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1. Determining the probability of spondyloarthritis in patients with uveitis

Author

A. A. Godzenko, I. Yu. Razumova, and S. I. Glukhova

Subjects
uveitis, probability of spondyloarthritis, Diseases of the musculoskeletal system, RC925-935
Abstract

Background. Uveitis is a heterogeneous group of inflammatory eye diseases, some of which may be associated with spondyloarthritis (SpA). The probability of SpA depends on the clinical features of uveitis.The aim – to develop a prognostic formula for determining the probability of spondyloarthritis in patients with uveitisMethods. 208 patients (pts) (79 men and 129 women) with different forms of uveitis, referred by ophthalmologists to the V.A. Nasonova Research Institute of Rheumatology, were assessed. The onset of uveitis at the age ≤30 years took place in 107/208 pts (51.44%), over 30 years – in 101 (48.56%). 139/208 pts had acute recurrent uveitis, 69 – chronic; 149 had isolated anterior uveitis (АU), 59 – posterior eye involvement, 160 had unilateral uveitis, 48 – bilateral; HLA-B27 was detected in 159 pts. Various SpA were identified in 60 cases and not confirmed in 148 pts. Groups of pts with and without SpA were compared by gender, age of uveitis onset, presence of HLA-B27, and clinical features of uveitis.Result. SpA was diagnosed in 45/139 pts with acute recurrent uveitis , and was not confirmed in 94/139 (odds ratio (OR) – 1.723; 95% confidence interval (95% CI): 0.879–3.379; p=0.113); SpA was confirmed in 15/69 pts with chronic uveitis, in 54/69 – with other forms of uveitis (OR=0.597; 95% CI: 0.304–1.172; p=0.134). SpA was diagnosed in 51/160 pts with unilateral uveitis and was not diagnosed in 109/160 (OR=2.028; 95% CI: 0.913–4.501; p=0.082); out of 48 pts with bilateral uveitis was 9 with SpA and 39 without SpA (OR=0.493; 95% CI: 0.222–1.095; p=0.082); among 149 pts with isolated AU – 55 with SpA and 94 without SpA (OR=6.319; 95% CI: 2.384–16.749; p=0.001); of 59 pts with panuveitis – 5 with SpA and 54 without SpA (OR=0.158; 95% CI: 0.060–0.419; p=0.001); among 159 HLA-B27-positive – 56 with SpA and 103 without SpA (OR=6.117; 95% CI: 2.091–17.888; p=0.001); the onset of uveitis at the age of ≤30 years was in 44/107 pts with SpA and in 63/107 – without SpA (OR=3.710; 95% CI: 1.921–7.168; p=0.001); SpA was confirmed in 39/79 male pts and was not confirmed in 40 (OR=5.014; 95% CI: 2.637–9.535; p=0.001).A formula to determine the probability of SpA in pts with uveitis was obtained by the method of multifactorial discriminant analysis: 1.972 × Х1 + 1.476 × Х2 + 1.418 × Х3 + 1.270 × Х4 + 0.668 × Х5 + 0.162 × Х6, where X1 – male; X2 – the onset of uveitis at the age of ≤30 years; X3 – HLA-B27; X4 – isolated anterior uveitis; X5 – unilateral uveitis; X6 – acute recurrent uveitis.If the amount is greater than 4.552, the probability of SpA is estimated as high, if the amount is less than or equal to 4.552, it is low.Conclusion. A combination of significant clinical parameters of uveitis (male, onset of uveitis at the age ≤30 years, HLA-B27, isolated anterior uveitis, unilateral lesion, acute recurrent course) allows to quantify the risk of SpA, that contributes to the timely diagnosis.

Published
2024
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2. Cataract Surgery in Vogt — Koyanagi — Harada Syndrome (Clinical Case)

Author

I. Yu. Razumova, A. S. Stoyukhina, L. Alharki, E. N. Korobov, and E. D. Khachaturova

Subjects
vogt — koyanagi — harada syndrome, phacoemulsification, iol implantation, exudative retinal detachment, uveitis, Ophthalmology, RE1-994
Abstract

The article describes a clinical case of the Vogt — Koyanagi — Harada syndrome with an ophthalmic manifestations: bilateral granulomatous panuveitis with funnel-shaped serous retinal detachment complicated by cataracts, clinical manifestations in the form of alopecia and poliosis, as well as the results of phacoemulsification with IOL implantation.

Published
2024
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3. Course of uveitis in patients with ankylosing spondylitis during the interleukin 17 inhibitors therapy

Author

A. A. Godzenko, E. M. Agafonova, A. E. Dimitreva, I. Yu. Razumova, and M. M. Urumova

Subjects
ankylosing spondylitis, uveitis, interleukin 17 inhibitors, Diseases of the musculoskeletal system, RC925-935
Abstract

