Uveitis overview: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Uveitis}} | {{Uveitis}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{TarekNafee}} | ||
== Overview == | == Overview == | ||
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== Historical Perspective == | == Historical Perspective == | ||
== Classification == | == Classification == | ||
Uveitis is best described using various, concurrent classification systems. Uveitis may be classified according to anatomical location into 4 subtypes, depending on which part of the [[uvea]] is primarily affected: [[anterior]], intermediate, [[posterior]], and panuveitis. Based on the duration of [[symptoms]] it may be further sub-classified as [[Acute (medical)|acute]] or [[Chronic (medical)|chronic]]. Upon further investigation, uveitis may be classified according to histological features of the inflammation such as [[granulomatous]] or non-[[granulomatous]]. Additionally, uveitis may be described by the [[laterality]] of the condition (unilateral or bilateral). Finally, uveitis may be classified by general underlying systemic causes such as [[infectious]], [[autoimmune]], [[iatrogenesis|drug-induced]], or [[idiopathic]].<ref name="pmid18379933">{{cite journal| author=Deschenes J, Murray PI, Rao NA, Nussenblatt RB, International Uveitis Study Group| title=International Uveitis Study Group (IUSG): clinical classification of uveitis. | journal=Ocul Immunol Inflamm | year= 2008 | volume= 16 | issue= 1 | pages= 1-2 | pmid=18379933 | doi=10.1080/09273940801899822 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18379933 }} </ref><ref name="pmid16196117">{{cite journal| author=Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group| title=Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. | journal=Am J Ophthalmol | year= 2005 | volume= 140 | issue= 3 | pages= 509-16 | pmid=16196117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16196117 }} </ref><ref name="pmid10688564">{{cite journal| author=McCluskey PJ, Towler HM, Lightman S| title=Management of chronic uveitis. | journal=BMJ | year= 2000 | volume= 320 | issue= 7234 | pages= 555-8 | pmid=10688564 | doi= | pmc=1117601 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10688564 }} </ref><ref name="pmid17311570">{{cite journal| author=Gutteridge IF, Hall AJ| title=Acute anterior uveitis in primary care. | journal=Clin Exp Optom | year= 2007 | volume= 90 | issue= 2 | pages= 70-82 | pmid=17311570 | doi=10.1111/j.1444-0938.2006.00128.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17311570 }} </ref><ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue= | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722 }} </ref> | |||
== Pathophysiology == | == Pathophysiology == | ||
The exact pathogenesis of uveitis is not fully understood. It is thought that uveitis is mediated by a genetic predisposition and an acquired cross immunity to infectious agents, or cross immunity to self-[[antigens]] due to underlying [[autoimmune]] diseases. It is estimated that 35% to 50% of cases of uveitis are [[idiopathic]].<ref name="pmid8619771">{{cite journal| author=Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ et al.| title=Referral patterns of uveitis in a tertiary eye care center. | journal=Arch Ophthalmol | year= 1996 | volume= 114 | issue= 5 | pages= 593-9 | pmid=8619771 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8619771 }} </ref><ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue= | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722 }} </ref> Development of uveitis is hypothesized to be the result of a genetic predisposition for acquiring the disease; contributions of several [[human leukocyte antigen|human leukocyte antigen (HLA)]] alleles are most commonly implicated.<ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue= | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722 }} </ref><ref name="pmid26438050">{{cite journal| author=Przeździecka-Dołyk J, Węgrzyn A, Turno-Kręcicka A, Misiuk-Hojło M| title=Immunopathogenic Background of Pars Planitis. | journal=Arch Immunol Ther Exp (Warsz) | year= 2016 | volume= 64 | issue= 2 | pages= 127-37 | pmid=26438050 | doi=10.1007/s00005-015-0361-y | pmc=4805694 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26438050 }} </ref> | |||
== Causes == | == Causes == | ||
Common causes of uveitis include [[seronegative spondyloarthropathy]], [[sarcoidosis]], [[juvenile idiopathic arthritis]], [[systemic lupus erythematosus]], [[Behçet syndrome]], [[multiple sclerosis]] [[AIDS]], [[syphilis]], and [[tuberculosis]].<ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue= | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722 }} </ref><ref name="pmid8619771">{{cite journal| author=Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ et al.| title=Referral patterns of uveitis in a tertiary eye care center. | journal=Arch Ophthalmol | year= 1996 | volume= 114 | issue= 5 | pages= 593-9 | pmid=8619771 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8619771 }} </ref> | |||
== Differentiating Uveitis from Other Diseases == | == Differentiating Uveitis from Other Diseases == | ||
