Revista Científica Interdisciplinaria Investigación y Saberes

2024, Vol. 14, No. 1 e-ISSN: 1390-8146

Published by: Universidad Técnica Luis Vargas Torres

How to cite this article (APA):

Carrillo, K., Delgado, C., López, K,. Vargas, L. (2024) Uveitis as an

ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the clinical implications,

Revista Científica Interdisciplinaria Investigación y Saberes, 14(1) 62-81

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A

detailed analysis of the clinical implications.

Uveítis como manifestación oftalmológica de enfermedades autoinmunes: Un análisis

detallado de las implicaciones clínicas

Kattya Grace Criollo Montalvo

Médico General. Instituto Almagro Clínica de Ojos. Hospital General Docente Calderón,

Kattya2207@gmail.com, https://orcid.org/0000-0001-7284-2125

Carla Jacqueline Delgado Soria

Médico General. Centro de Especialidades Consulmed, jacky94carl@gmail.com, https://orcid.org/0009-

0004-9731-7748

Kelly Jhomara López Vizcaíno

Licenciada en Enfermería. Consorcio médico Godoy, Salcedo, kellylopezvizcaino30@gmail.com

https://orcid.org/0009-0007-2705-418X

Lizbeth Solange Vargas Cárdenas

Médico General. Hospital General José María Velasco Ibarra, Tena, nela_salamander@hotmail.com

https://orcid.org/0009-0007-0608-8225

Uveitis, an ocular condition characterized by inflammation of the

middle layer of the eye, can manifest itself in association with various

systemic diseases, with autoimmune diseases being a prominent

component. Its complexity lies in its etiological diversity and the

variety of clinical manifestations, ranging from mild to severe

presentations. The aim of this research is to analyze the prevalence

and characteristics of uveitis in the context of autoimmune diseases,

and to examine the associated clinical repercussions. A

comprehensive literature review was conducted using specialized

databases, the sample comprised epidemiological studies and

systematic reviews related to AD and associated rheumatic diseases.

The results revealed a significant prevalence of uveitis in patients with

Abstract

Received 2023-06-08

Revised 2023-19-23

Published 2024-01-05

Corresponding Author

Kattya Grace Criollo Montalvo

Kattya2207@gmail.com

Pages: 62-81

https://creativecommons.org/licens

es/by-nc-sa/4.0/

Distributed under

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 1

AS, highlighting the importance of ophthalmologic surveillance in this

population.

Keywords:

non-infectious uveitis, ocular immunology, rheumatic

diseases, ocular manifestations, autoimmune diseases.

Resumen

La uveítis, una afección ocular caracterizada por la inflamación de la

capa intermedia del ojo, puede manifestarse asociada a diversas

enfermedades sistémicas, siendo las autoinmunes un componente

destacado. Su complejidad reside en su diversidad etiológica y la

variedad de manifestaciones clínicas, que van desde formas leves

hasta presentaciones severas. El objetivo de esta investigación es

analizar la prevalencia y características de la uveítis en el contexto de

enfermedades autoinmunes, y examinar las repercusiones clínicas

asociadas. Se llevó a cabo una revisión bibliográfica exhaustiva

utilizando bases de datos especializadas, la muestra comprendió

estudios epidemiológicos y revisiones sistemáticas relacionadas con

la EA y enfermedades reumáticas asociadas. Los resultados revelaron

una prevalencia significativa de uveítis en pacientes con EA,

destacando la importancia de la vigilancia oftalmológica en esta

población.

Palabras clave

Uveítis no infecciosa, inmunología ocular,

enfermedades reumáticas, manifestaciones oculares, enfermedades

autoinmunes.

Introduction

Uveitis is the most frequent ophthalmologic finding in the practice of

rheumatology and clinical immunology. This condition, often of

unknown origin, is characterized by inflammation of the uvea, which

encompasses the iris, ciliary body and choroid, fundamental

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 1

components of the middle eye. The anterior variety of uveitis impacts

the iris and ciliary body, while the posterior form is restricted to the

retina and choroid. Both presentations demand immediate evaluation

by an ophthalmologist, since untreated cases can lead to severe visual

problems, including blindness (Takeuchi et al., 2021).