Background. Biological disease-modifying antirheumatic drugs (bDMARDs) can have different effects on various clinical manifestations of ankylosing spondylitis (AS). Data on the effects of interleukin 17 inhibitors (iIL17) on uveitis in AS continue to accumulate. Objective – to evaluate the effect of iIL17 therapy on the course of uveitis in AS. Material and methods. 73 patients (pts) with AS (New York criteria, 1984), who received iIL17 (57 – secukinumab (SEC), 22 – netakimab (NTK)) for at least 1 year were included in the study. The average age of pts at the time of inclusion in the study was 41.93±8.95 years, the average duration of AS was 10.75±6.22 years. There were 40 (56.7%) men and 33 (43.3%) women among the pts. HLA-B27 was detected in 62/73 (85%), coxitis in 58 (79%), enthesitis in 63 (86.3%), peripheral arthritis in 57 (78%), psoriasis in 7 (9.5%), inflammatory bowel disease (IBD) in 3 (4.1%); in 6 (8.2%) the disease started before the age of 16; 19 (26%) pts had at least 1 episode of uveitis during the course of the disease. The rates of uveitis was estimated by comparing the number of incidences per 100 patient-years before the start of bDMARDs therapy and during iIL17 using. Result. The incidence rate of uveitis before the start of bDMARDs therapy for all pts was 8.3 per 100 pt-years (95% CI: 0.065–0.107), during iIL17 therapy – 9.2 per 100 pt-years (95% CI: 0.06–0.15; p=0.72). The incidence rate of uveitis among pts used SEC was 10.1 per 100 patient-years (95% CI: 0.079–0.13) before the start of bDMARDs therapy, during SEC using – 9.4 per 100 pt-years (95% CI: 0.05–0.15; p=0.74). The incidence rate of uveitis among pts used NTK was 4.8 per 100 pt-years (95% CI: 0.028–0.08) before the start of bDMARDs therapy, during the NTK using – 7.1 per 100 pt-years (95% CI: 0.019–0,22; p=0.3). For patients with a history of uveitis, the incidence rate of uveitis before the start of therapy with bDMARDs was 22.5 per 100 pt-years (95% CI: 0.18–0.28), during iIL17 therapy – 29.1 per 100 pt-years (95% CI: 0.18–0.43; p=0.29). Occurrences of uveitis were observed in 4 of 57 pts (7%) during the using of SEC, and in 1 of 25 pts (4%) – during the NTK therapy. 1 case of new-onset uveitis was recorded during the using of SEC. Conclusion. There were no significant differences in the incidence rates of uveitis during iIL17 using compared with non-biological therapy. iIL17 have not demonstrated a significant effect on the course of uveitis in AS in the study group.

Published
2023
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4. HLA-B27-associated uveitis: an independent disease or a variant of spondyloarthritis?

Author

A. A. Godzenko, I. Yu. Razumova, and I. A. Guseva

Subjects
spondyloarthritis, uveitis, hla-b27, Medicine
Abstract

The paper highlights the relationship between HLA-B27-associated uveitis and spondyloarthritis (SpA). It presents the genetic aspects of inflammation of the eyes and musculoskeletal system, the role of the HLA-B27 histocompatibility antigen, and the contribution of other genes to the development of uveitis and spondylitis. The authors characterize the general pathogenetic mechanisms of the development of these diseases: the importance of factors of innate immunity, proinflammatory cytokines in the initiation of inflammation of the eyes and joints. The detection rate of SpA is analyzed in various forms of uveitis; the predictors of SpA development are identified in the patients. An algorithm is presented, which makes it possible to timely diagnose SpA in the presence of acute anterior uveitis. HLA-B27, inflammation in the ocular anterior chamber, unilateral alternating eye lesions, an acute recurrent course, and uveitis onset at the age of less than 30 years are singled out as the most significant signs associated with SpA in patients with uveitis. The features of the course and the frequency of complications in uveitis with and without SpA are compared. It is shown that exacerbations of uveitis and associated complications occur statistically significantly more frequently in SpA. There is evidence for the need for a close interaction between ophthalmologists and rheumatologists in the management of patients with uveitis.

Published
2020
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5. Histocompatibility HLA class I in anterior uveitis patients with and without spondyloarthritis

Author

I. A. Guseva, A. A. Godzenko, and I. Yu. Razumova

Subjects
anterior uveitis, spondylarthritis, hla class i., Medicine
Abstract

Anterior uveitis (AU) and ankylosing spondylitis (AS) are associated with histocompatibility human leukocyte antigen (HLA)-B27. Previous genetic studies conducted in different populations have also demonstrated other genetic associations, including HLA, both general and individual ones for AU and AS.Objective: to investigate the association of HLA class I with AU depending on the presence or absence of spondyloarthritis (SpA).Patients and methods. The investigators used the data of HLA class I typing in the patients referred by ophthalmologists for examination to the V.A. Nasonova Research Institute of Rheumatology, as well as the previous databases of patients with AS. The investigation included retrospectively two groups of patients with AU: 1) 52 patients with a confirmed diagnosis of SpA (AU + SpA); 2) 96 patients who had other types of AU (idiopathic AU (n=52), viral uveitis (n=29), multiple sclerosis (n=2) toxoplasmosis (n=2), sarcoidosis (n=1), tuberculosis (n=1), chlamydiasis (n=3), Behcet's disease (n=2), juvenile chronic arthritis (n=3), and Fuchs' heterochromic cyclitis (n=1). A control group consisted of 150 healthy test donors. The distribution of HLA class I (A, B, and Cw) was analyzed when comparing the two groups of patients with AU and each control patient group. Results. HLA-B27 was detected in 96.1% of cases in the AU + SpA group, in 40.6% in the AU group, and in 7.3% in the controls. In HLA-27-positive patients, the risk (odds ratio (OR) for joint disease (AU + SpA) was 315.9 (95% confidence interval (CI), 61.9–2176.7); p

Published
2018
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6. THE FREQUENCY AND SEVERITY OF EXTRASKELETAL MANIFESTATIONS OF ANKYLOSING SPONDYLITIS

Author

A. A. Godzenko, A. G. Bochkova, O. A. Rumyantseva, Yu. O. Korsakova, I. Yu. Razumova, V. V. Badokin, and Sh. F. Erdes

Subjects
ankylosing spondylitis, uveitis, aortitis, nephritis, psoriasis, inflammatory bowel disease, Diseases of the musculoskeletal system, RC925-935
Abstract