Uveitis must be differentiated from other diseases that cause [[conjunctival injection]], [[eye pain]], [[photophobia]], or [[visual disturbance]]. Masquerade syndromes, which are ophthalmic disorders that clinically present as either an anterior or posterior uveitis but are not primarily inflammatory, must be differentiated from uveitis. As uveitis manifests in a variety of clinical etiologies, differentiation must also be established in accordance with the particular subtype.<ref name="pmid26187650">{{cite journal| author=Prior-Español Á, Martínez-Morillo M, Holgado-Pérez S, Juega FJ| title=Differential diagnosis of acute bilateral uveitis in the rheumatologist's office. | journal=Reumatol Clin | year= 2016 | volume= 12 | issue= 3 | pages= 174-175 | pmid=26187650 | doi=10.1016/j.reuma.2015.05.012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26187650 }} </ref><ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue= | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722 }} </ref><ref name=eyewikiuveitis>American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Category:Uveitis</ref><ref name="pmid11158819">{{cite journal| author=Rothova A, Ooijman F, Kerkhoff F, Van Der Lelij A, Lokhorst HM| title=Uveitis masquerade syndromes. | journal=Ophthalmology | year= 2001 | volume= 108 | issue= 2 | pages= 386-99 | pmid=11158819 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11158819 }} </ref> | |||
== Epidemiology and Demographics == | == Epidemiology and Demographics == | ||
Worldwide, the [[prevalence]] of uveitis ranges from 69 to 204 per 100,000 persons. The [[prevalence]] among different subtypes of uveitis varies greatly. [[Anterior]], [[Chronic (medical)|chronic]], non-[[granulomatous]] and non-[[infectious]] subtypes are more commonly seen than others. The worldwide [[incidence]] of uveitis ranges from 17 to 52 per 100,000 persons per year. The age, sex, and race distribution is also dictated by the [[prevalence]] of the underlying cause within those demographic groups.<ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue= | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722 }} </ref><ref name="pmid17311570">{{cite journal| author=Gutteridge IF, Hall AJ| title=Acute anterior uveitis in primary care. | journal=Clin Exp Optom | year= 2007 | volume= 90 | issue= 2 | pages= 70-82 | pmid=17311570 | doi=10.1111/j.1444-0938.2006.00128.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17311570 }} </ref><ref name="pmid8619771">{{cite journal| author=Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ et al.| title=Referral patterns of uveitis in a tertiary eye care center. | journal=Arch Ophthalmol | year= 1996 | volume= 114 | issue= 5 | pages= 593-9 | pmid=8619771 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8619771 }} </ref> | |||
== Risk Factors == | == Risk Factors == | ||
There are no established risk factors for most etiologies of uveitis. Some underlying causes have potent risk factors for developing uveitis such as [[seronegative spondyloarthropathies]], [[immunosuppression]], [[sarcoidosis]], and [[juvenile idiopathic arthritis]].<ref name=eyewikiuveitis>American Academy of Ophthalmology EyeWiki (2015-2016)http://eyewiki.aao.org/Category:Uveitis</ref> | |||
== Screening == | == Screening == | ||
There is insufficient evidence to recommend routine screening for uveitis for the general population. For patients diagnosed with or suspected of having [[juvenile idiopathic arthritis|juvenile idiopathic arthritis (JIA)]], screening guidelines have been recommended by the American Academy of Pediatrics (AAP) and the British Society of Paediatrics and Rheumatology (BSPAR).<ref name="pmid25825278">{{cite journal| author=Sen ES, Dick AD, Ramanan AV| title=Uveitis associated with juvenile idiopathic arthritis. | journal=Nat Rev Rheumatol | year= 2015 | volume= 11 | issue= 6 | pages= 338-48 | pmid=25825278 | doi=10.1038/nrrheum.2015.20 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25825278 }} </ref><ref name="pmid16651348">{{cite journal| author=Cassidy J, Kivlin J, Lindsley C, Nocton J, Section on Rheumatology. Section on Ophthalmology| title=Ophthalmologic examinations in children with juvenile rheumatoid arthritis. | journal=Pediatrics | year= 2006 | volume= 117 | issue= 5 | pages= 1843-5 | pmid=16651348 | doi=10.1542/peds.2006-0421 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16651348 }} </ref> | |||
== Natural History, Complications and Prognosis == | == Natural History, Complications and Prognosis == | ||