Current literature reveals that uveitis, although commonly associated

with systemic autoimmune diseases, can also present as a primary or

idiopathic entity. This aspect underscores the need for a thorough

understanding of the autoimmune mechanisms that trigger and

perpetuate intraocular inflammation.

It also highlights the importance of biomarkers in the early

identification of uveitis associated with autoimmune diseases. The

detection of specific autoantibodies and inflammatory cytokines

could not only facilitate more accurate diagnosis, but also open new

avenues for the development of targeted therapies (Sen & Ramanan,

2020).

Although the pathogenesis of uveitis is not yet fully understood, an

imbalance has been observed between effector T cells (Th1 and

Th17), which have effector and pathogenic functions, and regulatory

T cells (Treg), which play a crucial role in immunomodulation and

tolerance. In addition, proinflammatory cytokines play an essential

role in the pathophysiological mechanisms of uveitis. Elevated levels

of interleukin-6 (IL-6), IL-17, IL-23 and tumor necrosis factor alpha

(TNF α) have been identified in the blood and other ocular fluids of

patients with uveitis of various etiologies (Egwuagu et al., 2021)

Immunoprivilegiation is a feature present at certain sites in the body,

such as the brain, reproductive organs and the eye, and refers to a set

of complex molecular processes designed to regulate inflammation

and prevent potential damage to specialized tissues. The eye, in

particular, exhibits a unique immune system that incorporates

regulators and inhibitors of the immune response, thus playing a

crucial role in modulating the response to the presence of antigens.

This immune privilege is constitutively manifested in structures such

as the cornea, retina and anterior chamber of the eye (Mölzer et al.,

2020).

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

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The immune system uses four classic mechanisms to prevent

autoimmunity: clonal selection, active suppression, immune privilege

and clonal inactivation. Due to the uniqueness of the eye, these

mechanisms operate in a particular way. (De Revisión & Muravchik,

2023).During eye ontogeny, the eye becomes a sequestered organ.

Before the thymus is fully developed, some ocular antigens may never

reach the thymus. As a result, lymphocytes carrying antigen receptors

capable of recognizing these antigens are not eliminated (Bertrand et

al., 2019).

T lymphocytes that are specific for ocular antigens reach the

bloodstream with a frequency of one to five precursors per million

cells. Despite the presence of these autoreactive cells in the blood,

most people do not develop uveitis. This apparent protection is

attributed to the fact that the eye is considered an immunoprivileged

site.

Inflammatory eye diseases have been recognized since ancient times,

although only in recent times has progress been made in defining

more precisely the mechanisms underlying this phenomenon. In the

middle of the last century, the belief was held that most cases of

uveitis were caused by infectious agents, such as those linked to

diseases like syphilis and tuberculosis (Joltikov & Lobo-Chan,

2021).However, the significant contribution of endogenous

immunomodulatory mechanisms in these disorders, which, together

with genetic and environmental factors, form an essential triad, has

now been clearly evidenced. Research in animal models has

highlighted the crucial role of T cells in many of these disorders. The

development of T-cell lines has allowed a better understanding of

cellular interactions during ocular inflammatory episodes. The

presence of uveitogenic antigens in the eye also raises the significant

possibility of the occurrence of autoimmune processes (Joltikov &

Lobo-Chan, 2021).

The problem with this relationship lies in the growing evidence of an

intricate connection between uveitis and various autoimmune

diseases, such as rheumatoid arthritis, ankylosing spondylitis,

Behçet's syndrome, among others. Uveitis can manifest as a primary

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 1

entity or secondary to these systemic disorders, complicating the

diagnosis and clinical approach.

In this context, the problem formulation focuses on the need for

accurate and early identification of the relationship between uveitis

and autoimmune disorders. The lack of uniform criteria for the

evaluation and management of uveitis in the context of autoimmune

diseases highlights the urgency of addressing these gaps in medical

care.

The objectives of this article comprise a comprehensive review of the

current scientific literature to understand the bidirectional relationship

between uveitis and autoimmune diseases. In addition, we seek to

identify risk factors and clinical patterns that may improve the clinical

management of patients with these conditions.

This research is based on the need to integrate knowledge from

ophthalmology and rheumatology, recognizing the interdisciplinarity

required to comprehensively address uveitis in the context of

autoimmune diseases. This theoretical perspective will provide a solid

framework to critically analyze the existing scientific literature and

draw meaningful conclusions to guide clinical practice and future

research.