Ankylosing spondylitis (AS) is a systemic inflammatory disease involving not only the skeleton, but also other organs. The data on the frequency and clinical significance of extraskeletal manifestations are contradictory. Objective: to assess the frequency and severity of extraskeletal manifestations (ESMs) of AS in the authors' own clinical practice. Subjects and methods. 452 patients (363 men and 89 women) with AS fulfilling the 1984 relevant New York criteria were examined at the V.A. Nasonova Research Institute of Rheumatology in 2005 and 2014. The patients' median age was 31.5 [24; 41] years; median disease onset age, 19 [15; 23] years; disease duration, 11 [7; 18] years; HLA B27 was identified in 442 (97.7%) patients. In addition to standard laboratory and instrumental examinations, transthoracic echocardiography was performed in 172 patients. Rehberg's test, IgA test, histological examination of subcutaneous fat tissue or duodenal mucosa for amyloid, and renal ultrasound were made if there were urinary abnormalities and elevated creatinine levels. If indicated, there were consultations by an ophthalmologist with an appropriate instrumental examination (with evidence of uveitis in the history), a dermatologist, a nephrologist, an urologist, a gastroenterologist, and a endoscopist. Uveitis, cardiac involvement (conduction disturbance, aortic and valvular changes), inflammatory bowel disease (IBD), glomerulonephritis, and psoriasis were borne in mind as ESMs. The absolute number and percentage of patients having any ESM over the follow-up period were estimated. The number of exacerbations per year and that of complications were taken into account when evaluating uveitis; the magnitude of valvular regurgitation and the presence of prosthetic valves and a pacemaker were considered when assessing cardiac damage; the total body surface area (BSA) and the psoriasis areas and severity index (PASI) were estimated in psoriasis; the presence and stage of chronic kidney disease (CKD) and/or macrohematuria were kept in mind in nephropathy; when evaluating IBD, the Harvey–Bradshaw index (HBI) was determined on the basis of a stool frequency, the presence of blood in the stool, abdominal pain, and general well-being. Results and discussion. ESMs were detected in 218 (48%) of the 452 patients. Uveitis was present in 140 (30%) patients; in one-fourth of them, it relapsed frequently: three or more exacerbations per year and more than 10 during the disease; 41 (29%) patients had uveitis complications accompanied by visual impairment. Cardiac conduction disturbance was revealed in 61 (13%) patients. Five of them underwent pacemaker implantation. 71 (41.2%) patients were found to have aortic and valvular changes, including aortic root dilatation/thickening in 60 (34.8%) patients and aortic/mitral valve leaflet thickening in 63 (36.6%). Grades 3 and 4 valvular regurgitation was noted in 10 (5.8%) patients; valve replacement was carried out in 9 (5.2%) cases. Nephritis was diagnosed in 16 (3.5%) patients, 4 of them had Stage 2 or above of CKD. Psoriasis was present in 17 (3.7%) patients; 2 of them had severe psoriasis (BSA >10%). IBD (ulcerative colitis or Crohn's disease) was diagnosed in 16 (3.5%) patients, including 4 who showed a severe course. 79 (36%) patients were observed to have a concurrence of two or more ESMs; that of uveitis and heart disease was most commonly seen. Conclusion. ESMs are observed in nearly half (48%) of the patients with AS and can be concurrent; the most common ESMs of AS are uveitis, aortic root and heart valve lesions, and cardiac conduction disturbance. ESMs worsen the course and prognosis of AS.

Published
2017
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7. COURSE OF UVEITIS IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Author

A. A. Godzenko, A. G. Bochkova, O. A. Rumyantseva, I. Yu. Razumova, V. V. Badokin, and Sh. F. Erdes

Subjects
ankylosing spondylitis, uveitis, sulfasalazine, Diseases of the musculoskeletal system, RC925-935
Abstract

Relapsing uveitis is a serious problem for patients with ankylosing spondylitis (AS). Tumor necrosis factor-α inhibitors significantly reduce the frequency of uveitis attacks in AS patients, but they are not always available. In this connection, it is appropriate to evaluate the effect of traditional disease-modifying antirheumatic drugs on the course of uveitis in AS.Objective: to compare the frequency of uveitis attacks in AS during combined therapy using sulfasalazine (SULF) and nonsteroidal anti-inflammatory drugs (NSAIDs) versus monotherapy with NSAIDs.Subjects and methods. A total of 111 patients with significant AS who had at least one uveitis attack during the disease were examined. 49 subjects received combined therapy including SULF 2 grams daily and NSAIDs for at least 1 year. Six of the 49 patients were noted to have frequently relapsing uveitis (above 3 episodes yearly); 43 had no more than 3 ones per year. The remaining 62 patients took NSAIDs only throughout the follow-up period. Nine of them had an average of 3 uveitis attacks per year; 53 had no more than 3 ones per year. Out of the 49 patients receiving combined therapy with NSAIDs and SULF, 23 took NSAIDs only at least 1 year before SULF use; 10 of them were observed to have frequent relapses in that period and 13 had three or fewer episodes.Results and discussion. The entire group showed an average of 2.06±2.04 uveitis attacks per year during monotherapy with NSAIDs and 1.41±1.83 attacks yearly during combined therapy with NSAIDs and SULF (p = 0.08). Among the patients with less than 3 uveitis attacks per year, the mean number of episodes was significantly fewer during combined therapy than during NSAID monotherapy: 0.99±0.87 and 1.37±0.91, respectively (p = 0.04). Among those with frequently relapsing uveitis (more than 3 attacks per year), the mean number of episodes yearly was not significantly different during NSAID monotherapy and combined therapy: 5.7±2.5 and 5.5±2.7, respectively (p = 0.9). In a subgroup of patients receiving sequentially NSAID monotherapy and combined therapy with NSADs and SULF, 13 patients with three or fewer baseline attacks per year displayed a significant reduction in the frequency of episodes from 1.92±0.96 to 0.4±0.44 (p = 0.00003). During combined therapy versus monotherapy, 10 patients with frequently relapsing uveitis (over 3 episodes yearly) exhibited an insignificant reduction in the number of relapses from 5.9±3.02 to 5.33±1.1 (p = 0.6).Conclusion. Combined therapy with SULF and NSAIDs does not substantially affect the frequency of uveitis episodes in AS patients with frequently relapsing uveitis (above 3 attacks per year), but significantly reduces the number of episodes among patients with its mild course (less than 3 attacks yearly).