If left untreated, uveitis can progress to permanent [[vision loss]]. Complications of uveitis include [[cataracts]], [[glaucoma]], [[macular edema]], and [[retinal detachment]]. With appropriate treatment, most attacks of anterior uveitis resolve within days to weeks, however, relapses are common. Inflammation related to posterior uveitis may last from months to years and may cause permanent vision damage, even with treatment. <ref name=medlineuveitis> MedlinePlus Medical Encyclopedia Uveitis(2014)https://medlineplus.gov/ency/article/001005.htm</ref><ref name=patientuveitis>Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet</ref><ref name="pmid10688564">{{cite journal| author=McCluskey PJ, Towler HM, Lightman S| title=Management of chronic uveitis. | journal=BMJ | year= 2000 | volume= 320 | issue= 7234 | pages= 555-8 | pmid=10688564 | doi= | pmc=1117601 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10688564 }} </ref><ref name="pmid8703885">{{cite journal| author=Rothova A, Suttorp-van Schulten MS, Frits Treffers W, Kijlstra A| title=Causes and frequency of blindness in patients with intraocular inflammatory disease. | journal=Br J Ophthalmol | year= 1996 | volume= 80 | issue= 4 | pages= 332-6 | pmid=8703885 | doi= | pmc=505460 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8703885 }} </ref><ref name="pmid2249907">{{cite journal| author=Nussenblatt RB| title=The natural history of uveitis. | journal=Int Ophthalmol | year= 1990 | volume= 14 | issue= 5-6 | pages= 303-8 | pmid=2249907 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2249907 }} </ref> | |||
== Diagnosis == | == Diagnosis == | ||
=== History and Symptoms === | === History and Symptoms === | ||
Obtaining a complete history is an important aspect of making a diagnosis of uveitis. It provides insight into cause, precipitating factors, and associated underlying conditions. Uveitis can present unilaterally or bilaterally. Symptoms may develop [[Acute (medicine)|acutely]] or insidiously, and may vary depending on the underlying [[etiology]] of the uveitis. [[Acute (medicine)|Acute]] uveitis attacks are more commonly symptomatic and affect the [[anterior]] chamber. Symptoms of [[anterior]] uveitis include eye pain, [[eye redness]], and [[photophobia]]. [[Intermediate uveitis|Intermediate]], posterior, and panuveitis commonly present with [[floaters]], [[blurry vision]], and impaired vision. [[Chronic (medical)|Chronic]] uveitis usually has an indolent courses and may not present with eye pain or redness.<ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue= | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722 }} </ref> | |||
=== Physical Examination === | === Physical Examination === | ||
A complete [[medical history]] and comprehensive [[eye examination]] must be performed by an [[optometrist]] or [[ophthalmologist]] to properly diagnosis uveitis. Eye examination of patients with uveitis is usually remarkable for [[eye redness]] and increased or decreased [[intraocular pressure]]. Depending on the affected anatomy of the uvea, "snowbanking" or optic disc edema may be seen on [[dilated fundus exam]], and mutton fat keratic precipitates on [[slit lamp test]] may also be appreciated.<ref name=patientinfouveitis>Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet</ref><ref name=>{{Citation | |||
| last1 = Wyngaarden | first1 = James B. | |||
| last2 = Smith Jr. | first2 = Lloyd H. | |||
| title = [[Cecil Textbook Of Medicine]] | |||
| place = Philadelphia, PA | |||
| publisher = W.B. Saunders Company | |||
|pages = 2293-2294 | |||
| date = 1988 | |||
| isbn = 0-7216-1850-2 }}</ref> A complete physical examination can provide insight into the cause, and associated underlying conditions. | |||
=== Laboratory Findings === | === Laboratory Findings === | ||
There are no diagnostic lab findings associated with uveitis. The presence of certain non-specific laboratory findings, in the presence of uveitis, may be suggestive of certain underlying causes.<ref name="pmid23803478">{{cite journal| author=Majumder PD, Sudharshan S, Biswas J| title=Laboratory support in the diagnosis of uveitis. | journal=Indian J Ophthalmol | year= 2013 | volume= 61 | issue= 6 | pages= 269-76 | pmid=23803478 | doi=10.4103/0301-4738.114095 | pmc=3744779 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23803478 }} </ref><ref name="pmid20029142">{{cite journal| author=Agrawal RV, Murthy S, Sangwan V, Biswas J| title=Current approach in diagnosis and management of anterior uveitis. | journal=Indian J Ophthalmol | year= 2010 | volume= 58 | issue= 1 | pages= 11-9 | pmid=20029142 | doi=10.4103/0301-4738.58468 | pmc=2841369 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20029142 }} </ref><ref name="pmid23803476">{{cite journal| author=Rathinam SR, Babu M| title=Algorithmic approach in the diagnosis of uveitis. | journal=Indian J Ophthalmol | year= 2013 | volume= 61 | issue= 6 | pages= 255-62 | pmid=23803476 | doi=10.4103/0301-4738.114092 | pmc=3744777 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23803476 }} </ref><ref name="pmid20404984">{{cite journal| author=Herbort CP| title=Appraisal, work-up and diagnosis of anterior uveitis: a practical approach. | journal=Middle East Afr J Ophthalmol | year= 2009 | volume= 16 | issue= 4 | pages= 159-67 | pmid=20404984 | doi=10.4103/0974-9233.58416 | pmc=2855658 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404984 }} </ref><ref name="pmid2178095">{{cite journal| author=Kijlstra A| title=The value of laboratory testing in uveitis. | journal=Eye (Lond) | year= 1990 | volume= 4 ( Pt 5) | issue= | pages= 732-6 | pmid=2178095 | doi=10.1038/eye.1990.104 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2178095 }} </ref> | |||
=== X Ray === | === X Ray === | ||
