Treatment of Tubulointerstitial Nephritis and Uveitis Syndrome

Initial Treatment Approach

The American College of Rheumatology conditionally recommends beginning with prednisolone acetate 1% topical drops for anterior uveitis component, as this is preferred over other topical steroid formulations 1, 2
For short-term control of active uveitis, adding or increasing topical glucocorticoids is conditionally recommended over immediately adding systemic glucocorticoids, with a strength of evidence based on clinical guidelines from the American College of Rheumatology 1, 3
Limiting topical glucocorticoid therapy to ≤3 months when possible is recommended to minimize risk of complications such as elevated intraocular pressure and cataract formation, based on practical summaries from medical insights 4

If topical glucocorticoids are required for >3 months at 1-2 drops/day, adding systemic therapy is conditionally recommended to allow tapering of topical steroids, according to guidelines from the American College of Rheumatology 1, 2
For patients with severe active uveitis and sight-threatening complications, consider starting both methotrexate and a monoclonal antibody TNF inhibitor immediately, as recommended by the American College of Rheumatology 1, 3
Methotrexate (preferably subcutaneous route) is the first-line systemic immunomodulator for refractory cases, as conditionally recommended by the American College of Rheumatology 1, 3

For patients with controlled uveitis on therapy, ophthalmologic monitoring should occur no less frequently than every 3 months, as recommended by the American College of Rheumatology 1, 3
When tapering topical glucocorticoids, ophthalmologic monitoring within 1 month after each change in topical therapy is strongly recommended by the American College of Rheumatology 1, 3

For patients with well-controlled uveitis on systemic therapy, maintain treatment for at least 2 years before attempting to taper, as recommended by the American College of Rheumatology 6, 7
When tapering therapy in patients on both topical and systemic treatments, taper topical glucocorticoids first before tapering systemic therapy, according to guidelines from the American College of Rheumatology 6, 7