Published
2016
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8. PROGRESSION AND OUTCOMES OF UVEITIS IN PATIENTS WITH ANKYLOSING SPONDILITIS

Author

A. A. Godzenko, A. G. Bochkova, O. A. Rumyantseva, I. Yu. Razumova, V. V. Badokin, and Sh. F. Erdes

Subjects
uveitis, ankylosing spondylitis., Diseases of the musculoskeletal system, RC925-935
Abstract

Uveitis is a common extraskeletal manifestation of ankylosing spondylitis (AS) occurring in 20–40% of patients. Mostauthors underline a favorable prognosis for AS-associated uveitis.Objective: to study features of clinical picture and progression of AS-associated uveitis and to estimate the occurrence of its complications.Subjects and methods. Across-sectional study of 140 patients (98 males and 42 females) with AS, who had at least one uveitis attack over the period of disease and was followed up at V.A. Nasonova Research Institute of Rheumatology during 2008–2012. In addition to standard rheumatologic examination all patients were examined by ophthalmologist. Biomicroscopy, ophthalmoscopy, tonometry, computer-assisted perimetry, ultrasonography (B-scanning) of eyes and, if needed, fluorescein angiography and electrophysiological examination of retina were performed. Localization of uveitis, presence of complications affecting vision, total number of uveitis attacks by the moment of examination, mean number of uveitis attacks per year, correlation between the frequency of attacks and complications, presence of other extraskeletal manifestations and peripheral arthritis were assessed. The total number of uveitis attacks was defined from patients' interviews and respective medical documentation. Mean number of uveitis attacks was calculated as ratio of total number of uveitis attacks to the duration of disease for each patient. In the case of more than two attacks per year uveitis progression was consideredrefractory.Results.Mean duration of the disease was 17.7±11.03 years. In 19 patients (14%) AS manifested before and in 121 (86%) – after the age of 16 years. HLA-B27 was revealed in 135 (96%) patients, peripheral arthritis – in 43 (30%), whereas other extraskeletal manifestations – in 46 (32%). Early onset of uveitis in first 10 years of the disease was recorded in 81 (58%) patients, after10 years – in 21 (15%). Uveitis was the first clinical symptom of AS in 37 (26.4%) patients. 33 (24%) patients had more than 10 uveitis attacks during the disease, 17 (12%) – more than two attacks per year, whereas 18 (13%) had chronic uveitis. 118 (84%) had localized iridocyclitis, 12 (8%) – panuveitis, 2 (1%) – localized posterior uveitis. 122 (87%) patients had unilateral uveitis, 18 (13%) – bilateral, whereas 45 (36%) – alternating eye lesions (OD-OS). Uveitis complicated with vision impairment was observed in 41 (29%) patients: synechia in 26 (18%), vitreous degeneration – in 20 (14%), cataract – in 32 (23%), glaucoma – in 13 (9%), maculopathy – in 6 (4%), ribbon-like retinal degeneration – in 6 (4%), partial optic nerve atrophy – in 3 (2%). Authors revealed direct correlation between frequency of uveitis attacks and occurrence of synechia, cataract, glaucoma, vitreous degeneration.Conclusion. AS-associated uveitis is predominantly characterized by unilateral iridocyclitis (84%) and the onset in the first 10 years of disease (84.4%); 25% of cases were remarkable for frequent relapses: more than two attacks per year and more than 10 during the period of disease. One third of patients demonstrated vision impairments, and its progression correlated with the frequency of uveitis attacks.

Published
2014
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9. Corneal confocal microscopy in the diagnosis of non-infectious etiology uveitis

Author

I. Yu. Razumova, Z. V. Surnina, and L. М. Agaeva

Subjects
General Medicine
Abstract

Uveitis is one of the leading causes of blindness worldwide. Uveitis accounts for 10 to 15% of cases of complete vision loss and up to 35% of reversible vision loss. Particularly alarming is the fact that the debut of uveitis is recorded at a young working age. Uveitis includes a heterogeneous group consisting of at least 30 nosologies associated with various etiologies. The prognosis of the disease directly depends on the timely detection of its etiology. The review analyzes widely used methods for diagnosing patients with non-infectious uveitis. Special attention is paid to the advantages of confocal microscopy of the cornea, as the most modern non-invasive method that allows a detailed quantitative assessment of corneal subepithelial nerve plexuses and dendritic cells, the number of which increases during inflammatory processes, as well as a qualitative analysis of corneal precipitates and endothelial cells. Early detection of uveitis, which is an extra-articular manifestation of spondyloarthritis, allows appropriate treatment of severe systemic disease. It is assumed that the use of new approaches in the diagnosis of uveitis will prevent the development of severe complications up to complete loss of vision and improve the quality of life of patients.

Published
2022
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10. [Behçet's disease and uveitis]

Author

A. Godzenko and I Yu Razumova

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Behcet Syndrome, Population, Disease, Behcet's disease, medicine.disease, Dermatology, Uveitis, Ophthalmology, medicine, Humans, Autoimmune condition, business, education
Abstract

This literature review is dedicated to the Behçet's disease - a multi-symptom, severe autoimmune condition, relatively rare among the population of the former Soviet republics, and to one of its three most frequent manifestations - uveitis.Данный обзор посвящен болезни Бехчета — достаточно редко встречающемуся на постсоветском пространстве многосимптомному и достаточно тяжелому аутовоспалительному заболеванию, а также одному из трех наиболее частых его проявлений — увеиту.

Published
2021

11. [Nonsteroidal anti-inflammatory drugs in the treatment of anterior uveitis associated with spondyloarthritis]

Author

I Yu Razumova and A. Godzenko

Subjects
musculoskeletal diseases, medicine.medical_specialty, medicine.drug_class, Anti-inflammatory, Uveitis, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Spondylarthritis, medicine, Humans, In patient, 030203 arthritis & rheumatology, Nonsteroidal, business.industry, Anti-Inflammatory Agents, Non-Steroidal, medicine.disease, Dermatology, Uveitis, Anterior, stomatognathic diseases, Ophthalmology, chemistry, Acute Disease, 030221 ophthalmology & optometry, Anterior uveitis, business
Abstract

Anterior uveitis (AU) is one of the common extraskeletal manifestations of spondyloarthritis (SpA). The course of AU in patients with SpA is characterized by frequent relapses. The article considers the question of local and systemic use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment and prevention of SpA-associated uveitis exacerbations.Передний увеит традиционно является типичным внескелетным проявлением спондилоартритов (СпА). Течение переднего увеита при СпА характеризуется частыми рецидивами. В данном обзоре рассматривается вопрос местного и системного применения нестероидных противовоспалительных препаратов (НПВП) в лечении и предотвращении обострений увеита, ассоциированного со СпА.