There are no diagnostic x ray findings associated with uveitis. Positive x ray findings may be found in underlying conditions such as [[sarcoidosis]]<ref name="pmid7761646">{{cite journal| author=Miller BH, Rosado-de-Christenson ML, McAdams HP, Fishback NF| title=Thoracic sarcoidosis: radiologic-pathologic correlation. | journal=Radiographics | year= 1995 | volume= 15 | issue= 2 | pages= 421-37 | pmid=7761646 | doi=10.1148/radiographics.15.2.7761646 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7761646 }} </ref>, [[tuberculosis]]<ref name="pmid18716117">{{cite journal| author=Jeong YJ, Lee KS| title=Pulmonary tuberculosis: up-to-date imaging and management. | journal=AJR Am J Roentgenol | year= 2008 | volume= 191 | issue= 3 | pages= 834-44 | pmid=18716117 | doi=10.2214/AJR.07.3896 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18716117 }} </ref>, and [[seronegative spondyloarthropathies]]<ref name="pmid5569434">{{cite journal| author=Riley MJ, Ansell BM, Bywaters EG| title=Radiological manifestations of ankylosing spondylitis according to age at onset. | journal=Ann Rheum Dis | year= 1971 | volume= 30 | issue= 2 | pages= 138-48 | pmid=5569434 | doi= | pmc=1005741 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5569434 }} </ref><ref name="pmid18641245">{{cite journal| author=Jacobson JA, Girish G, Jiang Y, Resnick D| title=Radiographic evaluation of arthritis: inflammatory conditions. | journal=Radiology | year= 2008 | volume= 248 | issue= 2 | pages= 378-89 | pmid=18641245 | doi=10.1148/radiol.2482062110 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18641245 }} </ref>. | |||
=== CT === | === CT === | ||
There are no diagnostic CT scan findings associated with uveitis. The presence of certain CT findings, in the presence of uveitis, may be suggestive of specific underlying causes such as [[inflammatory bowel disease]]<ref name="pmid8659415">{{cite journal| author=Gore RM, Balthazar EJ, Ghahremani GG, Miller FH| title=CT features of ulcerative colitis and Crohn's disease. | journal=AJR Am J Roentgenol | year= 1996 | volume= 167 | issue= 1 | pages= 3-15 | pmid=8659415 | doi=10.2214/ajr.167.1.8659415 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8659415 }} </ref><ref name="pmid15143222">{{cite journal| author=Furukawa A, Saotome T, Yamasaki M, Maeda K, Nitta N, Takahashi M et al.| title=Cross-sectional imaging in Crohn disease. | journal=Radiographics | year= 2004 | volume= 24 | issue= 3 | pages= 689-702 | pmid=15143222 | doi=10.1148/rg.243035120 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15143222 }} </ref><ref name="pmid16702465">{{cite journal| author=Roggeveen MJ, Tismenetsky M, Shapiro R| title=Best cases from the AFIP: Ulcerative colitis. | journal=Radiographics | year= 2006 | volume= 26 | issue= 3 | pages= 947-51 | pmid=16702465 | doi=10.1148/rg.263055149 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16702465 }} </ref>, [[sarcoidosis]]<ref name="pmid14684507">{{cite journal| author=Warshauer DM, Lee JK| title=Imaging manifestations of abdominal sarcoidosis. | journal=AJR Am J Roentgenol | year= 2004 | volume= 182 | issue= 1 | pages= 15-28 | pmid=14684507 | doi=10.2214/ajr.182.1.1820015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14684507 }} </ref><ref name="pmid12034602">{{cite journal| author=Nakatsu M, Hatabu H, Morikawa K, Uematsu H, Ohno Y, Nishimura K et al.| title=Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign. | journal=AJR Am J Roentgenol | year= 2002 | volume= 178 | issue= 6 | pages= 1389-93 | pmid=12034602 | doi=10.2214/ajr.178.6.1781389 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12034602 }} </ref>, and [[Behcet's disease]]<ref name="pmid7997553">{{cite journal| author=Ahn JM, Im JG, Ryoo JW, Kim SJ, Do YS, Choi YW et al.| title=Thoracic manifestations of Behçet syndrome: radiographic and CT findings in nine patients. | journal=Radiology | year= 1995 | volume= 194 | issue= 1 | pages= 199-203 | pmid=7997553 | doi=10.1148/radiology.194.1.7997553 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7997553 }} </ref><ref name="pmid17024317">{{cite journal| author=Emad Y, Abdel-Razek N, Gheita T, el-Wakd M, el-Gohary T, Samadoni A| title=Multislice CT pulmonary findings in Behçet's disease (report of 16 cases). | journal=Clin Rheumatol | year= 2007 | volume= 26 | issue= 6 | pages= 879-84 | pmid=17024317 | doi=10.1007/s10067-006-0408-x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17024317 }} </ref>. | |||
=== MRI === | === MRI === | ||
There are no diagnostic MRI findings associated with uveitis. The presence of certain MRI findings, in the presence of uveitis, may be suggestive of specific underlying causes such as [[sarcoidosis]], [[multiple sclerosis]], [[Behcet's disease]], [[syphilis]], and joint abnormalities in [[seronegative spondyloarthropathies]].<ref name="pmid14736648">{{cite journal| author=Smith JK, Matheus MG, Castillo M| title=Imaging manifestations of neurosarcoidosis. | journal=AJR Am J Roentgenol | year= 2004 | volume= 182 | issue= 2 | pages= 289-95 | pmid=14736648 | doi=10.2214/ajr.182.2.1820289 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14736648 }} </ref><ref name="pmid20019103">{{cite journal| author=Lövblad KO, Anzalone N, Dörfler A, Essig M, Hurwitz B, Kappos L et al.