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Purpose: Determining uveitis etiology is a challenge. It is based primarily on demographic data and the characteristics of eye examination. It is not clear to what extent extraocular physical signs contribute to elucidating the etiology. This study aimed to establish the contribution of the clinical extra-ophthalmological features for the assessment of the underlying etiology of uveitis., Methods: We retrospectively reviewed 1307 patients with uveitis referred to our tertiary center between 2003 and 2021. Uveitis was classified according to the Standardization of Uveitis Nomenclature. Clinical features were collected at diagnosis by internists before the etiological diagnosis was made. The main outcome description was the contribution of clinical features., Results: Clinical extra-ophthalmological features contributed to the assessment of the underlying etiology of uveitis in 363 (27.8%) patients. The joint and the skin examinations were the most useful for etiological investigations, respectively in 12.3% and 11.8% of patients. Five etiologies of uveitis accounted for 80% of the cases: sarcoidosis, HLA-B27-related uveitis, Behçet's disease, multiple sclerosis, and Vogt-Koyanagi-Harada disease. Clinical extra-ophthalmological features were particularly important in the etiological diagnosis of acute bilateral anterior uveitis and panuveitis., Conclusion: This study suggests that clinical extra-ophthalmological features are essential for the etiological diagnosis of uveitis in more than a quarter of patients. It demonstrates once again the value of collaboration between ophthalmologists and other specialists experienced in performing extra-ophthalmological clinical examinations, particularly in patients with acute bilateral anterior uveitis and panuveitis.

Purpose: The study aims to determine the impact of initial management in Vogt-Koyanagi-Harada syndrome (VKHS)., Methods: Patients diagnosed with a VKHS between January 2001 and December 2020 in two French tertiary centers were included in a retrospective study., Results: Fifty patients were included with a median duration of follow-up of 29.8 months. All patients received oral prednisone after methylprednisolone in all but four of them. Five patients received at least one associated immunosuppressive therapy (IST) within the first 6 months and 26 patients received IST during the entire follow-up period. Twenty-eight patients presented at least one relapse at a median of 5.4 months from diagnosis. Multivariate analyses demonstrated a significant association between relapse and delayed treatment (>26 days) (HR = 3.69, CI95% 1.30-10.47, p = .01), whereas no association was observed between relapse and the number of corticosteroid pulses at initial management., Conclusion: An early corticosteroid treatment within the first 26 days of symptoms decreased the relapse rate.

Background: To evaluate the contribution of chest X-ray and chest CT for the diagnosis of sarcoid uveitis., Methods: Retrospective study on consecutive patients with uveitis of unknown etiology, who underwent both chest X-ray and CT during uveitis diagnosis workup in a tertiary French university hospital., Results: A total of 914 patients were included. Systemic sarcoidosis was identified in 23.1%. The probability of discordance between chest X-ray and CT increased with age at diagnosis ( p  < 0.001). In patients 30 years of age and younger, the probability of discordance was 5% or less, and 0.8% if the ACE level was normal. After 78.3 years of age, the probability of discordance was 20% or more., Conclusion: We recommend not to perform CT in patients under 30 years of age with a normal chest X ray and ACE level, and suggest performing chest CT first in the elderly.

Aim: To report on the prevalence and clinical implications of positive QuantiFERON-TB (QFT) test results in the diagnostic evaluation of a cohort of consecutive sarcoid uveitis patients in France., Design: Retrospective cross-sectional study., Methods: This study included consecutive sarcoid uveitis patients who all underwent QFT testing., Results: A total of 234 patients were included in the study, among them 28 (12%) were QFT-positive. Previously treated tuberculosis (TB) was documented in 2 patients. QFT-positive patients were older (59 ± 16 years vs. 51 ± 18 years, p = .025) and more in proportion to suffer from chronic uveitis and panuveitis compared to QFT-negative patients. Moderate and severe visual impairment were significantly more frequent in the QFT-positive group (35.7% vs. 18.9%, p = .049 and 25.0% vs. 9.2%, p = .022, respectively)., Conclusion: The significant proportion of QFT-positive patients (12%) in this large series of sarcoid uveitis patients makes us suggest not to exclude the diagnosis of sarcoidosis in case of positive QFT in a low-endemic country for tuberculosis, and to manage these patients early by initiating without delay systemic steroids associated with latent tuberculosis therapy.

Introduction: Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis in adults. In the past decade, many treatments have emerged to expand the therapeutic armamentarium of rheumatologists. Among emerging treatments, Janus Kinase inhibitors (JAKi) are promising in treating RA and several other inflammatory conditions, such as psoriatic arthritis (PsA). The JAK/STAT signaling pathway is located downstream certain cytokines receptors that are known to be involved in RA pathogenesis. So far, three JAKi are approved for the treatment of RA, while other JAKi, are under investigation., Areas Covered: Herein, the authors review those JAKi approved and emerging for the treatment of RA and provide their expert perspectives on the subject area., Expert Opinion: JAKi represent an interesting alternative to other DMARDs when MTX has failed. Long-term extension studies are still ongoing, but one can assume that most of the major safety concerns have already come out. Switching from one JAKi to another DMARD has been little studied, but in such cases, preferring a treatment which does not interfere with the JAK/STAT pathway seems to be a reasonable choice.