Published
2020

12. [Results of surgical treatment of complicated uveal cataract]

Author

Avetisov Se, K S Avetisov, and I Yu Razumova

Subjects
Adult, medicine.medical_specialty, Visual acuity, genetic structures, medicine.medical_treatment, Intraocular lens, Cataract Extraction, Aphakia, Cataract, Postoperative Complications, Cataracts, Ophthalmology, medicine, Humans, Decompensation, Retrospective Studies, Phacoemulsification, business.industry, medicine.disease, eye diseases, Cryoextraction, sense organs, medicine.symptom, business, Uveitis
Abstract

A retrospective analysis of the results of surgical treatment of complicated uveal cataracts of different origin.The study analyzed the results of surgical treatment of uveal cataract in 30 patients (34 eyes) who were divided into three groups by uveitis etiology. The first group included 11 patients with spondyloarthritis associated with the HLA-B27 antigen; the second group included 10 patients with juvenile chronic arthritis and spondyloarthritis, negative for HLA-B27 antigen; the third group consisted of 9 patients with other systemic autoimmune diseases and uveitis of unknown etiology, also negative for the HLA-B27 antigen. The average age of the patients was 35.8±2.6; 30.8±3.8 and 34.0±2.3 years, respectively. Four patients (6 eyes) with juvenile chronic arthritis and severe ribbon-like corneal degeneration underwent standard intracapsular cataract cryoextraction with subsequent spectacle correction of aphakia. In other cases, ultrasound phacoemulsification with implantation of an intraocular lens (IOL) was used as a surgical aid.Regardless of the surgery technique and the cause of uveal cataract, a statistically significant decrease in the number of exacerbations per year (Surgical treatment of uveal cataracts of various etiologies with adequate pre- and postoperative therapy provides an improvement in visual acuity and a reduction in the frequency of inflammation recurrence. Considering the high likelihood of IOP decompensation in the long-term postoperative period, IOP control should be given attention in such cases.Ретроспективный анализ результатов хирургического лечения увеальных катаракт различного генеза.Проанализированы результаты хирургического лечения увеальной катаракты у 30 пациентов (34 глаза), которые были разделены на три группы по этиологии увеита. В 1-ю группу включены 11 пациентов со спондилоартритами, ассоциированными с HLA-B27 антигеном; 2-я группа — 10 пациентов с ювенильным хроническим артритом и спондилоартритами, отрицательными по HLA-B27 антигену; 3-я группа — 9 пациентов с другими системными аутоиммунными заболеваниями и увеитом неясной этиологии, также отрицательными по HLA-B27 антигену. Возраст пациентов в среднем составил 35,8±2,6; 30,8±3,8 и 34,0±2,3 года соответственно. Четырем пациентам (6 глаз) с ювенильным хроническим артритом и выраженной лентовидной дегенерацией роговицы была произведена стандартная интракапсулярная криоэкстракция катаракты с последующей очковой коррекцией афакии. В остальных случаях в качестве хирургического пособия использовали ультразвуковую факоэмульсификацию с имплантацией интраокулярной линзы.Независимо от методики операции и причины увеальной катаракты после ее удаления отмечено статистически достоверное уменьшение количества обострений в год (Хирургическое лечение увеальных катаракт различной этиологии при адекватной пред- и послеоперационной терапии обеспечивает улучшение остроты зрения и сокращение частоты рецидивов воспаления. Учитывая высокую вероятность декомпенсации офтальмотонуса в отдаленном послеоперационном периоде, следует уделять внимание контролю его уровня.

Published
2020

13. [Features of the course of anterior uveitis associated with HLA-B27 antigen]

Author

I Yu Razumova, I A Guseva, and A. Godzenko

Subjects
medicine.medical_specialty, HLA-B27, business.industry, Glaucoma, Disease, medicine.disease, Uveitis, Anterior, Histocompatibility, Ophthalmology, Antigen, Internal medicine, Spondylarthritis, medicine, Humans, Anterior uveitis, business, Macular edema, Uveitis, HLA-B27 Antigen, Retrospective Studies
Abstract

