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T and B lymphocytes in patients with acute anterior uveitis and ankylosing spondylitis, and in their household contacts
344
Surv
CURRENT
Ophthalmol 25 (5) March-April 1981
OPHTHALMOLOGY
neoplasm in the Hereford breed has permitted use as an animal model for this disease. The authors describe the results of a new modality of therapy for ocular squamous cell carcinoma. This treatment can now be added to the existing methods including surgical excision, cryotherapy and radiation therapy. Hyperthermia utilizes minimal anesthesia and low-cost instrumentation. It reduces the need for tissue excision and offers encouraging results. While these advantages make this method potentially useful in agribusiness, its applications may be limited in human oncology. Nevertheless, selected patients may benefit from a noninvasive procedure for treatment of superficial neoplasms of the eyelids and conjunctiva. KIRK N. GELATT
T and B Lymphocytes in Patients with Acute Anterior Uveitis and Ankylosing Spondylitis, and in Their Household Contacts, by N.A. Byrom, J.R. Hobbs, D.M. Timlin, M.A. Cambell, A.J. Dean, M. Webley, and D.A. Brewerton. Lancet ii:601-603, 1979 Dr. Brewerton and his colleagues studied immunological changes during attacks of acute anterior uveitis. The mean total T-lymphocytes/F1 were 1125 in controls. During first attacks of uveitis, the mean totals were: 1217 at O-10 days, 981 at 1l-20 days, and 722 after 20 days (a highly significant decrease). The T-lymphopenia was still present at one year, long after the clinical evidence of disease had subsided. These findings suggest the possibility of a persistent viral infection. As might be expected, patients suffering recurrences had a T-lymphopenia at the onset of subsequent attacks. In the asymptomatic household contacts of uveitis patients, there was a T-lymphopenia which persisted for up to 3 months and then disappeared. This temporary T-lymphopenia occurred equally in sexual and nonsexual contacts, and in those who were not relatives of the patients, suggesting an infective agent that is widespread and not necessarily sexually transmitted. Presumably the infective agent caused overt disease only in the small proportion of individuals who were genetically predisposed. A similar degree of T-lymphopenia was recorded in patients with ankylosing spondylitis, a disease that is genetically and clinically closely associated with uveitis. These studies of uveitis and spondylitis are being extended in an effort to elucidate the nature of the agents apparently responsible. (Abstract by D. Brewerton)
Comment Since 1973, the HLA B27 antigen has been found in a high percentage of patients with acute anterior uveitis: 52% (Brewerton et al: Lancet 2:994, 1973); 71% (Editorial: Br Med J, Sept. 2, 1978); and 54% (Mapstone et al. Lnncet, April 13, p 68 I, 1974). HLA B27 is a hereditary marker in the form of antigens on the surface of nucleated cells, which makes the individual predisposed to certain diseases. About 1% of those with HLA B27 might be expected to develop acute anterior uveitis (Brewerton: Ann Rheum Dis 34:Suppl, p 33, 1975). Relative risk for uveitis in HLA B27 positive individuals is 14.4 (Woodrow et al: Ann Rheum Dis 37.504-509, 1978). Thus, other factors must be involved in the pathogenesis of acute anterior uveitis. Some patients with HLA B27 develop no apparent disease. Others develop only acute anterior uveitis; ankylosing spondylitis with or without acute anterior uveitis; Reiter’s disease, etc. Family studies illustrate the underlying genetic basis of these various syndromes. The available evidence suggests that the frequency of arthritic complaints associated with Yersinia enterocolitica (Ahvenon et al: Acta Rheum Ophthalmol Scan 15:232-253, 1969) is greater with Salmonella or Shigella infections (Brewerton: J Clin Puthol31: Suppl(Roy CONPath) I2:I 17-119, 1978). The Yersiniu agglutination reaction was investigated on 114 consecutive patients with uveitis and was most frequently positive in acute fibrinous iritis (40.7%). Tetracycline might be attempted in cases with positive Yersinia type III reactions (Norn: Ugeskrift for Lueger 142(13), 1980). Aho et al found HLA B27 in 43 of 49 patients with Yersiniu arthritis and in 36 of 40 with Reiter’s disease. The typical patient with yersinia arthritis is acutely ill with a leukocytosis with predominantly polymorphnuclear leukocytes (Ann Rheum Dis 34:Suppl 1:29-30, 1975). The latest results of the Brewerton group are exciting in that they incriminate a virus as another possible association with acute anterior uveitis. The differentiation of which acute anterior uveitis is associated with virus infection and which with such infections as Klebsieliu or Yersiniu may prove important for therapeutic reasons. T. F. SCHLAEGEL, JR.
