watson L, Asquith M, Rosenbaum JT. Preliminary Report on Interleukin-22, GM-CSF, and IL-17F in the Pathogenesis of Acute Anterior Uveitis. Ocul Immunol Inflamm 2021; 29:558-565. [PMID: 31763950 PMCID: PMC7246145 DOI: 10.1080/09273948.2019.1686156] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/19/2019] [Accepted: 10/24/2019] [Indexed: 01/17/2023]
Abstract
Purpose:Anterior uveitis is the most common anatomic subset of uveitis. We developed a novel multi-parametric flow cytometry panel to identify immune dysregulation signatures in HLA B27-associated acute anterior uveitis (AAU) and axial spondyloarthritis (AxSpA).Methods: We used fluorescence activated cell sorting to characterize T cell cytokine expression in stimulated T cell subsets from patients with AAU (n = 4) compared to healthy controls (n = 14) or subjects with AxSpA (n = 6).Results: Positive findings among subjects with AAU included a statistically significant increase in stimulated granulocyte-macrophage colony stimulating factor (GM-CSF), IL-17, and IL-22 synthesized by CD8 cells, a trend for stimulated ILC (innate lymphoid cells)-3 cells to synthesize more IL-22 (p = .07), and stimulated MAIT (mucosa associated innate lymphoid cells)-like cells that express the T cell receptor V alpha 7.2 to express IL-17A, IL-17F, and IL-22 in a greater percentage of cells relative to controls. IL-17F, GM- CSF, and IL-22 represent potentially novel targets in AAU.Conclusion: Our report is arguably the first to implicate IL-17F or ILC-3 and MAIT cells in the pathogenesis of AAU.Abbreviations AAU: acute anterior uveitis; AxSpA: axial spondyloarthritis; BASDAI: Bath ankylosing spondylitis disease activity index; CCR: chemokine receptor; DMSO: dimethylsulfoxide; EULAR:European League Against Rheumatism; FACS: fluorescence activated cell sorter; FBS: fetal bovine serum; FSC: orward light scatter; GM-CSF: granulocyte-macrophage colony stimulating factor; HC: healthy control; ILC: innate lymphoid cell; KIR: killer immunoglobulin receptor; MAIT: mucosal associated immune T cell; ND: not detected; NK: natural killer cell; OHSU-Oregon Health & Science University; PBMC: peripheral blood mononuclear cell; SSC: side light scatter; TCR: T cell receptor.
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Affiliation(s)
- Jerry Chien-Chieh Huang
- Department of Ophthalmology, Oregon Health & Science University (OHSU)
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan 2. Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | | | - Dongseok Choi
- OHSU-PSU School of Public Health, Oregon Health & Science University and Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Claire Mitchell
- Department of Ophthalmology, Oregon Health & Science University (OHSU)
| | - Lindsey Watson
- Department of Ophthalmology, Oregon Health & Science University (OHSU)
| | - Mark Asquith
- Department of Medicine, OHSU (Dr. Asquith is deceased)
| | - James T. Rosenbaum
- Departments of Ophthalmology, Medicine, and Cell Biology, OHSU
- Legacy Devers Eye Institute, Portland, Oregon
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Turk MA, Rosenbaum JT. A Good Detective Never Misses a Clue: Why the Epidemiology of Scleritis Deserves Our Attention. Arthritis Rheumatol 2021; 73:1127-1128. [PMID: 33750004 DOI: 10.1002/art.41724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Matthew A Turk
- St. Vincent's University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland
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Rosenbaum JT, Costenbader KH, Desmarais J, Ginzler EM, Fett N, Goodman SM, O'Dell JR, Schmajuk G, Werth VP, Melles RB, Marmor MF. Collaboration for the Management of Hydroxychloroquine. Ophthalmology 2021; 128:1115-1116. [PMID: 33752915 DOI: 10.1016/j.ophtha.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022] Open
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Kempen JH, Pistilli M, Begum H, Fitzgerald TD, Liesegang TL, Payal A, Zebardast N, Bhatt NP, Foster CS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE. Remission of Non-Infectious Anterior Scleritis: Incidence and Predictive Factors. Am J Ophthalmol 2021; 223:377-395. [PMID: 30951689 DOI: 10.1016/j.ajo.2019.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 02/18/2019] [Accepted: 03/20/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess how often non-infectious anterior scleritis remits and identify predictive factors. METHODS Our retrospective cohort study at four ocular inflammation subspecialty centers collected data for each affected eye/patient at every visit from center inception (1978, 1978, 1984, 2005) until 2010. Remission was defined as inactivity of disease off all suppressive medications at all visits spanning at least three consecutive months or at all visits up to the last visit (to avoid censoring patients stopping follow-up after remission). Factors potentially predictive of remission were assessed using Cox regression models. RESULTS During 1,906 years' aggregate follow-up of 832 affected eyes, remission occurred in 214 (170 of 584 patients). Median time-to-remission of scleritis = 7.8 years (95% confidence interval [CI]: 5.7, 9.5). More remissions occurred earlier than later during follow-up. Factors predictive of less scleritis remission included scleritis bilaterality (adjusted hazard ratio [aHR] = 0.46, 95% CI: 0.32-0.65); and diagnosis with any systemic inflammatory disease (aHR = 0.36, 95% CI: 0.23-0.58), or specifically with Rheumatoid Arthritis (aHR = 0.22), or Granulomatosis with Polyangiitis (aHR = 0.08). Statin treatment (aHR = 1.53, 95% CI: 1.03-2.26) within ≤90 days was associated with more remission incidence. CONCLUSIONS Our results suggest scleritis remission occurs more slowly in anterior scleritis than in newly diagnosed anterior uveitis or chronic anterior uveitis, suggesting that attempts at tapering suppressive medications is warranted after long intervals of suppression. Remission is less frequently achieved when systemic inflammatory diseases are present. Confirmatory studies of whether adjunctive statin treatment truly can enhance scleritis remission (as suggested here) are needed.
