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      New pharmacotherapy options for noninfectious posterior uveitis

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          Abstract

          Introduction

          Noninfectious inflammation of the posterior eye segment represents an important cause of visual impairment. It often affects relatively young people and causes a significant personal and social impact. Although steroids and nonbiologic-

          Disease-Modifying Antirheumatic Drugs (nbDMARDs) are effective both in acute and long- lasting diseases, however they are increasingly being replaced by biologic (DMARDs). bDMARD. This article therefore aims to identify recent advances in the therapy of noninfectious posterior segment uveitis.

          Methods

          A Medline-search was conducted using the terms: nbDMARD, bDMARD, posterior uveitis, intermediate uveitis, treatment, corticosteroid. In addition, clinical studies were included as registered at ClinicalTrials.gov.

          Results

          Currently two major lines of treatments can be identified: (1) the intraocular application of anti-inflammatory agents and (2) the introduction of new agents, e.g., (bDMARDs) and small-molecule-inhibitors. Whereas intravitreal treatments have the advantage to avoid systemic side effects, new systemic agents are progressively earning credit on the basis of their therapeutic effects.

          Conclusion

          Even when current treatment strategies are still hampered by the limited number of randomized controlled trials, promising progress and continuous efforts are seen.

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          Most cited references105

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          Standardization of Uveitis Nomenclature for Reporting Clinical Data. Results of the First International Workshop

          To begin a process of standardizing the methods for reporting clinical data in the field of uveitis. Consensus workshop. Members of an international working group were surveyed about diagnostic terminology, inflammation grading schema, and outcome measures, and the results used to develop a series of proposals to better standardize the use of these entities. Small groups employed nominal group techniques to achieve consensus on several of these issues. The group affirmed that an anatomic classification of uveitis should be used as a framework for subsequent work on diagnostic criteria for specific uveitic syndromes, and that the classification of uveitis entities should be on the basis of the location of the inflammation and not on the presence of structural complications. Issues regarding the use of the terms "intermediate uveitis," "pars planitis," "panuveitis," and descriptors of the onset and course of the uveitis were addressed. The following were adopted: standardized grading schema for anterior chamber cells, anterior chamber flare, and for vitreous haze; standardized methods of recording structural complications of uveitis; standardized definitions of outcomes, including "inactive" inflammation, "improvement'; and "worsening" of the inflammation, and "corticosteroid sparing," and standardized guidelines for reporting visual acuity outcomes. A process of standardizing the approach to reporting clinical data in uveitis research has begun, and several terms have been standardized.
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            Role of IL-6 and its soluble receptor in induction of chemokines and leukocyte recruitment.

            IL-6-/- mice showed impaired leukocyte accumulation in subcutaneous air pouches. Defective leukocyte accumulation was not due to a reduced migratory capacity of IL-6-/- leukocytes and was associated with a reduced in situ production of chemokines. These observations led to a reexamination of the interaction of IL-6 with endothelial cells (EC). EC express only the gp130 signal transducing chain and not the subunit-specific IL-6R and are therefore unresponsive to IL-6. However, EC are responsive to a combination of IL-6 and soluble IL-6R as measured by the activation of STAT3, chemokine expression, and augmentation of ICAM-1. Activation by IL-6-IL-6R complexes was inhibited by an IL-6 receptor antagonist and potentiated by a superagonist. Hence, in vivo and in vitro evidence supports the concept that the IL-6 system plays an unexpected positive role in local inflammatory reactions by amplifying leukocyte recruitment.
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              2018 update of the EULAR recommendations for the management of Behçet’s syndrome

              Several new treatment modalities with different mechanisms of action have been studied in patients with Behçet's syndrome (BS). The aim of the current effort was to update the recommendations in the light of these new data under the auspices of the European League Against Rheumatism (EULAR) Standing Committee for Clinical Affairs. A task force was formed that included BS experts from different specialties including internal medicine, rheumatology, ophthalmology, dermatology, neurology, gastroenterology, oral health medicine and vascular surgery, along with a methodologist, a health professional, two patients and two fellows in charge of the systematic literature search. Research questions were determined using a Delphi approach. EULAR standardised operating procedures was used as the framework. Results of the systematic literature review were presented to the task force during a meeting. The former recommendations were modified or new recommendations were formed after thorough discussions followed by voting. The recommendations on the medical management of mucocutaneous, joint, eye, vascular, neurological and gastrointestinal involvement of BS were modified; five overarching principles and a new recommendation about the surgical management of vascular involvement were added. These updated, evidence-based recommendations are intended to help physicians caring for patients with BS. They also attempt to highlight the shortcomings of the available clinical research with the aim of proposing an agenda for further research priorities.
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                Author and article information

                Contributors
                uwe.pleyer@charite.de
                nerip@clevelandclinicabudhabi.ae
                christoph.deuter@med.uni-tuebingen.de
                Journal
                Int Ophthalmol
                Int Ophthalmol
                International Ophthalmology
                Springer Netherlands (Dordrecht )
                0165-5701
                1573-2630
                25 February 2021
                25 February 2021
                2021
                : 41
                : 6
                : 2265-2281
                Affiliations
                [1 ]GRID grid.484013.a, Department of Ophthalmology, , Charité – Universitätsmedizin, Berlin Institute of Health, ; 13353 Berlin, Germany
                [2 ]Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
                [3 ]GRID grid.254293.b, ISNI 0000 0004 0435 0569, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, ; Cleveland, OH USA
                [4 ]GRID grid.411544.1, ISNI 0000 0001 0196 8249, Centre for Ophthalmology, , University Hospital, ; 72076 Tuebingen, Germany
                Author information
                http://orcid.org/0000-0002-5569-1473
                Article
                1763
                10.1007/s10792-021-01763-8
                8172489
                33634341
                29b2dc6f-c04b-4b06-91e9-c7baf4d3dcbd
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 29 January 2021
                : 10 February 2021
                Funding
                Funded by: Charité (3093)
                Categories
                Review
                Custom metadata
                © Springer Nature B.V. 2021

                Ophthalmology & Optometry
                bdmard,corticosteroid,nbdmard,tsdmard,therapy,uveitis
                Ophthalmology & Optometry
                bdmard, corticosteroid, nbdmard, tsdmard, therapy, uveitis

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