Proper treatment can preserve vision in Reiter’s syndrome patients

Control of inflammation in patients with ocular manifestations of Reiter’s syndrome can help preserve vision and improve the long-term visual prognosis, according to a study.

Szilard Kiss, MD, and colleagues at the Massachusetts Eye and Ear Infirmary (MEEI) in Boston conducted the noncomparative interventional case series.

Twenty men and 5 women with a mean age of 37 at baseline were followed for an average of 48.5 months. The researchers evaluated the extent of ocular involvement and influence of treatment on clinical outcomes as well as disease recurrence.

According to the study, 85% of the patients tested positive for the human leukocyte antigen B27, and 64% had a positive family history of the disease.

All patients had oligoarthritis and enthesitis, which affected the back in 56% of patients, the Achilles tendon in 52% and the sacroiliac joint in 24%. Additionally, 80% of patients had a history of infection, 68% of whom reported urethritis. A history of mucocutaneous lesions was also reported in 40% of patients.

At the time of referral to the MEEI, all patients had ocular involvement, which was unilateral in 68%. Of the involvement, 84% showed evidence of uveitis, 3% showed scleritis, 2% showed conjunctivitis, and 1% showed pars planitis and iridocyclitis.

The authors noted that conjunctivitis developed in 96% and anterior uveitis developed in 92% of patients during the course of follow-up. Additionally, posterior uveitis and keratitis developed in 64%, cataract in 56%, intermediate uveitis in 40%, scleritis and cystoid macular edema in 28%, and both papillitis and glaucoma in 16%.

All patients underwent systemic treatment for ocular inflammation, with 96% receiving nonsteroidal anti-inflammatory drugs. Corticosteroids were also used in 80% of patients, with 64% requiring systemic prednisone.

Immunosuppression with methotrexate was also initiated in 52% of patients, and seven patients required additional immunosuppressive agents.

The authors note that visual acuity in the study population was generally preserved, with even a slight improvement being evident. Initial visual acuity averaged 20/25 in the right eye and 20/30 in the left eye. At final follow-up, average visual acuity remained 20/25 in the right eye, but improved to an average 20/25 in the left eye. “This maintenance was accomplished only with the use of multiple systemic treatment methods, including immunosuppression, to control the chronic ocular inflammation,” the study authors wrote in the September issue of Ophthalmology.