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Verma R, Choi D, Chen AJ, Harrington CA, Wilson DJ, Grossniklaus HE, Dailey RA, Ng J, Steele EA, Planck SR, Korn BS, Kikkawa D, Czyz CN, Foster JA, Kazim M, Harris GJ, Edward DP, Al-Hussain H, Maktabi AMY, Alabiad C, Garcia A, Rosenbaum JT. Enrichment of IGF-1R and PPARγ signalling pathways in orbital inflammatory diseases: steps toward understanding pathogenesis. Br J Ophthalmol 2021; 106:1012-1017. [PMID: 33637620 DOI: 10.1136/bjophthalmol-2020-318330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/21/2021] [Accepted: 02/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Orbital inflammatory disease (OID) encompasses a wide range of pathology including thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis and non-specific orbital inflammation (NSOI), accounting for up to 6% of orbital diseases. Understanding the underlying pathophysiology of OID can improve diagnosis and help target therapy. AIMS To test the hypothesis that shared signalling pathways are activated in different forms of OID. METHODS In this secondary analysis, pathway analysis was performed on the previously reported differentially expressed genes from orbital adipose tissue using patients with OID and healthy controls who were characterised by microarray. For the original publications, tissue specimens were collected from oculoplastic surgeons at 10 international centres representing four countries (USA, Canada, Australia and Saudi Arabia). Diagnoses were independently confirmed by two masked ocular pathologists (DJW, HEG). Gene expression profiling analysis was performed at the Oregon Health & Science University. Eighty-three participants were included: 25 with TAO, 6 with orbital GPA, 7 with orbital sarcoidosis, 25 with NSOI and 20 healthy controls. RESULTS Among the 83 subjects (mean (SD) age, 52.8 (18.3) years; 70% (n=58) female), those with OID demonstrated perturbation of the downstream gene expressions of the IGF-1R (MAPK/RAS/RAF/MEK/ERK and PI3K/Akt/mTOR pathways), peroxisome proliferator-activated receptor-γ (PPARγ), adipocytokine and AMPK signalling pathways compared with healthy controls. Specifically, GPA samples differed from controls in gene expression within the insulin-like growth factor-1 receptor (IGF-1R, PI3K-Akt (p=0.001), RAS (p=0.005)), PPARγ (p=0.002), adipocytokine (p=0.004) or AMPK (p=<0.001) pathways. TAO, sarcoidosis and NSOI samples were also found to have statistically significant differential gene expression in these pathways. CONCLUSIONS Although OID includes a heterogenous group of pathologies, TAO, GPA, sarcoidosis and NSOI share enrichment of common gene signalling pathways, namely IGF-1R, PPARγ, adipocytokine and AMPK. Pathway analyses of gene expression suggest that other forms of orbital inflammation in addition to TAO may benefit from blockade of IGF-1R signalling pathways.
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Affiliation(s)
- Rohan Verma
- Oculofacial Plastic and Reconstructive Surgery, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA.,Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA
| | - Dongseok Choi
- Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA.,OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, South Korea.,Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Allison J Chen
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
| | - Christina A Harrington
- Integrated Genomics Laboratory, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA
| | | | - Roger A Dailey
- Oculofacial Plastic and Reconstructive Surgery, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA.,Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA
| | - John Ng
- Oculofacial Plastic and Reconstructive Surgery, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA.,Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA
| | - Eric A Steele
- Oculofacial Plastic and Reconstructive Surgery, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA.,Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA
| | - Stephen R Planck
- Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA.,Devers Eye Institute, Legacy Health System, Portland, Oregon, USA
| | - Bobby S Korn
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
| | - Don Kikkawa
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
| | - Craig N Czyz
- Oculofacial Plastic and Reconstructive Surgery, Ohio Health, Columbus, Ohio, USA
| | - Jill A Foster
- Oculofacial Plastic and Reconstructive Surgery, The Ohio State University, Nationwide Children's Hospital, Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio, USA
| | - Michael Kazim
- Edward S Harkness Eye Institute, Columbia University, New York, New York, USA
| | - Gerald J Harris
- Oculofacial Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Deepak P Edward
- Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Illinois, USA.,Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Haila Al-Hussain
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Chris Alabiad
- Oculofacial Plastic and Reconstructive Surgery, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Armando Garcia
- Oculofacial Plastic and Reconstructive Surgery, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University Casey Eye Institute, Portland, Oregon, USA .,Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Devers Eye Institute, Legacy Health System, Portland, Oregon, USA
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Pistilli M, Gangaputra SS, Pujari SS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Begum H, Fitzgerald TD, Dreger KA, Kempen JH. Contemporaneous Risk Factors for Visual Acuity in Non-Infectious Uveitis. Ocul Immunol Inflamm 2021; 29:1056-1063. [PMID: 33621148 DOI: 10.1080/09273948.2020.1828493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We evaluated the associations of clinical and demographic characteristics with visual acuity (VA) with over 5 years in a subspecialty noninfectious uveitis population. METHODS Retrospective data from 5,530 noninfectious uveitis patients were abstracted by expert reviewers, and contemporaneous associations of VA with demographic and clinical factors were modeled. RESULTS Patients were a median of 41 years old, 65% female, and 73% white. Eyes diagnosed ≥5 years prior to cohort entry had worse VA (-1.2 lines) than those diagnosed <6 months prior, and eyes with cataract surgery performed prior to entry had worse VA (-5.9 lines) than those performed during follow-up. Vitreous haze (-4.2 lines for 3+ vs quiet), hypotony (-2.5 lines for ≤5 mm Hg vs 6-23 mm Hg), and CNV (-1.8 lines) all were strongly associated with reduced VA. CONCLUSION Factors associated with reduced VA included well-known structural complications, and lack of subspecialty care during cataract surgery.