Methodology

This study is part of a literature review and critical analysis of the

scientific literature. The methodology adopted is based on the

compilation, review and synthesis of previous studies related to

uveitis as an ophthalmologic manifestation of autoimmune diseases.

This approach allows us to consolidate and comprehensively evaluate

the existing evidence in the medical literature, providing a holistic

view of the clinical implications of uveitis in the autoimmune context.

Given the nature of literature review research, the "sample" of this

study comprises a wide range of scientific articles, systematic reviews

and meta-analyses published in specialized databases. Studies

addressing the relationship between uveitis and autoimmune

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

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diseases were included, with a particular emphasis on research

exploring clinical, diagnostic and therapeutic aspects, published

within the last 7 years.

The search strategy is carried out comprehensively in databases such

as PubMed, Scopus, Google Scholar and Web of Science, as well as

university repositories, using a combination of keywords and specific

search terms. MeSH (Medical Subject Headings) terms are used in

PubMed to optimize search precision.

In addition, Boolean operators such as AND, OR, and NOT are

applied to refine the search and ensure the inclusion of relevant

studies. Synonyms and related terms are also considered to

encompass the diversity of the literature. The combination of these

elements ensures a comprehensive and accurate search.

Inclusion and exclusion criteria are established, considering the

relevance and quality of the selected studies. These criteria ensure

that the information collected is relevant to the subject of the study,

contributing to the soundness and validity of the review.

Thematic Relevance: Studies should specifically address the

relationship between uveitis and autoimmune diseases. Papers

exploring clinical, diagnostic and therapeutic aspects of this

association will be included.

Publication Period: Studies published in the last 7 years (2016-2023)

will be considered to ensure the inclusion of recent research and to

reflect the current state of knowledge in the field.

Type of Study: Systematic reviews, meta-analyses, observational

studies (cohort, case-control), clinical trials and experimental studies

that provide relevant information on uveitis and its connection with

autoimmune diseases will be included.

Language: Studies written in English and Spanish will be accepted to

ensure geographic and linguistic diversity.

Exclusion Criteria:

Thematic Irrelevance: Studies that do not specifically address the

relationship between uveitis and autoimmune diseases will be

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

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excluded, as well as those that do not provide clinically relevant

information.

Publication Period: Studies published within the last 7 years are

excluded to ensure the inclusion of recent and relevant research.

Type of Study: Non-original papers, such as editorials, letters to the

editor and conference abstracts, as well as those with insufficient or

low quality methodologies will be excluded.

Language: Studies in languages other than English and Spanish are

excluded, as the team's ability to evaluate and synthesize information

in those languages may be limited.

Full Text Access: Access to the full text of the study will be required

for a complete review of the information. Studies without access to

full text or with limited information will not be considered.

In this study, the systematic review methodology was used to

rigorously approach the analysis of the scientific literature related to

the specific topic. Following the guidelines and principles established

for this methodology, a transparent and reproducible process is

guaranteed. To efficiently manage the information collected,

bibliographic management tools were used, among which the

specialized software Mendeley stands out. This tool facilitates the

organization and management of bibliographic references, enabling

the creation of digital libraries and the automatic generation of

citations and bibliographies.

The selection of studies was carried out in a transparent and replicable

manner, applying predefined inclusion and exclusion criteria to

ensure the relevance and quality of the selected studies.

The methodological quality of the studies was assessed using specific

tools adapted to the nature of each type of research, such as AMSTAR

for systematic reviews and NOS for observational studies.

Finally, the narrative synthesis integrates and summarizes the key

findings of the selected studies in a descriptive manner. Patterns,

discrepancies and trends in the results were identified, providing a

comprehensive and coherent overview of the available evidence. This

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

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approach highlights clinical implications and provides guidance for

possible future research directions.

Results

Uveitis may present as primary or secondary to various conditions,

especially its association with systemic autoimmune rheumatic

diseases (SARD). Within the secondary forms, two main types are

distinguished: "anterior" uveitis, also known as iridocyclitis or iritis,

which affects the iris and ciliary body; and "posterior" uveitis, called

chorioretinitis, which usually involves the retina and choroid

(Rosenbaum et al., 2019).