To perform comparative analysis of the frequency of various complications of anterior uveitis associated with HLA-B27 antigen in patients with and without spondyloarthritis.Retrospective analysis included 189 patients with anterior uveitis (AU) associated with histocompatibility antigen (HLA-B27). The Follow-up period lasted 10 years.189 patients with AU associated with antigen HLA-B27 were divided into two groups. The first group included 108 patients with various diseases of the spondyloarthritis (SpA) group; the second study group consisted of 81 patient with no signs of SpA. Number of patients with complications was 1.5 times higher in the first group. Complicated cataract, glaucoma, synechiae, myodesopsia occurred significantly more frequently in patients of the first group compared to AU patients of the second group, where idiopathic AU was more prevalent. Cystoid macular edema, corneal degeneration, optic nerve atrophy were observed more often in patients with SpA, but differences between the groups were statistically insignificant. Combination of complications also occurred significantly more often in SpA patients. Comparison of the frequency of AU attacks showed that the amount of uveitis attacks per 100 patient-years was higher in patients with SpA. Mean number of AU attacks per year was also higher in the first study group, but differences between the groups were statistically insignificant.Retrospective analysis of 189 patients with AU associated with HLA-B27 antigen revealed significantly higher frequency of complications, together with more frequent acute episodes in patients with SpA in comparison with patients without it confirming the notion that a systemic inflammatory disease can influence the severity of the course of AU.Цель исследования - провести сравнительный анализ частоты развития различных вариантов осложнений передних увеитов, ассоциированных с HLA-B27-антигеном, у пациентов со спондилоартритами и без них. Материал и методы. Ретроспективно проведен анализ результатов обследований 189 пациентов с передним увеитом (ПУ), ассоциированным с антигеном гистосовместимости (HLA-B27). Срок наблюдения составил 10 лет. Результаты. 189 пациентов с ПУ, ассоциированным с HLA-B27-антигеном, были разделены на две группы. В 1-ю группу вошли 108 пациентов с различными заболеваниями, относящимися к группе спондилоартритов (СпА), 2-ю группу составил 81 пациент без признаков СпА. Число пациентов с осложнениями из 1-й группы в 1,5 раза превышало число пациентов из 2-й группы. Осложненную катаракту, глаукому, синехии, деструкцию стекловидного тела достоверно чаще наблюдали у пациентов 1-й группы по сравнению с ПУ у пациентов из 2-й группы, в которой преобладал идиопатический ПУ. Кистозный макулярный отек, дегенерация роговицы, атрофия зрительного нерва чаще отмечены при наличии СпА, однако межгрупповые различия были статистически недостоверны. Также достоверно чаще выявлено сочетание нескольких осложнений на фоне СпА. При сравнении частоты обострений ПУ оказалось, что число обострений увеита на 100 пациенто-лет было выше при наличии СпА. Среднее число обострений ПУ в год в 1-й группе также было выше, однако межгрупповые различия были статистически недостоверны. Заключение. Результаты ретроспективного анализа обследований 189 пациентов с ПУ, ассоциированным с HLA-В27-антигеном, продемонстрировали достоверно более высокую частоту развития осложнений при более высокой частоте обострений у больных СпА в сравнении с больными без СпА, что подтверждает представления о влиянии системного воспалительного заболевания на тяжесть течения ПУ.

Published
2019

14. Clinical uveitis evaluation and its value in the diagnosis of spondyloarthritis

Author

Alla Aleksandrovna Godzenko, I Yu Razumova, and A G Bochkova

Subjects
medicine.medical_specialty, Ankylosing spondylitis, business.industry, Immunology, Enthesitis, Arthritis, seronegative spondyloarthritis, Diseases of the musculoskeletal system, medicine.disease, Gastroenterology, Rheumatology, Lesion, RC925-935, Internal medicine, medicine, uveitis, Immunology and Allergy, Reactive arthritis, Sarcoidosis, medicine.symptom, business, Uveitis
Abstract

Objective: to estimate the value of clinical parameters of uveitis for the diagnosis of spondyloarthritis (SA). Subjects and methods. One hundred and five uveitis patients referred by ophthalmologists to the Research Institute of Rheumatology, Russian Academy of Medical Sciences, in 2007–2009 were examined. X-ray study of the pelvis and lumbar spine, HLA-B27 test, and objective examination were performed in all the patients to detect inflammatory back pain, arthritis, and enthesitis. Results. The diagnosis of SA was verified in 60 patients: 24 had ankylosing spondylitis, 2 had reactive arthritis, and 38 had undifferentiat ed SA. The diagnosis of SA was discarded in 45 patients. Subsequent examination of these patients diagnosed BehНet's disease in 2 of them, sarcoidosis in 1, toxoplasmosis in 4, virus infection-associated uveitis in 8, Fuchs' syndrome in 1, and unspecified uveitis in 29. There was unilateral uveitis in 51 (85%) of the 60 patients with SP and in 26 (58%) of the 45 patients without SP (p = 0.0033); alternat ing eye lesion in 30 (50%) of the 60 patients with SP and in 4 (8.9%) of the 45 patients without SP (p = 0.00001); anterior uveitis in 57 (95%) of the 60 patients with SP and in 32 of the 45 patients without SP (p = 0.0017); posterior uveitis in 6 (10%) of the 60 patients with SP and in 20 (44%) of the 45 patients without SP (p = 0.0001); panuveitis in 2 (3.3%) of the 60 patients with SP and in 10 (22.2%) of the 45 patients without SP (p = 0.0039), acute recurrent uveitis in 15 (33.3%) of the 45 patients without SP and in 44 (73%) of the 60 patients with SP (p = 0.0001). The age at onset was less than 30 years in 38 patients with SP and in 19 patients without SP (p = 0.04). Conclusion. The estimation of the location and course of uveitis is important in diagnosing SP that is probable in patients with acute anteri or unilateral uveitis with alternating eye lesion, which occurred before the age of 30 years.

Published
2011

15. Application of TNF-alpha inhibitors in treatment of uveitis associated with ankylosing spondylitis

Author

I Yu Razumova and A. Godzenko

Subjects
medicine.medical_specialty, Visual acuity, Exacerbation, Receptors, Tumor Necrosis Factor, Etanercept, Uveitis, 03 medical and health sciences, 0302 clinical medicine, medicine, Adalimumab, Humans, Spondylitis, Ankylosing, 030203 arthritis & rheumatology, Ankylosing spondylitis, Tumor Necrosis Factor-alpha, business.industry, Antibodies, Monoclonal, medicine.disease, Dermatology, Infliximab, Ophthalmology, Immunoglobulin G, 030221 ophthalmology & optometry, Tumor necrosis factor alpha, medicine.symptom, business, medicine.drug
Abstract

Uveitis is one of the most frequent extraskeletal manifestations of ankylosing spondylitis (AS). Despite iridocyclitis being the most prevalent form of uveitis in patients with AS, and the rareness of the involvement of posterior eye segments in the inflammatory process, the frequent exacerbation of the disease, a significant number of patients develop complications that lead to decrease of visual acuity. The review features theoretical prerequisites for application of tumor necrosis factor alpha (TNF-alpha) inhibitors: infliximab, adalimumab and etanercept. Literature data speaks for high efficacy of TNF-alpha inhibitors in prevention and arrest of uveitis onset in patients with AS.Увеит - одно из наиболее частых внескелетных проявлений анкилозирующего спондилита (АС). Несмотря на то что преобладающей формой увеита при АС является иридоциклит и редко вовлекаются в воспалительный процесс задние отделы глаза, тем не менее из-за частых обострений заболевания у значительной части больных развиваются осложнения, приводящие к снижению остроты зрения. В обзоре представлены теоретические предпосылки использования ингибиторов фактора некроза опухоли альфа (ФНОα): инфликсимаба, адалимумаба и этанерцепта. Данные литературы свидетельствуют о высокой эффективности ингибиторов ФНОα в отношении купирования и предотвращения атак увеита при АС.

