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SHORT REPORT Multiple Sclerosis 2008; 14: 415417

Uveitis associated with multiple sclerosis


Julie Le Scanff1, Pascal Sve1, Christel Renoux2, Christiane Broussolle1, Christian Confavreux2
and Sandra Vukusic 2

Our study aimed to determine the frequency of uveitis among MS patients through the Lyon MS
Database and compare the clinical spectrum and time course of MS in patients with or without
uveitis. Twenty-eight patients with uveitis were detected. The prevalence of uveitis in our population
was 0.65% (28/4300). Uveitis preceded onset of MS in 46% of the patients; it occurred simultane-
ously or after MS, in 18% and 36% of the cases, respectively. The topography and timing of uveitis
were not associated with any significant difference in MS course and prognosis. There was no differ-
ence in the course and prognosis in patients with or without uveitis. Multiple Sclerosis 2008; 14:
415417. http://msj.sagepub.com

Key words: multiple sclerosis; uveitis

Introduction de Neurologie since 1957 [5]. Since 1990, data have


been computerized using specific software, the
Uveitis is an inflammation of the uveal tract which European Database for Multiple Sclerosis (EDMUS)
appears unusually in multiple sclerosis (MS) system [5]. Data confidentiality and security were
patients. The reported frequency of uveitis in MS ensured in keeping with the recommendations of
patients varies widely, from 0.4% to 26.9% [1]. the French Commission Nationale Informatique et
Surprisingly, the prevalence of MS in the total pop- Liberts, which gave approval. All patients gave
ulation of patients with uveitis is 12% [1,2]. Two their informed consent for their data to be saved in
large studies have recently investigated the fre- the database.
quency and clinical aspects of uveitis in MS
patients [3,4] and showed conflicting results with Definition of cases
regard to the interval between onset of neurological
and ocular symptoms, and to the patterns of uveitis Uveitis was registered in the EDMUS software as a
associated with MS. Our study presents the clinical symptom of MS. Patients were examined every six
findings for the Lyon Multiple Sclerosis cohort. Our months and were interviewed about the occurrence
aim was first to determine the frequency of uveitis of visual symptoms. Patients with uveitis were auto-
in this large population of MS patients, and second matically extracted and their source medical records
to compare the clinical spectrum and time course were subsequently reviewed for confirmation.
of MS in patients with or without uveitis. Uveitis was classified anatomically according to the
International Uveitis Study Group criteria [6]. Cases
of uveitis not related to MS were excluded.
A series of clinical variables was systematically
Methods assessed for each patient: gender, date of MS onset,
age at MS onset and uveitis onset, type of uveitis,
Patient population and data collection
presence of pars planitis or periphlebitis, and dis-
Patients were identified through the Lyon Multiple ability assessed through the Kurtzke Disability
Sclerosis Database, registered at the Lyon Clinique Status Scale (DSS) [7].

1
Department of Internal Medicine, Hospices Civils de Lyon, Hotel Dieu, 1 place de lHpital, 69288 Lyon Cedex 02,
France and University Claude Bernard Lyon 1, Lyon, France
2
Department of Neurology A and EDMUS Coordinating Center, Hpital Neurologique, Hospices Civils de Lyon, Lyon,
France; INSERM U842, Lyon, France; Universit Lyon 1, Lyon, France
Author for correspondence: P Sve, Department of Internal Medicine, Htel Dieu, 1 place de lHpital, 69288 Lyon
Cedex 02, France. E-mail: pascal.seve@chu-lyon.fr
Received 21 February 2007; accepted 27 July 2007

2008 SAGE Publications 10.1177/1352458507083444


Los Angeles, London, New Delhi and Singapore
416 JL Scanff et al.