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Affiliation(s)
- Maxwell Pistilli
- Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sapna S Gangaputra
- Department of Ophthalmology and Vision Sciences, Vanderbilt Eye Institute, Nashville, Tennessee, USA
| | | | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grace A Levy-Clarke
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA.,Tampa Bay Uveitis Center, Tampa, Florida, USA
| | | | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,Portland Veteran's Affairs Medical Center, Portland, Oregon, USA
| | - Jennifer E Thorne
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nirali P Bhatt
- Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Hosne Begum
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tonetta D Fitzgerald
- Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kurt A Dreger
- Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,MCM Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia, USA
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Rosenbaum JT, Harrington CA, Searles RP, Fei SS, Zaki A, Arepalli S, Paley MA, Hassman LM, Vitale AT, Conrady CD, Keath P, Mitchell C, Watson L, Planck SR, Martin TM, Choi D. Revising the Diagnosis of Idiopathic Uveitis by Peripheral Blood Transcriptomics. Am J Ophthalmol 2021; 222:15-23. [PMID: 32941857 DOI: 10.1016/j.ajo.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To test the hypothesis that idiopathic uveitis can be categorized into subtypes based on gene expression from blood. DESIGN Case control study. METHODS We applied RNA-Seq to peripheral blood from patients with uveitis associated with 1 of 4 systemic diseases, including axial spondyloarthritis (n = 17), sarcoidosis (n = 13), inflammatory bowel disease (n = 12), tubulo-interstitial nephritis with uveitis (n = 10), or idiopathic uveitis (n = 38) as well as 18 healthy control subjects evaluated predominantly at Oregon Health and Science University. A high-dimensional negative binomial regression model implemented in the edgeR R package compared each disease group with the control subjects. The 20 most distinctive genes for each diagnosis were extracted. Of 80 genes, there were 75 unique genes. A classification algorithm was developed by fitting a gradient boosting tree with 5-fold cross-validation. Messenger RNA from subjects with idiopathic uveitis were analyzed to see if any fit clinically and by gene expression pattern with one of the diagnosable entities. RESULTS For uveitis associated with a diagnosable systemic disease, gene expression profiling achieved an overall accuracy of 85% (balanced average of sensitivity plus specificity, P < .001). Although most patients with idiopathic uveitis presumably have none of these 4 associated systemic diseases, gene expression profiles helped to reclassify 11 of 38 subjects. CONCLUSIONS Peripheral blood gene expression profiling is a potential adjunct in accurate differential diagnosis of the cause of uveitis. Validation of these results and characterization of the gene expression profile from additional discrete diagnoses could enhance the value of these observations.
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Affiliation(s)
- James T Rosenbaum
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA; Department of Cell Biology, Oregon Health and Science University, Portland, Oregon, USA; Legacy Devers Eye Institute, Portland, Oregon, USA.
| | - Christina A Harrington
- Integrated Genomics Laboratory, Oregon Health and Science University, Portland, Oregon, USA; Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Robert P Searles
- Integrated Genomics Laboratory, Oregon Health and Science University, Portland, Oregon, USA
| | - Suzanne S Fei
- Bioinformatics and Biostatistics Core, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon, USA
| | - Amr Zaki
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Sruthi Arepalli
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael A Paley
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Lynn M Hassman
- Department of Ophthalmology, Washington University, St Louis, Missouri, USA
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Christopher D Conrady
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Puthyda Keath
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Claire Mitchell
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Lindsey Watson
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Stephen R Planck
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Tammy M Martin
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA; Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | - Dongseok Choi
- Department of Ophthalmology/Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA; Oregon Health and Science University-Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
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Abstract
Spondyloarthritis (SpA) is a group of immune mediated inflammatory diseases with a strong association to the major histocompatibility (MHC) class I molecule, HLA-B27. Although the association between HLA-B27 and AS has been known for almost 50 years, the mechanisms underlying disease pathogenesis are elusive. Over the years, three hypotheses have been proposed to explain HLA-B27 and disease association: 1) HLA B27 presents arthritogenic peptides and thus creates a pathological immune response; 2) HLA-B27 misfolding causes endoplasmic reticulum (ER) stress which activates the unfolded protein response (UPR); 3) HLA-B27 dimerizes on the cell surface and acts as a target for natural killer (NK) cells. None of these hypotheses explains SpA pathogenesis completely. Evidence supports the hypothesis that HLA-B27-related diseases have a microbial pathogenesis. In animal models of various SpAs, a germ-free environment abrogates disease development and colonizing these animals with gut commensal microbes can restore disease manifestations. The depth of microbial influence on SpA development has been realized due to our ability to characterize microbial communities in the gut using next-generation sequencing approaches. In this review, we will discuss various putative pathobionts in the pathogenesis of HLA-B27-associated diseases. We pursue whether a single pathobiont or a disruption of microbial community and function is associated with HLA-B27-related diseases. Furthermore, rather than a specific pathobiont, metabolic functions of various disease-associated microbes might be key. While the use of germ-free models of SpA have facilitated understanding the role of microbes in disease development, future studies with animal models that mimic diverse microbial communities instead of mono-colonization are indispensable. We discuss the causal mechanisms underlying disease pathogenesis including the role of these pathobionts on mucin degradation, mucosal adherence, and gut epithelial barrier disruption and inflammation. Finally, we review the various uses of microbes as therapeutic modalities including pre/probiotics, diet, microbial metabolites and fecal microbiota transplant. Unravelling these complex host-microbe interactions will lead to the development of new targets/therapies for alleviation of SpA and other HLA-B27 associated diseases.