The prevalence of uveitis varies according to regions and detection

methods, being estimated at around 1/4500 in the general

population, being more frequent in the range of 20 to 60 years of age

with equal representation in both sexes (García-Aparicio et al., 2021).

In the context of ARDS, uveitis can manifest as an acute episode

affecting one eye, evolving in some cases into a chronic inflammatory

process. It is crucial to perform a rigorous study for an accurate

diagnosis and classification, to initiate treatment immediately and to

evaluate possible complications.

Etiopathogenesis

Most cases of uveitis are sporadic and of unknown etiology, but may

be associated with ARDS or syndromes affecting various ocular

structures. Non-infectious or autoimmune causes, such as HLA-B27-

related uveitis, have specific clinical features, such as male

predominance, unilateral acute onset and recurrences. The

inflammatory process is supported by Th17 cells and proinflammatory

cytokines, contributing to the unbalanced ocular immune response,

which can lead to ocular tissue damage and perpetuate the

inflammatory process (Fanlo et al., 2021).

Immune disorders affecting the eye are commonly divided into two

main categories: antibody-mediated diseases and cell-mediated

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

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diseases. Autoimmunity, as a rule, develops when the

aforementioned safeguarding mechanisms fail (Kemeny-Beke &

Szodoray, 2020).

In the context of uveitis, both in experimental models and in humans,

the breakdown of the blood-retinal barrier marks the onset of the

autoimmune process and, in some cases, serves as a triggering factor.

Thymic presentation of ocular antigens has been shown to be crucial

in the development of uveitis, as evidenced by experiments with rats

susceptible to experimental autoimmune uveoretinitis (Sabat, 2020).

(Zhong et al., 2023), in theirstudies states that activation of T

lymphocytes in response to eye-specific antigens, such as arrestin (S-

Ag), in the thymus can induce an autoimmune response in the eye.

Furthermore, in animal models of autoimmune uveitis, it has been

observed that uveitogenic T lymphocytes can migrate to the

periphery after reactivation against retinal antigens, which is also

reflected in patients with middle and posterior uveitis.

After activation of T lymphocytes that recognize uveitogenic

epitopes, migration into the eye is initiated, triggering a series of

events that lead to destruction of the photoreceptor layer and visual

loss. Although any activated T lymphocyte can penetrate the retina,

only cells that recognize the pathogenic epitopes continue into the

retina, breaking the blood-retinal barrier by secreting cytokines

(Bertrand et al., 2019).

In experimental autoimmune uveitis, mast cell degranulation has been

observed in the choroid, suggesting lgE-independent, possibly

complement-mediated activation. In multiple forms of uveitis,

inflammatory cells such as macrophages, neutrophils, antigen-

presenting cells, and T lymphocytes play a crucial role, and their

presence characterizes the hallmark of uveitis (Huguet Rodriguez et

al., 2022).

Classification:

Uveitis is classified according to the primary anatomic site of

inflammation, distinguishing between anterior, intermediate and

posterior uveitis. Panuveitis, on the other hand, involves inflammation

of all three components of the uvea. In an epidemiological study

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

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conducted in Northern California, a prevalence of uveitis was

estimated at 115/100,000 persons, with an incidence ranging from

47.1 to 52.4/100,000 person-years. On the other hand, prevalence

estimates of NIU (Noninfectious Uveitis) based on administrative

claims from 14 million privately insured persons in the United States

were 121/100,000 persons (Joltikov & Lobo-Chan, 2021).

Anterior uveitis stands out as the most common form of uveitis,

accounting for 81% of all cases of UIN, with a prevalence of

98/100,000 adults, according to a retrospective analysis of claims in

the U.S. Intermediate, posterior infections and non-infectious

panuveitis accounted for 0.9% (prevalence, 1/100,000), 8.6%

(prevalence, 10/100,000) and 9.6% (prevalence, 12/100,000),

respectively. These data highlight the significant prevalence of

anterior uveitis compared to other forms in the adult population

(Sabat, 2020).

Anterior uveitis

Anterior uveitis, which accounts for approximately three-quarters of

all uveitis cases, has an incidence of 8 per 100,000 population.

