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      Behçet’s Uveitis: Current Diagnostic and Therapeutic Approach

      review-article
      1 , *
      Turkish Journal of Ophthalmology
      Galenos Publishing
      Behçet’s uveitis, imaging, treatment, biologics, prognosis

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          Abstract

          Behçet’s disease is a chronic, multisystem inflammatory disorder characterized by relapsing inflammation. Although its etiopathogenesis has not yet been clarified, both the adaptive and innate immune systems, genetic predisposition, and environmental factors have all been implicated. It is more frequent and more severe in males in the third and fourth decades of life. The eye is the most frequently involved organ in the course of the disease. Ocular involvement (Behçet’s uveitis) is characterized by bilateral recurrent non-granulomatous panuveitis and occlusive retinal vasculitis. Recurrent inflammatory episodes in the posterior segment may lead to permanent vision loss due to irreversible retinal damage and complications such as macular scarring, macular atrophy, and optic atrophy. Early and aggressive immunomodulatory treatment and the use of biologic agents when needed are crucial for preventing recurrences and improving visual prognosis.

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          Most cited references104

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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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            Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel.

            To provide recommendations for the use of immunosuppressive drugs in the treatment of patients with ocular inflammatory disorders. A 12-person panel of physicians with expertise in ophthalmologic, pediatric, and rheumatologic disease, in research, and in the use of immunosuppressive drugs in patient care. Published clinical study results. Recommendations were rated according to the quality and strength of available evidence. The panel was convened in September of 1999 and met regularly through May 2000. Subgroups of the panel summarized and presented available information on specific topics to the full panel; recommendations and ratings were determined by group consensus. Although corticosteroids represent one of the mainstays in the management of patients with ocular inflammation, in many patients, the severity of the disease, the presence of corticosteroid side effects, or the requirement for doses of systemic corticosteroids highly likely to result in corticosteroid complications supports the rationale for immunosuppressive drugs (for example, antimetabolites, T-cell inhibitors, and alkylating agents) being used in the management of these patients. Because of the potential for side effects, treatment must be individualized and regular monitoring performed. With careful use of immunosuppressive drugs for treatment of ocular inflammatory disorders, many patients will benefit from them either with better control of the ocular inflammation or with a decrease in corticosteroid side effects.
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              Adalimumab in Patients with Active Noninfectious Uveitis

              Patients with noninfectious uveitis are at risk for long-term complications of uncontrolled inflammation, as well as for the adverse effects of long-term glucocorticoid therapy. We conducted a trial to assess the efficacy and safety of adalimumab as a glucocorticoid-sparing agent for the treatment of noninfectious uveitis.
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                Author and article information

                Journal
                Turk J Ophthalmol
                Turk J Ophthalmol
                TJO
                Turkish Journal of Ophthalmology
                Galenos Publishing
                2149-8695
                2149-8709
                June 2020
                27 June 2020
                : 50
                : 3
                : 169-182
                Affiliations
                [1 ]University of Health Sciences Turkey, Ulucanlar Eye Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
                Author notes
                * Address for Correspondence: University of Health Sciences Turkey, Ulucanlar Eye Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey Phone: +03123126261 E-mail: pinarozdal@ 123456hotmail.com
                Author information
                https://orcid.org/0000-0002-5714-7172
                Article
                39759
                10.4274/tjo.galenos.2019.60308
                7338748
                32631005
                6db9df8d-12b9-4077-8fda-8c7fbee401b5
                © Copyright 2020 by Turkish Ophthalmological Association | Turkish Journal of Ophthalmology, published by Galenos Publishing House.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 August 2019
                : 17 December 2019
                Categories
                Review

                behçet’s uveitis,imaging,treatment,biologics,prognosis
                behçet’s uveitis, imaging, treatment, biologics, prognosis

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