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Affiliation(s)
- Tejpal Gill
- Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - James T Rosenbaum
- Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health & Science University, Portland, OR, United States.,Legacy Devers Eye Institute, Portland, OR, United States
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Lee MJ, Hamilton BE, Pettersson D, Ogle K, Murdock J, Dailey RA, Ng JD, Steele EA, Verma R, Planck SR, Martin TM, Choi D, Rosenbaum JT. Radiologic imaging shows variable accuracy in diagnosing orbital inflammatory disease and assessing its activity. Sci Rep 2020; 10:21875. [PMID: 33318556 PMCID: PMC7736889 DOI: 10.1038/s41598-020-78830-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Radiologic orbital imaging provides important information in the diagnosis and management of orbital inflammation. However, the diagnostic value of orbital imaging is not well elucidated. This study aimed to investigate the diagnostic accuracy of orbital imaging to diagnose orbital inflammatory diseases and its ability to detect active inflammation. We collected 75 scans of 52 patients (49 computed tomography (CT) scans; 26 magnetic resonance (MR) imaging scans). Clinical diagnoses included thyroid eye disease (TED) (41 scans, 31 patients), non-specific orbital inflammation (NSOI) (22 scans, 14 patients), sarcoidosis (4 scans, 3 patients), IgG4-related ophthalmic disease (IgG4-ROD) (5 scans, 3 patients), and granulomatosis with polyangiitis (GPA) (3 scans, 1 patient). Two experienced neuroradiologists interpreted the scans, offered a most likely diagnosis, and assessed the activity of inflammation, blinded to clinical findings. The accuracy rate of radiological diagnosis compared to each clinical diagnosis was evaluated. Sensitivity and specificity in detecting active inflammation were analyzed for TED and NSOI. The accuracy rate of radiologic diagnosis was 80.0% for IgG4-ROD, 77.3% for NSOI, and 73.2% for TED. Orbital imaging could not diagnose sarcoidosis. Orbital CT had a sensitivity of 50.0% and a specificity of 75.0% to predict active TED using clinical assessment as the gold standard. The sensitivity/specificity of orbital MR was 83.3/16.7% for the detection of active NSOI. In conclusion, orbital imaging is accurate for the diagnosis of IgG4, NSOI, and TED. Further studies with a large number of cases are needed to confirm this finding, especially with regard to uncommon diseases. Orbital CT showed moderate sensitivity and good specificity for identifying active TED.
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Affiliation(s)
- Min Joung Lee
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA.
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, 14068, Republic of Korea.
| | - Bronwyn E Hamilton
- Department of Radiology, Oregon Health and Science University, Portland, OR, USA
| | - David Pettersson
- Department of Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Kimberly Ogle
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jennifer Murdock
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Roger A Dailey
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - John D Ng
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Eric A Steele
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Rohan Verma
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Stephen R Planck
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Tammy M Martin
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Dongseok Choi
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
- Oregon Health and Science University-Portland State University School of Public Health, Oregon Health and Science University, Portland, USA
- Graduate School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
- Devers Eye Institute, Legacy Health System, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
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Suhler EB, Jaffe GJ, Fortin E, Lim LL, Merrill PT, Dick AD, Brezin AP, Nguyen QD, Thorne JE, Van Calster J, Cimino L, Adan A, Goto H, Kaburaki T, Kramer M, Vitale AT, Kron M, Song AP, Liu J, Pathai S, Douglas KM, Schlaen A, Muccioli C, Van Velthoven MEJ, Zierhut M, Rosenbaum JT. Long-Term Safety and Efficacy of Adalimumab in Patients with Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis. Ophthalmology 2020; 128:899-909. [PMID: 33157077 DOI: 10.1016/j.ophtha.2020.10.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 10/07/2020] [Accepted: 10/29/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate long-term efficacy and safety of extended treatment with adalimumab in patients with noninfectious intermediate, posterior, or panuveitis. DESIGN Open-label, multicenter, phase 3 extension study (VISUAL III). PARTICIPANTS Adults who had completed a randomized, placebo-controlled phase 3 parent trial (VISUAL I or II) without treatment failure (inactive uveitis) or who discontinued the study after meeting treatment failure criteria (active uveitis). METHODS Patients received subcutaneous adalimumab 40 mg every other week. Data were collected for ≤ 362 weeks. Adverse events (AEs) were recorded until 70 days after the last dose. MAIN OUTCOME MEASURES Long-term safety and quiescence; other efficacy variables included inflammatory lesions, anterior chamber cell and vitreous haze grade, macular edema, visual acuity, and dose of uveitis-related systemic corticosteroids. RESULTS At study entry, 67% of patients (283/424) showed active uveitis and 33% (141/424) showed inactive uveitis; 60 patients subsequently met exclusion criteria, and 364 were included in the intention-to-treat analysis. Efficacy variables were analyzed through week 150, when approximately 50% of patients (214/424) remained in the study. Patients showing quiescence increased from 34% (122/364) at week 0 to 85% (153/180) at week 150. Corticosteroid-free quiescence was achieved by 54% (66/123) and 89% (51/57) of patients with active or inactive uveitis at study entry. Mean daily dose of systemic corticosteroids was reduced from 9.4 ± 17.1 mg/day at week 0 (n = 359) to 1.5 ± 3.9 mg/day at week 150 (n = 181). The percentage of patients who achieved other efficacy variables increased over time for those with active uveitis at study entry and was maintained for those with inactive uveitis. The most frequently reported treatment-emergent AEs of special interest were infections (n = 275; 79 events/100 patient-years [PY]); AEs and serious AEs occurred at a rate of 396 events/100 PY and 15 events/100 PY, respectively. CONCLUSIONS Long-term treatment with adalimumab led to quiescence and reduced corticosteroid use for patients who entered VISUAL III with active uveitis and led to maintenance of quiescence for those with inactive uveitis. AEs were comparable with those reported in the parent trials and consistent with the known safety profile of adalimumab.