Published
2018
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16. Uveitis-associated HLA class 1 histocompatibility antigens

Author

I Yu Razumova, O K Vorob'eva, A. Godzenko, and I A Guseva

Subjects
Adult, Male, Systemic disease, medicine.medical_specialty, Adolescent, Statistics as Topic, Human leukocyte antigen, Behcet's disease, 030204 cardiovascular system & hematology, Uveitis, 03 medical and health sciences, 0302 clinical medicine, Antigen, Internal medicine, medicine, Minor histocompatibility antigen, Humans, HLA-B27 Antigen, business.industry, Histocompatibility Antigens Class I, Prognosis, medicine.disease, Rheumatology, Histocompatibility, Ophthalmology, Immunology, 030221 ophthalmology & optometry, Female, business
Abstract

to evaluate the diagnostic and prognostic significance of HLA class 1 histocompatibility antigens in the development of anterior uveitis.A total of 137 patients with anterior uveitis followed up at the Research Institute of Eye Diseases in 2009-2016 were tested for HLA antigens (A and B loci). The average patient's age was 29±12.4 years. All patients underwent a thorough medical interview with clinical and laboratory assessment. In case of suspected association with systemic disease, the patients were referred for consultation at the V.A. Nasonova Research Institute of Rheumatology. HLA typing was performed using a standard microlymphocytotoxicity test with specific anti-HLA sera (production of Gisans CC, Saint Petersburg). Statistical processing was performed with Statistica 6.0 software by applying methods of descriptive and nonparametric statistics (Mann-Whitney test).The results of HLA class 1 typing indicated a significant positive association between uveitis and the HLA-B27 antigen (p0.00001). Moreover, there was a trend toward decreased frequencies of В7, B12, and B21 antigens (p=0.1), however, the changes were not statistically significant as compared to the control group. Other HLA class 1 antigens also did not differ significantly in frequency between uveitis patients and the controls.The study has confirmed an association between certain histocompatibility antigens and systemic diseases. However, a statistically reliable relationship has been established only for the HLA-B27 antigen.Цель - оценить диагностическое и прогностическое значение аллелей антигенов гистосовместимости (HLA) класса 1 в развитии передних увеитов. Материал и методы. Проведено типирование на антигены гистосовместимости HLA класса 1 (А и В-локусы) у 137 пациентов с передним увеитом, наблюдавшихся в ФГБНУ 'НИИ глазных болезней' с 2009 по 2016 г. Средний возраст больных составил 29±12,4 года. После тщательного сбора анамнеза, офтальмологического и лабораторного обследований при подозрении на ассоциацию воспалительного заболевания глаз с системным заболеванием пациенты были проконсультированы в ФГБНУ НИИР им. В.А. Насоновой. Типирование HLA-антигенов класса 1 (А и B-локусы) осуществляли с помощью стандартного микролимфоцитотоксического теста с использованием специфических анти-HLA-сывороток ЗАО 'Гисанс' (Санкт-Петербург). Статистическую обработку материала проводили с помощью программы Statistica 6,0 с применением методов описательной и непараметрической статистики (критерий Манна-Уитни). Результаты. Проведенное типирование на антигены гистосовместимости (HLA) класса 1 показало выраженную положительную ассоциативную связь увеита с антигеном HLA-B27 (p0,00001). Выявлена также тенденция к снижению частот антигенов В7, B12 и B21 (p=0,1), однако различия в частотах этих антигенов в группе больных и в контроле не были статистически значимыми. Статистически значимых различий в частоте других HLA класса 1 у больных с увеитами в сравнении с показателями контрольной группы получено не было. Заключение. Исследование подтвердило ассоциацию некоторых антигенов гистосовместимости с определенными нозологическими заболеваниями, но статистически достоверной эта связь была только у заболеваний, ассоциированных с HLA-B27 антигеном.

Published
2017
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17. Uveitis in spondyloarthritis patients and its association with HLA-B27 histocompatibility antigen: prospective study

Author

I Yu Razumova, I A Guseva, A. Godzenko, and O K Vorob'eva

Subjects
Adult, Male, musculoskeletal diseases, medicine.medical_specialty, Adolescent, Statistics as Topic, Russia, Uveitis, 03 medical and health sciences, 0302 clinical medicine, Antigen, Internal medicine, medicine, Humans, Spondylitis, Ankylosing, Prospective Studies, 030212 general & internal medicine, Age of Onset, Prospective cohort study, Spondylitis, HLA-B27 Antigen, 030203 arthritis & rheumatology, HLA-B27, business.industry, Patient Acuity, medicine.disease, Histocompatibility, Ophthalmology, Etiology, Female, Age of onset, business
Abstract