| title=MR imaging in multiple sclerosis: review and recommendations for current practice. | journal=AJNR Am J Neuroradiol | year= 2010 | volume= 31 | issue= 6 | pages= 983-9 | pmid=20019103 | doi=10.3174/ajnr.A1906 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20019103 }} </ref><ref name="pmid21257930">{{cite journal| author=Hegde AN, Mohan S, Lath N, Lim CC| title=Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. | journal=Radiographics | year= 2011 | volume= 31 | issue= 1 | pages= 5-30 | pmid=21257930 | doi=10.1148/rg.311105041 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21257930 }} </ref><ref name="pmid22330117">{{cite journal| author=Pandey S| title=Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis. | journal=J Spinal Cord Med | year= 2011 | volume= 34 | issue= 6 | pages= 609-11 | pmid=22330117 | doi=10.1179/2045772311Y.0000000041 | pmc=3237288 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22330117 }} </ref><ref name="pmid18641245">{{cite journal| author=Jacobson JA, Girish G, Jiang Y, Resnick D| title=Radiographic evaluation of arthritis: inflammatory conditions. | journal=Radiology | year= 2008 | volume= 248 | issue= 2 | pages= 378-89 | pmid=18641245 | doi=10.1148/radiol.2482062110 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18641245 }} </ref> | |||
=== Ultrasound === | === Ultrasound === | ||
There are no diagnostic ultrasound findings associated with uveitis. | |||
=== Other Imaging Findings === | === Other Imaging Findings === | ||
There are no other diagnostic imaging findings associated with uveitis. | |||
=== Other Diagnostic Studies === | === Other Diagnostic Studies === | ||
Other diagnostic studies associated with uveitis include [[slit lamp test]] and ocular [[tonometry]]. The [[slit lamp test]] is considered a gold standard modality in diagnosing uveitis. While intraocular pressure may increase or decrease depending on the anatomical location and severity of the inflammation, [[slit lamp test]] findings are relatively more consistent. Common [[slit lamp test]] findings include presence of inflammatory cells in the anterior chamber, keratic precipitates, and mutton fat precipitates. [[Slit lamp test]] findings associated with anatomical location include snowbanking in intermediate uveitis (e.g., pars planitis), snowballing in vitritis, and retinal edema in posterior uveitis.<ref name="pmid20943722">{{cite journal| author=Guly CM, Forrester JV| title=Investigation and management of uveitis. | journal=BMJ | year= 2010 | volume= 341 | issue= | pages= c4976 | pmid=20943722 | doi=10.1136/bmj.c4976 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20943722 }} </ref><ref name=neigov>National Eye Institute (2016) https://nei.nih.gov/health/uveitis/uveitis </ref> | |||
== Treatment == | == Treatment == | ||
=== Medical Therapy === | === Medical Therapy === | ||
The mainstay of therapy for uveitis is steroids, either as topical eye drops or oral therapy with [[Prednisolone]]. [[Acyclovir]] is the drug of choice for empiric therapy in anterior uveitis. The treatment for intermediate and posterior uveitis generally depends on the underlying disease.<ref name=uveitisbook>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 978-0-443-06839-3 | pages = }}</ref> | |||
=== Surgery === | === Surgery === | ||
There is no indication for surgical intervention in uveitis. Surgical management of uveitis is most commonly reserved for management of complications of uveitis or, rarely, for diagnostic purposes. Common complications of uveitis requiring surgery include [[cataract surgery]], [[glaucoma surgery]], or [[band keratopathy]]. Common indications for the diagnostic utility of surgery in uveitis include [[vitreous]] tap, [[vitreous]] biopsy, and posterior uveal biopsy.<ref name="pmid: PMC3744781">{{cite journal| author=Katzav S, Shapiro J, Segal S, yM| title=General nesthesia during excision of a mouse tumor accelerates postsurgical growth of metastases by suppression of natural killer cell activity. | journal=Isr J Med Sci | year= 1986 | volume= 22 | issue= 5 | pages= 339-45 | pmid=: PMC3744781 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pu bmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3744781 }} </ref> | |||
=== Primary Prevention === | === Primary Prevention === | ||
Appropriate treatment of an underlying disorder may help to prevent uveitis in persons with a systemic infection or inflammatory disease. | |||
=== Secondary Prevention === | === Secondary Prevention === | ||
There are no secondary prevention methods associated with uveitis. | |||
== References == | == References == | ||
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Revision as of 18:51, 11 August 2016
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Uveitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Uveitis overview On the Web |
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American Roentgen Ray Society Images of Uveitis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Overview
Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye. The uvea consists of the iris, ciliary body, and choroid, and it provides most of the blood supply to the retina. Uveitis may occur in either eye or both eyes. Uveitis is estimated to be responsible for approximately 10% of the blindness in the United States.