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Affiliation(s)
- Eric B Suhler
- Casey Eye Institute, Oregon Health & Science University, OHSU-PSU School of Public Health, and VA Portland Health Care System, Portland, Oregon.
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Eric Fortin
- Department of Ophthalmology, University of Montreal, Montreal, Canada
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Pauline T Merrill
- Department of Ophthalmology, Rush University Medical Center, Chicago, Illinois
| | - Andrew D Dick
- Translational Health Sciences (Ophthalmology), University of Bristol, Bristol Eye Hospital, Bristol, United Kingdom, and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London, Institute of Ophthalmology, London, United Kingdom
| | - Antoine P Brezin
- Department of Ophthalmology, Université Paris Descartes, Hôpital Cochin, Paris, France
| | - Quan Dong Nguyen
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Jennifer E Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, and Department of Epidemiology, Center for Clinical Trials, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL IRCCS, Reggio Emilia, Italy
| | - Alfredo Adan
- Facultad de Medicina, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Hiroshi Goto
- Department of Ophthalmolgy, Medical University, Tokyo, Japan
| | | | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Martina Kron
- AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | | | | | - Sophia Pathai
- Johnson & Johnson Vision, Singapore, Republic of Singapore
| | | | - Ariel Schlaen
- Department of Ophthalmology, Austral University, Buenos Aires, Argentina
| | - Cristina Muccioli
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | | | - Manfred Zierhut
- Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - James T Rosenbaum
- Departments of Ophthalmology and Medicine, Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
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Rosenbaum JT, Hamilton H, Weisman MH, Reveille JD, Winthrop KL, Choi D. The Effect of HLA-B27 on Susceptibility and Severity of COVID-19. J Rheumatol 2020; 48:621-622. [PMID: 33060311 DOI: 10.3899/jrheum.200939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- James T Rosenbaum
- Departments of Medicine, Ophthalmology, and Cell Biology, Oregon Health & Science University, Portland, Oregon, USA; .,Legacy Devers Eye Institute, Portland, Oregon, USA
| | | | | | - John D Reveille
- Department of Medicine, University of Texas, Houston, Texas, USA
| | - Kevin L Winthrop
- OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
| | - Dongseok Choi
- OHSU-PSU School of Public Health and Departments of Medicine and Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
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40
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Lee MJ, Planck SR, Choi D, Harrington CA, Wilson DJ, Dailey RA, Ng JD, Steele EA, Hamilton BE, Khwarg SI, Rosenbaum JT. Non-specific orbital inflammation: Current understanding and unmet needs. Prog Retin Eye Res 2020; 81:100885. [PMID: 32717379 DOI: 10.1016/j.preteyeres.2020.100885] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
Non-specific orbital inflammation (NSOI) is a noninfectious inflammatory condition of the orbit. Although it is generally considered the most common diagnosis derived from an orbital biopsy, it is a diagnosis of exclusion, meaning that the diagnosis requires exclusion of a systemic process or another identifiable etiology of orbital inflammation. The clinical diagnosis of NSOI is ill-defined, but it is typically characterized by acute orbital signs and symptoms, including pain, proptosis, periorbital edema, chemosis, diplopia, and less commonly visual disturbance. NSOI poses a diagnostic and therapeutic challenge: The clinical presentations and histological findings are heterogeneous, and there are no specific diagnostic criteria or treatment guidelines. The etiology and pathogenesis of NSOI are poorly understood. Here we recapitulate our current clinical understanding of NSOI, with an emphasis on the most recent findings on clinical characteristics, imaging findings, and treatment outcomes. Furthermore, gene expression profiling of NSOI and its implications are presented and discussed.
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Affiliation(s)
- Min Joung Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, Gyeonggi-do, 14068, Republic of Korea; Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Stephen R Planck
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Dongseok Choi
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA; OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SWSam Jackson Park Road, Portland, OR, 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA; Graduate School of Dentistry, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Christina A Harrington
- Integrated Genomics Laboratory, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - David J Wilson
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Roger A Dailey
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - John D Ng
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Eric A Steele
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA
| | - Bronwyn E Hamilton
- Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger Blvd, Portland, OR, 97239, USA; Department of Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA; Devers Eye Institute, Legacy Health Systems, 1040 NW 22nd Avenue, Portland, OR, 97210, USA.
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41
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Han YS, Rivera-Grana E, Rosenbaum JT, Schleisman M, Davin S, Martin TM, Furst AB, Asquith M. Expression of Cytokines in Porcine Iris, Retina and Choroidal Tissues Stimulated by Microbe-associated Molecular Patterns. Curr Eye Res 2020; 46:255-262. [PMID: 32589043 DOI: 10.1080/02713683.2020.1789176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The innate immune system is strongly implicated in the pathogenesis of uveitis. This study was designed to clarify the responses of the innate immune system in uveal tissues. MATERIALS AND METHODS We utilized quantitative, real-time RT-PCR to measure mRNA of innate immune system receptors from porcine iris, choroid, and retina tissues. We used RT-PCR for cytokines to evaluate the responses of these tissues to specific ligands or extracts of whole bacteria that activate the innate immune system. We used ELISA for IL-6 on selected choroidal supernatants to confirm that the mRNA measurement correlated with protein levels. RESULTS In each of the studied tissues, we detected the expression of important receptors belonging to the innate immune system including dectin-1, TLR4, TLR8, and NOD2. Relative mRNA expression was generally lower in the retina compared to iris or choroid. All three tissues demonstrated upregulation of cytokine mRNA in response to a range of ligands that activate the innate immune system. The measurement of IL-6 protein was consistent with results based on mRNA. Notably, the expression of mRNA for IL-23 was more pronounced than IL-12 in all three tissues after stimulation with various innate immune system ligands. CONCLUSIONS These data provide evidence of a potent innate immune response intrinsic to uveal tissues. Specific innate immune system ligands as well as bacterial extracts enhanced the production of several inflammatory cytokines. Furthermore, the observation of higher upregulation of IL-23 mRNA, compared to IL-12 in response to innate immune stimuli, suggested that a local TH17 response might be more robust than a local TH1 response in uveal tissues. Our results expand the understanding as to how the innate immune system may contribute to uveitis.