Definition of the control group Lyon natural history, without uveitis. MS duration
was similar between the two groups, with a mean of
The control group was identified through the Lyon
12.9 years and 11.5 years, respectively, in patients
natural history cohort of 1844 patients. The database
with and without uveitis (P  0.44). There was no
was locked in 1997, before the first immunoactive
significant difference between patients with and
drugs with proven efficacy in MS were marketed [5].
without uveitis for sex ratio (P  0.49), mean age at
Because this subgroup of patients have been exten-
MS onset (P  0.40), or overall disease course
sively studied, their data are rather exhaustive,
(P  0.44). Median times to reach DSS 4 and DSS 6
which is not always the case for the patients recent-
were respectively 12 and 23.9 years in patients with
ly registered in the database.
uveitis and 11.4 and 24.9 years in patients without
uveitis (P  0.44 and P  0.66, respectively).
Results
Thirty-one of the 4300 patients making up the Discussion
Lyon MS database had experienced uveitis at least
once. Two patients with uveitis associated with The association of MS and uveitis is rare, occurring
HLAB27 antigen and one patient with Fuchs dis- in only 0.65%. Earlier studies reported a higher
ease were excluded. Finally, 28 patients distributed frequency, but two late studies of larger cohorts
into 19 women and 9 men were analyzed. The with neurological symptoms describe a similar
prevalence of uveitis in our population was 0.65% prevalence of 1% (12 out of 1098 patients) [3] and
(28/4300). 1.7% (8 out of 450 patients) [4]. The prevalence of
uveitis in our local area is approximately 38 cases
per 100 000 inhabitants in the general population
Clinical characteristics of MS patients with [8], making uveitis 17 times more common in MS
concomitant uveitis patients.
The detailed clinical characteristics of our 28 Posterior uveitis was the most frequent presenta-
patients are presented in Table 1. MS course was tion in our study, whereas intermediate uveitis and
relapsing-remitting in 20 patients (71.4%) and sec- panuveitis had previously been reported to be the
ondary progressive in eight (28.6%) patients. None most common types of uveitis in MS patients
had progressive onset. Mean age at onset of uveitis referred to uveitis clinics [1]. In other studies
was 29.6 years and mean age at onset of neurologi- however [4,9], anterior and particularly chronic
cal symptoms was 28.1 years. Uveitis preceded neu- bilateral granulomatous anterior uveitis were the
rological symptoms in 13 of the 28 patients most frequent types of uveitis associated with MS.
(46.4%). In five patients (17.9%), neurological and Intermediate uveitis may be difficult to diagnose.
ocular symptoms developed simultaneously. In 10 In our study, as most symptomatic attacks of uveitis
patients (35.7%), uveitis lasted from one to 28 years were not diagnosed in uveitis clinics, we may have
(mean, 10.9 years) after onset of MS. Uveitis preced- underestimated the frequency of pars planitis and,
ing MS onset had no specific (e.g., anatomic) features in some cases, of panuveitis.
and median time to reach DSS was not significantly Malinowski et al. [10] found that 16.2% (/6.2)
different according to the timing of uveitis. patients with pars planitis could develop MS within
Posterior uveitis was the most common present- five years. In our study though, uveitis preceding
ing feature (10 patients, 35.7%). Isolated anterior MS onset had no specific (e.g., anatomic) features.
uveitis was observed in eight patients (28.6%), One explanation for these heterogeneous results
panuveitis in eight patients (28.6%) and intermedi- may be recruitment bias, as most reports have been
ate uveitis in two patients (7.1%). Retinal written by ophthalmologists before assessing
periphlebitis was noted in five patients (17.8%). patients for ocular disorder [1,3]. Differing results
The time course of uveitis was acute in five may also express the broad clinical spectrum of
patients, all with anterior uveitis (1 granulomatous) ocular inflammation in MS. Our series offers the
and chronic (more than 3 months) in 23. Fourteen advantage of being representative of MS patients in
patients (50%) had bilateral uveitis and five our region.
patients showed a relapsing course of uveitis. Our results confirm previous reports of the liter-
Median follow-up was 13 years (range 138). ature on the clinical characteristics of MS patients.
Patients with MS-associated uveitis are usually
young adult or middle-aged Caucasians, most of
Comparative demographic and disease-related
them female. In accordance with Biousses study
characteristics of MS patients with or without uveitis
[3], onset of uveitis usually preceded MS diagnosis
The data of the 28 MS patients with uveitis were or was concomitant. There was no correlation
compared to those of 1553 MS patients from the between the time course of uveitis and MS, and

Multiple Sclerosis 2008; 14: 415417 http://msj.sagepub.com


Uveitis associated with multiple sclerosis 417

Table 1 Clinical characteristics of MS patients with uveitis

Age at uveitis Uveitis Age at MS MS course (at last Follow-up


Patient Sex onset (years) Type of uveitis evolution onset (years) follow-up) (years)

1 M 29 Anterior acute 27 Relapsing-Remitting 2


2 F 31 Anterior acute 35 Relapsing-Remitting 1
3 F 44 Panuveitis chronic 30 Relapsing-Remitting 23
4 F 26 Posterior periphlebitis chronic 38 Relapsing-Remitting 23
5 M 9 Intermediate chronic 12 Secondary-Progressive 19
6 F 27 Intermediate chronic 27 Relapsing-Remitting 11
7 F 23 Anterior acute 34 Relapsing-Remitting 2
8 F 21 Posterior chronic 24 Relapsing-Remitting 19
9 F 25 Anterior granulomatous chronic 27 Relapsing-Remitting 11
10 F 15 Anterior chronic 25 Relapsing-Remitting 19
11 F 30 Panuveitis chronic 22 Secondary-Progressive 21
12 M 51 Anterior acute 39 Secondary-Progressive 13
13 F 25 Posterior chronic 27 Relapsing-Remitting 6
14 M 41 Panuveitis chronic 41 Secondary-Progressive 15
15 M 24 Panuveitis chronic 27 Relapsing-Remitting 5
16 F 33 Anterior acute 42 Relapsing-Remitting 3
17 F 20 Panuveitis chronic 14 Secondary-Progressive 18
18 F 55 Posterior periphlebitis chronic 27 Relapsing-Remitting 30
19 F 8 Posterior chronic 16 Relapsing-Remitting 5
20 F 15 Panuveitis periphlebitis chronic 15 Relapsing-Remitting 4
21 M 46 Posterior periphlebitis chronic 32 Relapsing-Remitting 13
22 F 25 Panuveitis chronic 24 Relapsing-Remitting 13
23 F 44 Panuveitis periphlebitis chronic 40 Relapsing-Remitting 5
24 F 31 Posterior chronic 34 Relapsing-Remitting 13
25 M 26 Anterior chronic 26 Relapsing-Remitting 4
26 M 30 Posterior chronic 31 Secondary-Progressive 15
27 M 27 Posterior chronic 27 Secondary-Progressive 13
28 F 49 Posterior chronic 23 Secondary-Progressive 38

M, male; F, female; UA, anterior uveitis; UP, posterior uveitis; PU, panuveitis; UI, intermediate uveitis; RR, relapsing-remitting;
SP, secondary-progressive

the clinical course or severity of MS. It does not References


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