Purpose: The purpose of this article is to report the first case of primary vitreoretinal lymphoma in a patient with sarcoid uveitis., Material and Methods: A 63-year-old woman with biopsy-proven sarcoid uveitis diagnosed 7 years ago was presented for a 6-month history of bilateral intermediate uveitis and gait disturbance with cerebral magnetic resonance imaging suggestive of neurosarcoidosis. Because of corticoids resistance, a vitrectomy and a cerebral biopsy were performed. The final diagnosis was primary central nervous system diffuse lymphoma. Patient died despite the chemotherapy with an initial improvement of visual and neurological features., Conclusion: Ophthalmologists should know that patient followed up with sarcoid uveitis can develop a primary vitreoretinal diffuse large B-cell lymphoma.

Purpose : Despite the huge advance in diagnostic technics, about one-third of uveitis is still considered of unknown etiology. In this study, we aimed to report their clinical features and to describe how a diagnosis has been finally reached for some patients. Methods : We retrospectively reviewed all patients with uveitis referred to our tertiary center between 2002 and 2016. The unknown etiology was admitted after a new ophthalmologic examination and a full work-up in internal medicine in our tertiary center. Results : Among 957 patients with uveitis, 355 had uveitis of unknown etiology. The clinical and epidemiological characteristics of this subgroup were no different from those with a known etiology. Out of 104 patients who were followed-up for more than 1 year, a diagnosis was finally achieved in 20 patients. The diagnosis was determined either because of the occurrence of a new clinical symptom ( n  = 10), a new/repeated non-ophthalmologic investigation ( n  = 7), or a new/repeated ophthalmic exam ( n  = 3). Conclusion : A prolonged follow-up, with repeated exams, may allow the determination of an etiology in about one-fifth of uveitis initially considered as idiopathic.

Purpose: To report the outcomes of initial methylprednisolone pulse then oral prednisone in the treatment of birdshot chorioretinopathy (BSCR)., Methods: We retrospectively reviewed medical records of 21 BSCR patients, treated with initial methylprednisolone, prednisone, or immunosuppressive therapy. Main outcome measures were changes in visual acuity, intraocular inflammation, concomitant immunosuppressive drug or intravitreal steroid, and adverse events., Results: In total, 14 patients were initially treated with methylprednisolone; four patients with prednisone; and three with immunosuppressive drug. Intraocular inflammation was controlled in 10 of 14 patients (71%) at 1 year, with a mean dose of 6.2 mg/day prednisone. Patients treated initially by methylprednisolone had improved visual acuity at 1 year, but it was not significantly different from patients treated initially by prednisone., Conclusions: Corticosteroid therapy, including initial methylprednisolone pulse then prednisone, was effective in stabilizing vision and decreasing inflammation in most patients with BSCR.

Purpose: To assess the value of lumbar punctures in adult patients with unexplained intermediate uveitis (IU)., Methods: Retrospective study of 17 patients with unexplained IU. All the patients underwent physical examination, complete laboratory tests, and cerebrospinal MRI., Results: Out of the 12 patients who underwent a lumbar puncture, six had oligoclonal bands and/or increased IgG index., Conclusion: Intrathecal synthesis of immunoglobulins is not rare in patients with unexplained IU. A longer follow-up is mandatory to determine whether intrathecal immunoglobulins synthesis has a predictive value for subsequent progression to multiple sclerosis.

Objective: Beta-tubulin isotype III is a microtubule component associated with resistance to chemotherapy and poor outcome in various cancers. This study aimed to investigate its expression in prostate cancer and its role as a prognostic factor in this setting., Material and Methods: A tissue microarray was constructed of 289 prostate cancers from radical prostatectomy specimens with a median follow-up of 48.9 months. Slides were immunostained for β-tubulin III. The intensity and extent of immunoreactivity and their product [immunoreactivity product (IRP)] were evaluated., Results: Tubulin III was expressed in the cytoplasm of prostate cancer cells but not in benign glands. Only 11.6% of cancers were positive for tubulin III. Among low-grade (Gleason score 5-6) and high-grade (Gleason score 7-10) cancers, 6.0% and 16.6% were positive, respectively (p = 0.006). β-Tubulin III expression was more often seen in high-stage disease and more often in metastases (62.5%) than in primary lesions (11.6%) (p < 0.001). The intensity, extent and IRP of tubulin III all predicted biochemical recurrence in univariate Cox analysis (p = 0.02, p = 0.048 and p = 0.012, respectively). IRP was an independent predictor of prognosis when adjusted for serum prostate-specific antigen in a multivariate Cox analysis (p = 0.005), but not when the Gleason score was added to the model (p = 0.17)., Conclusion: β-Tubulin III predicts biochemical recurrence after radical prostatectomy in a subset of patients. Its practical utility is limited by the low number of cases positive for this biomarker.