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Affiliation(s)
- Yong Seop Han
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University , Portland, OR, USA.,Institute of Health Science, Gyeongsang National University College of Medicine , Jinju, Korea (The Republic of).,Department of Ophthalmology, Gyeongsang National University Changwon Hospital , Changwon, Korea (The Republic of)
| | - Erick Rivera-Grana
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University , Portland, OR, USA.,Department of Ophthalmology, University of Puerto Rico School of Medicine , San Juan, Puerto Rico
| | - James T Rosenbaum
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University , Portland, OR, USA.,Legacy Devers Eye Institute , Portland, OR, USA.,Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University , Portland, OR, USA
| | - Matthew Schleisman
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University , Portland, OR, USA
| | - Sean Davin
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University , Portland, OR, USA
| | - Tammy M Martin
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University , Portland, OR, USA
| | - Alec B Furst
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University , Portland, OR, USA
| | - Mark Asquith
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University , Portland, OR, USA.,Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University , Portland, OR, USA
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Abstract
Spondyloarthritis, although primarily a joint-centered disease, is associated with extra-articular features, such as gut inflammation, psoriasis, and/or uveitis. Evidence points to underlying genetic predisposing factors and/or environmental factors. This is most clear in the gut, with progress through 16S and metagenomics sequencing studies and the results of functional studies in preclinical arthritis models. Translation of these findings to the clinic is making progress based on encouraging results of fecal microbial transplant studies in several human diseases. This review elaborates on novel trends in host-microbial interplay in spondyloarthritis, focusing on microbiota, immune dysregulation, and disease progression, and modulation by HLA-B27.
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Affiliation(s)
- Emilie Dumas
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology Unit), Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium; Molecular Immunology and Inflammation Unit, VIB Center for Inflammatory Research, Ghent, Belgium
| | - Koen Venken
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology Unit), Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium; Molecular Immunology and Inflammation Unit, VIB Center for Inflammatory Research, Ghent, Belgium
| | - James T Rosenbaum
- Oregon Health & Science University, Portland, OR, USA; Legacy Devers Eye Institute, Portland, OR, USA
| | - Dirk Elewaut
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics (Rheumatology Unit), Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium; Molecular Immunology and Inflammation Unit, VIB Center for Inflammatory Research, Ghent, Belgium.
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43
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Deodhar AA, Miceli-Richard C, Baraliakos X, Marzo-Ortega H, Gladman DD, Blanco R, Das Gupta A, Martin R, Safi J, Porter B, Shete A, Rosenbaum JT. Incidence of Uveitis in Secukinumab-treated Patients With Ankylosing Spondylitis: Pooled Data Analysis From Three Phase 3 Studies. ACR Open Rheumatol 2020; 2:294-299. [PMID: 32352653 PMCID: PMC7231512 DOI: 10.1002/acr2.11139] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/23/2020] [Indexed: 01/17/2023] Open
Abstract
Objective The objective of this study was to report the incidence of uveitis in secukinumab‐treated patients with ankylosing spondylitis (AS) in a pooled analysis of three phase 3 trials (MEASURE 1‐3 [ClinicalTrials.gov identifiers NCT01358175, NCT01649375, NCT02008916]). Methods Analysis included pooled patient‐level data from all patients (N = 794) who received any dose (one or more) of secukinumab up to the last patient attending the week 156 study visit in MEASURE 1 and up to the week 156 visit in MEASURE 2 and the week 104 visit in MEASURE 3 for each patient. Postmarketing data were from the periodic safety update report. Incidence of uveitis is reported as the exposure‐adjusted incidence rate (EAIR) per 100 patient‐years of secukinumab exposure. Results Overall, 135 (17%) patients reported preexisting (but not active or ongoing) uveitis at baseline, and 589 (74.2%) patients were HLA antigen B27 positive. The EAIR for uveitis was 1.4 per 100 patient‐years over the entire treatment period. Among all cases of uveitis (n = 26), 14 (54%) were flares. The exposure‐adjusted reporting rate of uveitis in the postmarketing data (which included patients across the three approved indications of psoriasis, psoriatic arthritis, and AS) was 0.03 per 100 patient‐years based on cumulative secukinumab exposure of 96 054 patient‐years. Conclusion The incidence rate of uveitis in secukinumab‐treated patients with active AS does not suggest an increased risk with secukinumab treatment.
