The management of adult and paediatric uveitis for rheumatologists

Uveitis encompasses multiple different conditions that are all characterized by intra-ocular inflammation. Uveitis occurs in the context of many different rheumatological conditions and carries a substantial risk to vision. Uveitis can develop both at the early stages of rheumatic diseases, sometimes even preceding other clinical features, and at later stages of disease. Uveitis can also occur as either a direct or an indirect complication of therapies used to treat patients with rheumatic disease. Conversely, patients with uveitis of non-rheumatic aetiology sometimes require immunosuppression, a treatment option that is not readily accessible to ophthalmologists. Thus, collaborative working between rheumatologists and ophthalmologists is critical for optimal management of patients with uveitis. This Review is written with rheumatologists in mind, to assist in the care of patients with uveitis. We collate and summarize the latest evidence and best practice in the diagnosis, management and prognostication of uveitis, including future trends and research priorities. This Review provides an overview of the pathogenesis, classification and diagnosis of and treatment strategies for adult and paediatric rheumatology patients with uveitis. The authors highlight the importance of collaborations between ophthalmologists and rheumatologists to provide optimal treatment of uveitis, improve patient care and enhance future research. Uveitis accounts for up to 10% of visual impairment globally, highlighting the need for prompt recognition and management.TNF inhibitors have significantly improved outcomes in both adult and paediatric uveitis, with the strongest evidence for adalimumab. An exception is etanercept, which worsens uveitis.The second-line biologic option for uveitis is IL-6 inhibitors, with intravenous tocilizumab having the most substantial supporting evidence.Collaborative work between rheumatologists and ophthalmologists is critical for optimal management of uveitis.More trials are needed in uveitis, as there is a wide array of novel molecules available for systemic rheumatic diseases that should be explored for therapeutic use in uveitis.