Surv
CURRENT
Ophthalmol 25 (5) March-April 1981
OPHTHALMOLOGY
neoplasm in the Hereford breed has permitted use as an animal model for this disease. The authors describe the results of a new modality of therapy for ocular squamous cell carcinoma. This treatment can now be added to the existing methods including surgical excision, cryotherapy and radiation therapy. Hyperthermia utilizes minimal anesthesia and low-cost instrumentation. It reduces the need for tissue excision and offers encouraging results. While these advantages make this method potentially useful in agribusiness, its applications may be limited in human oncology. Nevertheless, selected patients may benefit from a noninvasive procedure for treatment of superficial neoplasms of the eyelids and conjunctiva. KIRK N. GELATT
T and B Lymphocytes in Patients with Acute Anterior Uveitis and Ankylosing Spondylitis, and in Their Household Contacts, by N.A. Byrom, J.R. Hobbs, D.M. Timlin, M.A. Cambell, A.J. Dean, M. Webley, and D.A. Brewerton. Lancet ii:601-603, 1979 Dr. Brewerton and his colleagues studied immunological changes during attacks of acute anterior uveitis. The mean total T-lymphocytes/F1 were 1125 in controls. During first attacks of uveitis, the mean totals were: 1217 at O-10 days, 981 at 1l-20 days, and 722 after 20 days (a highly significant decrease). The T-lymphopenia was still present at one year, long after the clinical evidence of disease had subsided. These findings suggest the possibility of a persistent viral infection. As might be expected, patients suffering recurrences had a T-lymphopenia at the onset of subsequent attacks. In the asymptomatic household contacts of uveitis patients, there was a T-lymphopenia which persisted for up to 3 months and then disappeared. This temporary T-lymphopenia occurred equally in sexual and nonsexual contacts, and in those who were not relatives of the patients, suggesting an infective agent that is widespread and not necessarily sexually transmitted. Presumably the infective agent caused overt disease only in the small proportion of individuals who were genetically predisposed. A similar degree of T-lymphopenia was recorded in patients with ankylosing spondylitis, a disease that is genetically and clinically closely associated with uveitis. These studies of uveitis and spondylitis are being extended in an effort to elucidate the nature of the agents apparently responsible. (Abstract by D. Brewerton)
Comment Since 1973, the HLA B27 antigen has been found in a high percentage of patients with acute anterior uveitis: 52% (Brewerton et al: Lancet 2:994, 1973); 71% (Editorial: Br Med J, Sept. 2, 1978); and 54% (Mapstone et al. Lnncet, April 13, p 68 I, 1974). HLA B27 is a hereditary marker in the form of antigens on the surface of nucleated cells, which makes the individual predisposed to certain diseases. About 1% of those with HLA B27 might be expected to develop acute anterior uveitis (Brewerton: Ann Rheum Dis 34:Suppl, p 33, 1975). Relative risk for uveitis in HLA B27 positive individuals is 14.4 (Woodrow et al: Ann Rheum Dis 37.504-509, 1978). Thus, other factors must be involved in the pathogenesis of acute anterior uveitis. Some patients with HLA B27 develop no apparent disease. Others develop only acute anterior uveitis; ankylosing spondylitis with or without acute anterior uveitis; Reiter’s disease, etc. Family studies illustrate the underlying genetic basis of these various syndromes. The available evidence suggests that the frequency of arthritic complaints associated with Yersinia enterocolitica (Ahvenon et al: Acta Rheum Ophthalmol Scan 15:232-253, 1969) is greater with Salmonella or Shigella infections (Brewerton: J Clin Puthol31: Suppl(Roy CONPath) I2:I 17-119, 1978). The Yersiniu agglutination reaction was investigated on 114 consecutive patients with uveitis and was most frequently positive in acute fibrinous iritis (40.7%). Tetracycline might be attempted in cases with positive Yersinia type III reactions (Norn: Ugeskrift for Lueger 142(13), 1980). Aho et al found HLA B27 in 43 of 49 patients with Yersiniu arthritis and in 36 of 40 with Reiter’s disease. The typical patient with yersinia arthritis is acutely ill with a leukocytosis with predominantly polymorphnuclear leukocytes (Ann Rheum Dis 34:Suppl 1:29-30, 1975). The latest results of the Brewerton group are exciting in that they incriminate a virus as another possible association with acute anterior uveitis. The differentiation of which acute anterior uveitis is associated with virus infection and which with such infections as Klebsieliu or Yersiniu may prove important for therapeutic reasons. T. F. SCHLAEGEL, JR.