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Affiliation(s)
| | - Corine Miceli-Richard
- Paris Descartes University, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, and European League Against Rheumatism Center of Excellence, Paris, France
| | | | | | | | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Ruvie Martin
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Jorge Safi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Brian Porter
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland
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Harrington CA, Fei SS, Minnier J, Carbone L, Searles R, Davis BA, Ogle K, Planck SR, Rosenbaum JT, Choi D. RNA-Seq of human whole blood: Evaluation of globin RNA depletion on Ribo-Zero library method. Sci Rep 2020; 10:6271. [PMID: 32286338 PMCID: PMC7156519 DOI: 10.1038/s41598-020-62801-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/18/2020] [Indexed: 11/11/2022] Open
Abstract
Peripheral blood is a highly accessible biofluid providing a rich source of information about human physiology and health status. However, for studies of the blood transcriptome with RNA sequencing (RNA-Seq) techniques, high levels of hemoglobin mRNAs (hgbRNA) present in blood can occupy valuable sequencing space, impacting detection and quantification of non-hgbRNAs. In this study, we evaluated two methods for preparing ribosomal RNA (rRNA)-depleted sequencing libraries for RNA-Seq of whole blood, one of which is also designed to deplete hgbRNAs. Two experiments were performed: one evaluating library performance across 6 human blood samples and the other examining library reproducibility and performance in a two-subject subset. We find that addition of hgbRNA depletion to the rRNA-depletion protocol for library preparation from blood RNA effectively reduces highly abundant hgbRNA reads; however, it does not result in a statistically significant increase in differentially expressed genes in our patient-control study. Bioinformatic removal of globin gene counts in non-hgbRNA depleted libraries provides improvement in overall performance of these libraries. We conclude that use of a standard ribosomal RNA depletion method for library preparation coupled with bioinformatic removal of globin gene counts is sufficient for reproducible and sensitive measurement of both coding and noncoding RNAs in the blood transcriptome.
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Affiliation(s)
- Christina A Harrington
- Integrated Genomics Laboratory, Oregon Health & Science University, Portland, Oregon, USA. .,Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA.
| | - Suzanne S Fei
- Bioinformatics & Biostatistics Core, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA
| | - Jessica Minnier
- Integrated Genomics Laboratory, Oregon Health & Science University, Portland, Oregon, USA.,OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Lucia Carbone
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, Oregon, USA.,Bioinformatics & Biostatistics Core, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA.,Knight Cardiovascular Institute, Oregon Health & Science University Portland, Oregon, USA.,3181 Sam Jackson Park Rd, Oregon Health & Science University, Portland, Oregon, United States
| | - Robert Searles
- Integrated Genomics Laboratory, Oregon Health & Science University, Portland, Oregon, USA.,3181 Sam Jackson Park Rd, Oregon Health & Science University, Portland, Oregon, United States
| | - Brett A Davis
- Bioinformatics & Biostatistics Core, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon, USA.,Knight Cardiovascular Institute, Oregon Health & Science University Portland, Oregon, USA
| | - Kimberly Ogle
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephen R Planck
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.,Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.,Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Legacy Devers Eye Institute, Legacy Health System, Portland, Oregon, USA
| | - Dongseok Choi
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.,Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Graduate School of Dentistry, Kyung Hee University, Seoul, Korea
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45
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Rosenbaum JT, Karstens L. Bugs, Drugs, and Shrugs. Arthritis Rheumatol 2020; 72:515-517. [PMID: 31736274 PMCID: PMC7113093 DOI: 10.1002/art.41166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/07/2019] [Indexed: 11/09/2022]
Affiliation(s)
- James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland
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46
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Burmester GR, Gordon KB, Rosenbaum JT, Arikan D, Lau WL, Li P, Faccin F, Panaccione R. Long-Term Safety of Adalimumab in 29,967 Adult Patients From Global Clinical Trials Across Multiple Indications: An Updated Analysis. Adv Ther 2020; 37:364-380. [PMID: 31748904 PMCID: PMC6979455 DOI: 10.1007/s12325-019-01145-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The safety profile of adalimumab was previously reported in 23,458 patients across multiple indications. Here we report the long-term safety of adalimumab in adults with plaque psoriasis (Ps), hidradenitis suppurativa (HS), rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, non-radiographic axial spondyloarthritis, peripheral spondyloarthritis, Crohn's disease (CD), ulcerative colitis (UC), and non-infectious uveitis (UV). METHODS Safety data from 77 clinical trials were pooled. Safety assessments included adverse events (AEs) and serious AEs (SAEs) that occurred after the first study dose and within 70 days (5 half-lives) after the last study dose. RESULTS A total of 29,967 patients were included, representing 56,916 patient-years (PY) of exposure. The most frequently reported SAE of interest was infection (3.7/100 PY) with highest incidences in CD, RA, UV, and UC (3.5/100 PY-6.9/100 PY); serious infections in Ps (1.8/100 PY) and HS (2.8/100 PY) were lower. The observed number of deaths was below what would be expected in an age- and sex-adjusted population for most adalimumab-treated patients (including Ps). Lack of real-life data and limited long-term data (> 5 years) for most patients are limitations of this analysis. CONCLUSION The safety profile of adalimumab was consistent with previous findings and no new safety signals were observed.
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Affiliation(s)
| | | | - James T Rosenbaum
- Oregon Health and Science University and Legacy Devers Eye Institute, Portland, OR, USA
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47
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Pistilli M, Joffe MM, Gangaputra SS, Pujari SS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Begum H, Fitzgerald TD, Dreger KA, Altaweel MM, Holbrook JT, Kempen JH. Visual Acuity Outcome over Time in Non-Infectious Uveitis. Ocul Immunol Inflamm 2019; 29:1064-1071. [PMID: 31821051 DOI: 10.1080/09273948.2019.1687733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: We evaluated visual acuity (VA) over 5 years in a subspecialty noninfectious uveitis population.Methods: Retrospective data from 5,530 noninfectious uveitis patients with anterior, intermediate, posterior or panuveitis were abstracted by expert reviewers. Mean VA was calculated using inverse probability of censoring weighting to account for losses to follow-up.Results: Patients were a median of 41 years old, 65% female, and 73% white. Initial mean VA was worse among panuveitis (20/84) than posterior (20/64), intermediate (20/47), and anterior (20/37) uveitides. On average, mean VA improved by 0.62, 0.51, 0.37, and 0.26 logMAR-equivalent lines over 2 years, respectively (each P < .001), then remained stable, except posterior uveitis mean VA worsened to initial levels.Conclusion: Mean VA of uveitic eyes improved and, typically, improvement was sustained under uveitis subspecialty care. Because VA tends to improve under tertiary care, mean VA change appears a better outcome for clinical studies than time-to-loss of VA.