Historical Perspective
Classification
Uveitis is best described using various, concurrent classification systems. Uveitis may be classified according to anatomical location into 4 subtypes, depending on which part of the uvea is primarily affected: anterior, intermediate, posterior, and panuveitis. Based on the duration of symptoms it may be further sub-classified as acute or chronic. Upon further investigation, uveitis may be classified according to histological features of the inflammation such as granulomatous or non-granulomatous. Additionally, uveitis may be described by the laterality of the condition (unilateral or bilateral). Finally, uveitis may be classified by general underlying systemic causes such as infectious, autoimmune, drug-induced, or idiopathic.[1][2][3][4][5]
Pathophysiology
The exact pathogenesis of uveitis is not fully understood. It is thought that uveitis is mediated by a genetic predisposition and an acquired cross immunity to infectious agents, or cross immunity to self-antigens due to underlying autoimmune diseases. It is estimated that 35% to 50% of cases of uveitis are idiopathic.[6][5] Development of uveitis is hypothesized to be the result of a genetic predisposition for acquiring the disease; contributions of several human leukocyte antigen (HLA) alleles are most commonly implicated.[5][7]
Causes
Common causes of uveitis include seronegative spondyloarthropathy, sarcoidosis, juvenile idiopathic arthritis, systemic lupus erythematosus, Behçet syndrome, multiple sclerosis AIDS, syphilis, and tuberculosis.[5][6]
Differentiating Uveitis from Other Diseases
Uveitis must be differentiated from other diseases that cause conjunctival injection, eye pain, photophobia, or visual disturbance. Masquerade syndromes, which are ophthalmic disorders that clinically present as either an anterior or posterior uveitis but are not primarily inflammatory, must be differentiated from uveitis. As uveitis manifests in a variety of clinical etiologies, differentiation must also be established in accordance with the particular subtype.[8][5][9][10]
Epidemiology and Demographics
Worldwide, the prevalence of uveitis ranges from 69 to 204 per 100,000 persons. The prevalence among different subtypes of uveitis varies greatly. Anterior, chronic, non-granulomatous and non-infectious subtypes are more commonly seen than others. The worldwide incidence of uveitis ranges from 17 to 52 per 100,000 persons per year. The age, sex, and race distribution is also dictated by the prevalence of the underlying cause within those demographic groups.[5][4][6]
Risk Factors
There are no established risk factors for most etiologies of uveitis. Some underlying causes have potent risk factors for developing uveitis such as seronegative spondyloarthropathies, immunosuppression, sarcoidosis, and juvenile idiopathic arthritis.[9]
Screening
There is insufficient evidence to recommend routine screening for uveitis for the general population. For patients diagnosed with or suspected of having juvenile idiopathic arthritis (JIA), screening guidelines have been recommended by the American Academy of Pediatrics (AAP) and the British Society of Paediatrics and Rheumatology (BSPAR).[11][12]
Natural History, Complications and Prognosis
If left untreated, uveitis can progress to permanent vision loss. Complications of uveitis include cataracts, glaucoma, macular edema, and retinal detachment. With appropriate treatment, most attacks of anterior uveitis resolve within days to weeks, however, relapses are common. Inflammation related to posterior uveitis may last from months to years and may cause permanent vision damage, even with treatment. [13][14][3][15][16]
Diagnosis
History and Symptoms
Obtaining a complete history is an important aspect of making a diagnosis of uveitis. It provides insight into cause, precipitating factors, and associated underlying conditions. Uveitis can present unilaterally or bilaterally. Symptoms may develop acutely or insidiously, and may vary depending on the underlying etiology of the uveitis. Acute uveitis attacks are more commonly symptomatic and affect the anterior chamber. Symptoms of anterior uveitis include eye pain, eye redness, and photophobia. Intermediate, posterior, and panuveitis commonly present with floaters, blurry vision, and impaired vision. Chronic uveitis usually has an indolent courses and may not present with eye pain or redness.[5]
Physical Examination
A complete medical history and comprehensive eye examination must be performed by an optometrist or ophthalmologist to properly diagnosis uveitis. Eye examination of patients with uveitis is usually remarkable for eye redness and increased or decreased intraocular pressure. Depending on the affected anatomy of the uvea, "snowbanking" or optic disc edema may be seen on dilated fundus exam, and mutton fat keratic precipitates on slit lamp test may also be appreciated.[17][18] A complete physical examination can provide insight into the cause, and associated underlying conditions.
Laboratory Findings
There are no diagnostic lab findings associated with uveitis. The presence of certain non-specific laboratory findings, in the presence of uveitis, may be suggestive of certain underlying causes.[19][20][21][22][23]
X Ray
There are no diagnostic x ray findings associated with uveitis. Positive x ray findings may be found in underlying conditions such as sarcoidosis[24], tuberculosis[25], and seronegative spondyloarthropathies[26][27].
CT
There are no diagnostic CT scan findings associated with uveitis. The presence of certain CT findings, in the presence of uveitis, may be suggestive of specific underlying causes such as inflammatory bowel disease[28][29][30], sarcoidosis[31][32], and Behcet's disease[33][34].