Although more manageable, these uveitis can lead to serious

complications, such as glaucoma and macular edema, ultimately

leading to blindness. Among the most common causes of anterior

uveitis are spondyloarthropathies, which are classified as

histocompatibility antigen HLA-B27-related uveitis. This antigen not

only predisposes to anterior uveitis, but is also associated with various

spondyloarthropathies, such as ankylosing spondylitis, Reiter's

syndrome, psoriatic arthritis, and inflammatory bowel disease (IBD)

(Sabat, 2020).

HLA-B27 haplotype-linked uveitis is a unique entity characterized by

its anterior, acute, relapsing and unilateral nature in each episode.

Although less chronic than other forms of anterior uveitis, they are

usually more severe due to high inflammatory activity during flares.

These uveitis more frequently affect males and individuals of slightly

younger age compared to patients with HLA-B27-negative uveitis.

The presence of the HLA-B27 haplotype is significant, as it suggests

possible pathogenic mechanisms, such as the interaction of gram-

negative bacteria with HLA class I antigens in triggering anterior

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

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uveitis. However, it is important to note that antibiotic treatment has

not been shown to improve or reduce the recurrence of these

inflammatory episodes (Fuseau et al., 2023).

Patients with anterior uveitis, either with or without associated

sacroiliitis, have been observed to have non-symptomatic intestinal

inflammatory infiltrates.

Intermediate uveitis

The main focus of inflammation is located in the vitreous humor.

Clinical symptoms include blurred vision, the presence of floaters and

sensitivity to light. Representative origins include malignant

neoplasms, sarcoidosis and multiple sclerosis. Pars planitis, which is

the idiopathic form of intermediate uveitis, is characterized by the

presence of "snow banks" (white exudates over the pars plana and

ora serrata) and "snowballs" (aggregates of inflammatory cells in the

vitreous) (Rosenbaum et al., 2019).

Posterior uveitis

the primary sites of inflammation are the retina and/or choroid,

presenting with focal, multifocal or diffuse manifestations of

choroiditis. Clinical symptoms include floaters, and pain and redness

are generally not experienced. Representative associated diseases

include autoimmune disorders, Behçet's disease, and sarcoidosis

(Rosenbaum et al., 2019).

Panuveitis

The anterior chamber, vitreous humor, and retina and/or choroid are

affected. Clinical symptoms include floaters, pain, redness, and light

sensitivity. Representative associated diseases include autoimmune

disorders, sarcoidosis, Vogt-Koyanagi-Harada syndrome, and

Behçet's disease (Rosenbaum et al., 2019).

Relationship with the microbiome

In the pathophysiology of chronic or recurrent inflammation, the

microbiome may serve as a source of antigens and antigen-specific T

cells. The intestinal microbiota, the most prevalent in humans with

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

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approximately 10^4 microorganisms, is mainly composed of

Firmicutes and Bacteroidetes, followed by Actinobacteria and

Proteobacteria, and to a lesser extent by Fusobacteria and

Verrucomicrobia (Mölzer et al., 2020).This microbiome is established

at birth by maternal transmission and undergoes constant changes to

achieve a homeostatic balance with the host immune system,

influenced by factors such as diet, chronic stress, circadian rhythm,

exposure to drugs, toxins, colonization by other external

microorganisms and various diseases (Kalogeropoulos et al., 2022).

The intestinal microbiota plays a key role in a variety of physiological

functions, including regulation of the immune system by modulating

innate and adaptive responses. Dysbiosis, an alteration in the

composition of the microbiota, can affect the immune system and

induce disease (Colmán et al., 2022).Experimental studies have

evidenced a relationship between dysbiosis and immune-mediated

diseases, and it has been observed that certain bacterial strains can

promote Th17 differentiation in the intestine, being associated with

immune-mediated diseases such as non-infectious uveitis. On the

other hand, some bacterial species favor Treg cell differentiation,

contributing to immune system homeostasis. Dysbiosis has been

linked to the pathogenesis of uveitis through several mechanisms,

including antigenic mimicry, destruction of the intestinal barrier due

to increased permeability of the intestine, loss of immune

homeostasis at the intestinal level, and reduced synthesis of anti-

inflammatory metabolites (Colmán et al., 2022).

Diseases Associated with Uveitis

Ankylosing spondylitis: genetically associated with HLA-B27 in a high

percentage of patients, it presents a 30% incidence of anterior uveitis,

being more frequent in men. Arthritis is the main manifestation, and

response to treatment with topical steroids is common (Guajardo,

2019).