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Affiliation(s)
- Maxwell Pistilli
- The Scheie Eye Institute, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,The Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Marshall M Joffe
- The Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Sapna S Gangaputra
- Department of Ophthalmology and Vision Sciences, Vanderbilt Eye Institute, Nashville, TN, USA
| | | | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Departments of Ophthalmology and Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Laboratory of Immunology, National Eye Institute, Bethesda, MD, USA
| | - Grace A Levy-Clarke
- Tampa Bay Uveitis Center, Tampa, FL, USA.,Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA
| | | | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, Bethesda, MD, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA.,Ophthalmology Service, Portland Veteran's Affairs Medical Center, Portland, OR, USA
| | - Jennifer E Thorne
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nirali P Bhatt
- The Scheie Eye Institute, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Hosne Begum
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tonetta D Fitzgerald
- The Scheie Eye Institute, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Kurt A Dreger
- The Scheie Eye Institute, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael M Altaweel
- The Fundus Photograph Reading Center, University of Wisconsin School of Medicine, Madison, WI, USA.,Department of Ophthalmology and Vision Sciences, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Janet T Holbrook
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Clinical Trials and Synthesis, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,MCM Eye Unit, MCM General Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
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Rosenbaum JT, Bodaghi B, Couto C, Zierhut M, Acharya N, Pavesio C, Tay-Kearney ML, Neri P, Douglas K, Pathai S, Song AP, Kron M, Foster CS. New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Semin Arthritis Rheum 2019; 49:438-445. [DOI: 10.1016/j.semarthrit.2019.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 04/18/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
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Gangaputra SS, Newcomb CW, Joffe MM, Dreger K, Begum H, Artornsombudh P, Pujari SS, Daniel E, Sen HN, Suhler EB, Thorne JE, Bhatt NP, Foster CS, Jabs DA, Nussenblatt RB, Rosenbaum JT, Levy-Clarke GA, Kempen JH. Comparison Between Methotrexate and Mycophenolate Mofetil Monotherapy for the Control of Noninfectious Ocular Inflammatory Diseases. Am J Ophthalmol 2019; 208:68-75. [PMID: 31344346 DOI: 10.1016/j.ajo.2019.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/13/2019] [Accepted: 07/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare mycophenolate mofetil (MMF) to methotrexate (MTX) as corticosteroid-sparing therapy for ocular inflammatory diseases. DESIGN Retrospective analysis of cohort study data. METHODS Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained via medical record review. The study included 352 patients who were taking single-agent immunosuppression with MTX or MMF at 4 tertiary uveitis clinics. Marginal structural models (MSM)-derived statistical weighting created a virtual population with covariates and censoring patterns balanced across alternative treatments. With this methodological approach, the results estimate what would have happened had none of the patients stopped their treatment. Survival analysis with stabilized MSM-derived weights simulated a clinical trial comparing MMF vs MTX for noninfectious inflammatory eye disorders. The primary outcome was complete control of inflammation on prednisone ≤10 mg/day, sustained for ≥30 days. RESULTS The time to success was shorter (more favorable) for MMF than MTX (hazard ratio = 0.68, 95% confidence interval: 0.46-0.99). Adjusting for covariates, the proportion achieving success was higher at every point in time for MMF than MTX from 2 to 8 months, then converges at 9 months. The onset of corticosteroid-sparing success took more than 3 months for most patients in both groups. Outcomes of treatment (MMF vs MTX) were similar across all anatomic sites of inflammation. The incidence of stopping therapy for toxicity was similar in both groups. CONCLUSIONS Our results suggest that, on average, MMF may be faster than MTX in achieving corticosteroid-sparing success in ocular inflammatory diseases.
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Affiliation(s)
- Sapna S Gangaputra
- Vanderbilt Eye Institute, Nashville, Tennessee, USA; Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Craig W Newcomb
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marshall M Joffe
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kurt Dreger
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hosne Begum
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Pichaporn Artornsombudh
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Department of Ophthalmology, Somdech Phra Pinkloa Hospital, Royal Thai Navy, Bangkok, Thailand; Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | - Siddharth S Pujari
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Siddharth Netralaya, Belgaum, Karnataka, India
| | - Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA; Portland Veteran's Affairs Medical Center, Portland, Oregon, USA
| | - Jennifer E Thorne
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nirali P Bhatt
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA; Departments of Ophthalmology and Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA; Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA; Legacy Devers Eye Institute, Portland, Oregon, USA
| | | | - John H Kempen
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA; MCM Eye Unit/Ophthalmology, MyungSung Christian Medical Center and MyungSung Medical School, Addis Ababa, Ethiopia
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Abstract
Acute anterior uveitis is the most common extra-articular clinical manifestation of spondyloarthropathy. Rheumatologists should be aware of uveitis, know how it presents, understand the differential diagnosis of uveitis and arthritis, and be familiar with the role of systemic medications in the treatment or prevention of uveitis.
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Affiliation(s)
- James T Rosenbaum
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States; Legacy Devers Eye Institute, Suite 200, Portland, OR 97210, United States.
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