MRI
There are no diagnostic MRI findings associated with uveitis. The presence of certain MRI findings, in the presence of uveitis, may be suggestive of specific underlying causes such as sarcoidosis, multiple sclerosis, Behcet's disease, syphilis, and joint abnormalities in seronegative spondyloarthropathies.[35][36][37][38][27]
Ultrasound
There are no diagnostic ultrasound findings associated with uveitis.
Other Imaging Findings
There are no other diagnostic imaging findings associated with uveitis.
Other Diagnostic Studies
Other diagnostic studies associated with uveitis include slit lamp test and ocular tonometry. The slit lamp test is considered a gold standard modality in diagnosing uveitis. While intraocular pressure may increase or decrease depending on the anatomical location and severity of the inflammation, slit lamp test findings are relatively more consistent. Common slit lamp test findings include presence of inflammatory cells in the anterior chamber, keratic precipitates, and mutton fat precipitates. Slit lamp test findings associated with anatomical location include snowbanking in intermediate uveitis (e.g., pars planitis), snowballing in vitritis, and retinal edema in posterior uveitis.[5][39]
Treatment
Medical Therapy
The mainstay of therapy for uveitis is steroids, either as topical eye drops or oral therapy with Prednisolone. Acyclovir is the drug of choice for empiric therapy in anterior uveitis. The treatment for intermediate and posterior uveitis generally depends on the underlying disease.[40]
Surgery
There is no indication for surgical intervention in uveitis. Surgical management of uveitis is most commonly reserved for management of complications of uveitis or, rarely, for diagnostic purposes. Common complications of uveitis requiring surgery include cataract surgery, glaucoma surgery, or band keratopathy. Common indications for the diagnostic utility of surgery in uveitis include vitreous tap, vitreous biopsy, and posterior uveal biopsy.[41]
Primary Prevention
Appropriate treatment of an underlying disorder may help to prevent uveitis in persons with a systemic infection or inflammatory disease.
Secondary Prevention
There are no secondary prevention methods associated with uveitis.
References
- ↑ Deschenes J, Murray PI, Rao NA, Nussenblatt RB, International Uveitis Study Group (2008). "International Uveitis Study Group (IUSG): clinical classification of uveitis". Ocul Immunol Inflamm. 16 (1): 1–2. doi:10.1080/09273940801899822. PMID 18379933.
- ↑ Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group (2005). "Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop". Am J Ophthalmol. 140 (3): 509–16. PMID 16196117.
- ↑ 3.0 3.1 McCluskey PJ, Towler HM, Lightman S (2000). "Management of chronic uveitis". BMJ. 320 (7234): 555–8. PMC 1117601. PMID 10688564.
- ↑ 4.0 4.1 Gutteridge IF, Hall AJ (2007). "Acute anterior uveitis in primary care". Clin Exp Optom. 90 (2): 70–82. doi:10.1111/j.1444-0938.2006.00128.x. PMID 17311570.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Guly CM, Forrester JV (2010). "Investigation and management of uveitis". BMJ. 341: c4976. doi:10.1136/bmj.c4976. PMID 20943722.
- ↑ 6.0 6.1 6.2 Rodriguez A, Calonge M, Pedroza-Seres M, Akova YA, Messmer EM, D'Amico DJ; et al. (1996). "Referral patterns of uveitis in a tertiary eye care center". Arch Ophthalmol. 114 (5): 593–9. PMID 8619771.
- ↑ Przeździecka-Dołyk J, Węgrzyn A, Turno-Kręcicka A, Misiuk-Hojło M (2016). "Immunopathogenic Background of Pars Planitis". Arch Immunol Ther Exp (Warsz). 64 (2): 127–37. doi:10.1007/s00005-015-0361-y. PMC 4805694. PMID 26438050.
- ↑ Prior-Español Á, Martínez-Morillo M, Holgado-Pérez S, Juega FJ (2016). "Differential diagnosis of acute bilateral uveitis in the rheumatologist's office". Reumatol Clin. 12 (3): 174–175. doi:10.1016/j.reuma.2015.05.012. PMID 26187650.
- ↑ 9.0 9.1 American Academy of Ophthalmology EyeWiki (2015)http://eyewiki.aao.org/Category:Uveitis
- ↑ Rothova A, Ooijman F, Kerkhoff F, Van Der Lelij A, Lokhorst HM (2001). "Uveitis masquerade syndromes". Ophthalmology. 108 (2): 386–99. PMID 11158819.
- ↑ Sen ES, Dick AD, Ramanan AV (2015). "Uveitis associated with juvenile idiopathic arthritis". Nat Rev Rheumatol. 11 (6): 338–48. doi:10.1038/nrrheum.2015.20. PMID 25825278.
- ↑ Cassidy J, Kivlin J, Lindsley C, Nocton J, Section on Rheumatology. Section on Ophthalmology (2006). "Ophthalmologic examinations in children with juvenile rheumatoid arthritis". Pediatrics. 117 (5): 1843–5. doi:10.1542/peds.2006-0421. PMID 16651348.