Juvenile rheumatoid arthritis: this disease, the most commonly

associated with uveitis, presents with diverse symptoms, including

anterior uveitis, keratitis and secondary cataracts. The pauciarticular

form is the most prevalent, affecting more girls than boys.

Rheumatoid factor is generally negative, and treatment may include

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

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topical steroids, systemic steroids, azathioprine and cyclosporin

(Huguet Rodriguez et al., 2022).

Inflammatory Bowel Disease: Anterior uveitis is the most common

manifestation in this disease, with a frequency of 60% in HLA-B27

positive individuals. In Crohn's disease, uveitis may be bilateral,

chronic and associated with retinal vasculitis.

Psoriasis Approximately 7% of patients with psoriasis develop

arthritis, and 7% of these patients develop uveitis (Mudie et al., 2022)

Sarcoidosis: affects up to 20% of patients initially ocular, presenting

uveitis in 7% of cases. It can be anterior, posterior or intermediate,

the latter being less frequent (Davis, 2020).

Behcet's disease: mainly affects the posterior segment of the eye, and

recurrent iridocyclitis is the most significant ocular manifestation. It is

more common in females, with a high probability of bilateral

presentation (Contreras Abarca et al., 2020).

Multiple sclerosis: demyelination of the optic nerve leads to optic

neuritis, and uveitis occurs in a range of 2.4 to 27%, manifesting as

peripheral uveitis (Guajardo, 2019).

Vogt-Koyanagi-Harada syndrome: this bilateral and diffuse panuveitis

with retinal detachment is more common in Asians. It presents with

blurred vision and multifocal manifestations in the choroid, followed

by a chronic phase characterized by choroidal depigmentation. It is

the second leading cause of uveitis in Saudi Arabia and accounts for

9.2% in Japan (Lam et al., 2020).

The intrinsic connection between rheumatic diseases and ocular

complications is an important and complex facet that requires a

comprehensive understanding.

In a study conducted by (Guajardo, 2019)highlights that patients

suffering from Ankylosing Spondylitis (AS) experience uveitis in

approximately 25% of cases throughout their disease. In a significant

number of cases, uveitis may manifest as the first symptom of the

disease, and in many other cases, it helps to identify a barely

symptomatic low back pain.

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

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In 80% of cases, both eyes are affected, although they rarely become

inflamed simultaneously. For this reason, it is classified as a unilateral

uveitis in each episode, although flare-ups may affect both eyes at

different times. This type of uveitis is predominantly anterior, i.e., an

iritis or iridocyclitis, and its course is acute, presenting symptoms such

as pain, red eye, photophobia and decreased vision. (Guajardo, 2019)

(Fanlo et al., 2021) states that the use of the slit lamp (biomicroscopy)

facilitates the observation of aqueous humor turbidity caused by

excess proteins and cells. These cells may also adhere to the posterior

aspect of the cornea, resulting in retrokeratotic precipitates. Uveitis

tends to be recurrent, with some patients experiencing monthly flare-

ups.

It is characteristic for those who have had multiple flare-ups to

perceive the approach of a recurrence up to 24 hours earlier, even

when the slit lamp examination is apparently normal. Decreased

vision during the attack is primarily due to a clouding of the aqueous

humor and occasionally to secondary macular edema. In addition, the

iris tends to adhere to the lens (posterior synechiae) and to the corneal

periphery (anterior synechiae) as a result of the inflammatory process

(Kemeny-Beke & Szodoray, 2020)..

On the other hand, (Sabat, 2020) in his research, details that (AD)

affects males more frequently, with an incidence of approximately 2.5

to 3 times more than in females. Women generally experience a

milder form of the disease, with more peripheral joint involvement.

(Fuseau et al., 2023)in their research on Reiter's syndrome (RS),

characterizes the triad of arthritis, urethritis and conjunctivitis. It affects

mainly males, and joint manifestations may include tenosynovitis,

plantar fasciitis, sacroiliitis and inflammatory oligoarthritis. Uveitis

occurs in 3-12% of cases and is similar to that seen in patients with

AS.

(Bertrand et al., 2019)according to an observational study involving

7641 patients, 55.8% manifested ocular symptoms, with anterior and

posterior uveitis standing out as the most frequent, affecting 41% and

46%, respectively. Retinal vasculitis, cataracts and conjunctivitis

affected 33%, 24% and 6% of patients, respectively.