to perform a prospective study of clinical presentation and course of uveitis in spondyloarthritis (SpA) patients as well as its association with the HLA-B27 histocompatibility antigen.The study included 219 patients with uveitis, all tested for HLA-B27 antigen and various infections (viral, bacterial, and parasitic) as well as examined for locomotive system involvement.The presence of the HLA-B27 antigen was determined in 142 (64.8%) out of 219 patients, of them 87 were diagnosed with an entity of the SpA group. The remaining 77 (35.2%) patients appeared to be HLA-B27-negative, but 13 were still diagnosed with an entity of the SpA group. There were 10 (4.6%) patients with 2 or more diseases from the SpA group («clinical decussation»). When comparing the two groups of HLA-B27-positive and negative patients having both SpA and uveitis, no statistically significant difference was found as to the age of onset, site, frequency of attacks, and uni- or bilateral involvement (p0.05). We also performed a comparison of HLA-B27-positive and negative patients with no account to their SpA status and revealed a higher complication rate in those that were «negative» (p0.0001), which can be explained by the fact that HLA-B27-negative patients often have autoimmune or infectious uveitis of different origin notable for long attacks and short remissions.Assessing the site and course of uveitis as well as HLA-B27 testing of uveitis patients has proved important for etiological diagnosis. Diseases of the SpA group have been shown to be 6.7 times more common in HLA-B27-positive patients as compared to HLA-B27-negative ones. Clinical presentation of uveitis in the presence of SpA in both HLA-B27-positive and negative patients resembles that of idiopathic uveitis - an independent HLA-B27-associated syndrome (р0.05). Cases of «decussation» between entities of the SpA group are usually more severe in terms of clinical presentation and course of uveitis and are associated with a worse prognosis. Complications of uveitis are more likely to be found in non-SpA HLA-B27-negative patients (р0.0001).Цель - проспективное исследование клиники и течения увеитов при заболеваниях группы спондилоартритов (СпА) и их ассоциации с антигеном гистосовместимости HLA-B27. Материал и методы. Под нашим наблюдением находились 219 пациентов с увеитами. Все больные были обследованы на наличие антигена HLA-B27, на предмет поражения опорно-двигательного аппарата, а также на наличие вирусных, бактериальных и паразитарных инфекций. Результаты. По данным обследования 219 пациентов с увеитами, HLA-B27-антиген выявлен у 142 (64,8%) человек, из них у 87 диагностированы заболевания из группы СпА. Из 77 (35,2%) пациентов с HLA-B27– заболевания из группы СпА установлены у 13 человек. У 10 (4,6%) больных наблюдали по 2 и более заболеваний из группы СпА (клинический перекрест). При сравнении двух групп пациентов с увеитами при СпА, положительных и отрицательных по HLA-B27-антигену, не было получено статистически значимой разницы по возрасту возникновения заболевания, локализации процесса, частоте атак, одно- и двустороннему поражению (р0,05). При сравнении двух групп пациентов, положительных и отрицательных по HLA-B27-антигену, без учета наличия СпА следует отметить более частые осложнения в группе HLA-B27– (p0,0001), что связано с преобладанием в данной группе пациентов с другой системной аутоиммунной и инфекционной этиологией увеита, отличающейся продолжительными периодами обострений с короткими ремиссиями. Заключение. Оценка локализации и течения увеита, а также исследование пациентов с увеитами на наличие антигена гистосовместимости HLA-B27 важны в определении этиологии заболевания. Заболевания из группы СпА выявлены в 6,7 раза чаще у пациентов с HLA-B27+ по сравнению с пациентами с HLA-B27–. Клиника и течение увеита при СпА с HLA-B27+ и HLA-B27-антигеном схожа с клиникой и течением идиопатического увеита как самостоятельного синдрома, ассоциированного с HLA-B27-антигеном (р0,05). Наличие клинических перекрестов между заболеваниями, относящихся к группе СпА, осложняют клинику и течение увеита и существенно ухудшают прогноз. Осложнения увеита развиваются чаще у пациентов без СпА, отрицательных по HLA-B27-антигену (р0,0001).

Published
2016
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18. IMPACT OF THE THERAPY WITH TUMOR NECROSIS FACTOR α INHIBITORS ON THE FREQUENCY OF UVEITIS EXACERBATIONS IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Author

Alla A Godzenko, A G Bochkova, O A Rumyantseva, I Yu Razumova, and Sh F Erdes

Subjects
musculoskeletal diseases, medicine.medical_specialty, Ankylosing spondylitis, business.industry, Immunology, Diseases of the musculoskeletal system, medicine.disease, Gastroenterology, Infliximab, Etanercept, RC925-935, Rheumatology, tumor necrosis factor α inhibitors, Sulfasalazine, Internal medicine, ankylosing spondylitis, uveitis, medicine, Adalimumab, Immunology and Allergy, Methotrexate, Tumor necrosis factor alpha, business, Uveitis, medicine.drug
Abstract

The course of uveitis in patients with ankylosing spondylitis (AS) does not always correlate with inflammation in the axial skeleton and peripheral joints. Effect of tumor necrosis factor α (TNFα) inhibitors on uveitis has been insufficiently studied yet, unlike their effect on the peripheral joints and spine. Objective. To compare the frequency of uveitis attacks in patients with AS during treatment with TNFα inhibitors and the conventional anti-inflammatory therapy. Materials and Methods. The study included 48 patients with AS and recurrent uveitis treated with TNFα inhibitors: 25 – infliximab, 15 – adalimumab, 9 – etanercept; 7 patients received two or more drugs sequentially. Median [25th, 75th percentiles] of the treatment duration was 3 [3.5; 5] years. The duration of treatment since the first attack of uveitis until administration of TNFα inhibitors was 5 [5; 9.7] years. Eighteen patients received only nonsteroidal anti-inflammatory drugs (NSAIDs), 30 patients received NSAIDs and basic anti-inflammatory drugs (DMARDs), including sulfasalazine (n = 23), methotrexate (n = 4), and cyclosporine (n = 4). Results. The median number of uveitis exacerbations during the standard anti-inflammatory therapy was 1 [0.4; 3] per year; during treatment with TNFα inhibitors – 0 [0; 0.5] per year (p = 0.0007). In 19 of 48 patients (40%), no exacerbations of uveitis were registered during therapy with these drugs. The frequency of uveitis attacks in patients treated with infliximab decreased from 1 [0.2; 2.75] to 0.1 [0; 0.8] episodes per year (p = 0.002), adalimumab – from 1.75 [1; 4.5] to 0 [0; 0.07] (p = 0.04), etanercept – from 0.95 [0.5; 1.75] to 0 [0; 0.07] (p = 0.001). Conclusion. Administration of TNFα inhibitors significantly reduces the frequency of uveitis attacks in patients with AS.

Published
2014
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