Management of Uveitis in Patients with High Risk of Recurrence

Initial Diagnostic Workup and Treatment Approach

The American College of Rheumatology recommends obtaining rheumatology consultation for evaluation of axial and peripheral joint involvement, even in the absence of current symptoms, given a strong family history of ankylosing spondylitis 2
The American Academy of Ophthalmology suggests starting prednisolone acetate 1% eye drops for immediate inflammation control, but recognizes this is only short-term bridging therapy (≤3 months maximum) 3, 4
The European League Against Rheumatism recommends initiating subcutaneous methotrexate 15-25 mg weekly immediately, rather than waiting for topical steroid failure, given a high risk of recurrent disease 1, 4

The American College of Rheumatology recommends adding monoclonal anti-TNF antibody (adalimumab or infliximab) if inflammation persists after 3 months on methotrexate 1, 4
The American Academy of Ophthalmology suggests that monoclonal antibodies (adalimumab/infliximab) are strongly preferred over etanercept for HLA-B27-associated uveitis, due to etanercept's lack of efficacy and potential to paradoxically worsen inflammation 4, 5

The American Academy of Ophthalmology recommends ophthalmologic examination every 3 months minimum while on stable systemic therapy, and within 1 month follow-up after any medication change or dose adjustment 1, 3
The European League Against Rheumatism suggests a minimum 2 years of completely inactive disease off all topical steroids before considering tapering systemic immunosuppression 1
The American College of Rheumatology recommends tapering topical glucocorticoids first before reducing systemic therapy when disease is controlled 3