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

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Regarding Behçet's syndrome (Contreras Abarca et al., 2020)states

that it is characterized by non-granulomatous intraocular inflammation

and retinal vasculitis of intermittent course, presenting as recurrent

self-limited exacerbations, which generate a potentially irreversible

cumulative damage. In his study, he has observed that ocular damage

tends to be more pronounced in men than in women, arising on

average between 2 and 3 years after the onset of symptomatology.

Initially, it manifests unilaterally and progresses to bilateral

involvement, both symmetrically and asymmetrically. It has been

shown that up to 8.6% of patients debut with ocular symptoms as their

first manifestation. Uveitis stands out as one of the most frequently

reported conditions, underscoring the importance of performing a

thorough differential diagnosis during evaluation. This uveitis can

involve both the anterior and posterior segments, or even both

simultaneously (panuveitis). (Contreras Abarca et al., 2020).

Psoriatic arthropathy affects about 30% of patients with psoriatic

arthritis, according to. (Hysa et al., 2021)and up to 30% of these

experience ocular involvement. Conjunctivitis occurs in 20% of cases,

while unilateral relapsing acute anterior relapsing uveitis manifests in

7-10%. Ocular involvement is more frequent in male patients with

psoriasis of the scalp or ciliary areas, and in those with arthritis,

especially sacroiliitis and spondylitis. (Barbini et al., 2023).

Inflammatory Bowel Disease (IBD), which includes Ulcerative Colitis

(UC) and Crohn's Disease (CD), is a chronic disorder of unknown

etiology, (Kalogeropoulos et al., 2022b)reports that the incidence of

these diseases is 10.4 and 5.6 per 100,000 inhabitants/year,

respectively. Genetic factors and external triggers are believed to be

involved in their development, and clinical manifestations can affect

any part of the gastrointestinal tract. Ocular manifestations in IBD

vary, and the incidence ranges from 3.5 to 11.8%. Episcleritis and

scleritis are most common, but there may also be corneal

involvement, uveitis and other complications. As for Rheumatoid

Arthritis (RA). (Giancane et al., 2016), evidence that, between 20-35%

of patients may develop ocular manifestations, such as uveitis,

keratoconjunctivitis sicca, episcleritis, scleritis and corneal

involvement. Corneal involvement can present in different forms, such

as corneal ulcers and peripheral corneal thinning. Treatment focuses

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 1

on the use of artificial tears and, in severe cases, immunosuppressants

may be required.

For his part, (Rosenbaum et al., 2019), affirms thatin Juvenile

Idiopathic Arthritis (JIA), which corresponds to an inflammatory

connective tissue disease in children, approximately 20% of cases are

associated with chronic uveitis. Although most ocular flares occur

during the first year of JIA, even after several years of joint inactivity,

episodes of uveitis may occur.

Conclusions

Ocular inflammation represents a common clinical manifestation in

several systemic autoimmune diseases, playing a crucial role. Within

this group of pathologies, different clinical entities associated with

specific patterns of uveitis and other ocular manifestations have been

identified. Discriminating patterns have been established linking

particular forms of uveitis, including relapsing unilateral acute anterior

uveitis, with specific systemic diseases, including those of a

rheumatologic nature.

Relapsing unilateral acute anterior uveitis stands out as the most

common presentation in spondyloarthropathies, and can sometimes

act as the initial symptom of a previously undiagnosed underlying

spondyloarthropathy. The identification of uveitis as a possible initial

symptom in some cases of AS such as Behçet's Syndrome,

Inflammatory Bowel Disease (IBD) and Rheumatoid Arthritis (RA),

among others, underscores the need for close collaboration between

rheumatologists and ophthalmologists, this multidisciplinary

approach allows early identification, accurate diagnosis and effective

management of autoimmune diseases and their ocular

manifestations, thus improving the quality of life and prognosis of

those affected. A thorough understanding of these clinical patterns

contributes to more personalized care and the implementation of

specific therapeutic strategies, promoting a comprehensive approach

to the care of patients with these complex medical conditions.

Uveitis as an ophthalmologic manifestation of autoimmune diseases: A detailed analysis of the

clinical implications.

Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 1

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