- ↑ MedlinePlus Medical Encyclopedia Uveitis(2014)https://medlineplus.gov/ency/article/001005.htm
- ↑ Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet
- ↑ Rothova A, Suttorp-van Schulten MS, Frits Treffers W, Kijlstra A (1996). "Causes and frequency of blindness in patients with intraocular inflammatory disease". Br J Ophthalmol. 80 (4): 332–6. PMC 505460. PMID 8703885.
- ↑ Nussenblatt RB (1990). "The natural history of uveitis". Int Ophthalmol. 14 (5–6): 303–8. PMID 2249907.
- ↑ Patient Trusted Medical Information and Support (2016)http://patient.info/health/uveitis-leaflet
- ↑ Wyngaarden, James B.; Smith Jr., Lloyd H. (1988), Cecil Textbook Of Medicine, Philadelphia, PA: W.B. Saunders Company, pp. 2293–2294, ISBN 0-7216-1850-2
- ↑ Majumder PD, Sudharshan S, Biswas J (2013). "Laboratory support in the diagnosis of uveitis". Indian J Ophthalmol. 61 (6): 269–76. doi:10.4103/0301-4738.114095. PMC 3744779. PMID 23803478.
- ↑ Agrawal RV, Murthy S, Sangwan V, Biswas J (2010). "Current approach in diagnosis and management of anterior uveitis". Indian J Ophthalmol. 58 (1): 11–9. doi:10.4103/0301-4738.58468. PMC 2841369. PMID 20029142.
- ↑ Rathinam SR, Babu M (2013). "Algorithmic approach in the diagnosis of uveitis". Indian J Ophthalmol. 61 (6): 255–62. doi:10.4103/0301-4738.114092. PMC 3744777. PMID 23803476.
- ↑ Herbort CP (2009). "Appraisal, work-up and diagnosis of anterior uveitis: a practical approach". Middle East Afr J Ophthalmol. 16 (4): 159–67. doi:10.4103/0974-9233.58416. PMC 2855658. PMID 20404984.
- ↑ Kijlstra A (1990). "The value of laboratory testing in uveitis". Eye (Lond). 4 ( Pt 5): 732–6. doi:10.1038/eye.1990.104. PMID 2178095.
- ↑ Miller BH, Rosado-de-Christenson ML, McAdams HP, Fishback NF (1995). "Thoracic sarcoidosis: radiologic-pathologic correlation". Radiographics. 15 (2): 421–37. doi:10.1148/radiographics.15.2.7761646. PMID 7761646.
- ↑ Jeong YJ, Lee KS (2008). "Pulmonary tuberculosis: up-to-date imaging and management". AJR Am J Roentgenol. 191 (3): 834–44. doi:10.2214/AJR.07.3896. PMID 18716117.
- ↑ Riley MJ, Ansell BM, Bywaters EG (1971). "Radiological manifestations of ankylosing spondylitis according to age at onset". Ann Rheum Dis. 30 (2): 138–48. PMC 1005741. PMID 5569434.
- ↑ 27.0 27.1 Jacobson JA, Girish G, Jiang Y, Resnick D (2008). "Radiographic evaluation of arthritis: inflammatory conditions". Radiology. 248 (2): 378–89. doi:10.1148/radiol.2482062110. PMID 18641245.
- ↑ Gore RM, Balthazar EJ, Ghahremani GG, Miller FH (1996). "CT features of ulcerative colitis and Crohn's disease". AJR Am J Roentgenol. 167 (1): 3–15. doi:10.2214/ajr.167.1.8659415. PMID 8659415.
- ↑ Furukawa A, Saotome T, Yamasaki M, Maeda K, Nitta N, Takahashi M; et al. (2004). "Cross-sectional imaging in Crohn disease". Radiographics. 24 (3): 689–702. doi:10.1148/rg.243035120. PMID 15143222.
- ↑ Roggeveen MJ, Tismenetsky M, Shapiro R (2006). "Best cases from the AFIP: Ulcerative colitis". Radiographics. 26 (3): 947–51. doi:10.1148/rg.263055149. PMID 16702465.
- ↑ Warshauer DM, Lee JK (2004). "Imaging manifestations of abdominal sarcoidosis". AJR Am J Roentgenol. 182 (1): 15–28. doi:10.2214/ajr.182.1.1820015. PMID 14684507.
- ↑ Nakatsu M, Hatabu H, Morikawa K, Uematsu H, Ohno Y, Nishimura K; et al. (2002). "Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign". AJR Am J Roentgenol. 178 (6): 1389–93. doi:10.2214/ajr.178.6.1781389. PMID 12034602.
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- ↑ Pandey S (2011). "Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis". J Spinal Cord Med. 34 (6): 609–11. doi:10.1179/2045772311Y.0000000041. PMC 3237288. PMID 22330117.
- ↑ National Eye Institute (2016) https://nei.nih.gov/health/uveitis/uveitis
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ Katzav S, Shapiro J, Segal S, yM (1986). bmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3744781 "General nesthesia during excision of a mouse tumor accelerates postsurgical growth of metastases by suppression of natural killer cell activity" Check
|url=value (help). Isr J Med Sci. 22 (5): 339–45. PMID PMC3744781 : PMC3744781 Check|pmid=value (help).