Multiple Sclerosis-associated Uveitis

Bryn M Burkholder; James P Dunn

Disclosures

Expert Rev Ophthalmol. 2012;7(6):587-594. 

In This Article

Abstract and Introduction

Abstract

Uveitis is uncommon in patients with multiple sclerosis (MS), but the link between the two entities is clearly established. While a common etiology or pathologic process remains unknown, shared human leukocyte antigens suggest a genetic predisposition. The treatment for MS-associated uveitis is not distinct from treatment of other types of noninfectious uveitis, but interferons may serve as a common therapeutic avenue for both CNS and eye disease. Further study is needed to better understand MS-associated uveitis and its link to demyelinating CNS disease.

Introduction

Multiple sclerosis (MS) is a chronic demyelinating disease of the CNS that has a wide variety of ophthalmic and neuro-ophthalmic manifestations. The diagnosis of MS is defined by the presence of demyelinating lesions, separated by time and space, in the brain and spinal cord.[1,2] MS classically presents in young females between the ages of 20 and 50 but can be seen in children and older adults as well.[3,4] Overall disease prevalence is estimated to be 120 per 100,000, but significant geographic variation exists.[5] MS has been characterized into four different subtypes, which include relapsing/remitting, primary progressive, secondary progressive and relapsing progressive, depending on the time course and progression of neurologic disability.[6] The pathophysiology of MS likely involves a complex interplay between genetic and environmental factors, which are still incompletely identified.[5] Although significant advances have been made in the treatment of MS in recent years, the disease remains a major cause of disability and economic burden.[3]

The association between MS and uveitis is well known and was reported as early as 1947.[7] Many of the descriptions of MS-associated uveitis come from studies of patients with pars planitis, a type of intermediate uveitis characterized by vitritis and inflammatory exudates (snowbanks) on the pars plana. Although pars planitis is, by definition, an idiopathic process without any known underlying systemic associations,[8] some patients initially diagnosed with pars planitis will subsequently develop MS.[9–12] The literature is confusing in this regard, in that some studies that assess the risk of development of MS in patients with uveitis have looked at all patients with uveitis, whereas others have looked only at that subset of patients with intermediate uveitis. Furthermore, many of the studies did not utilize or predate the availability of MRI. Studies describing uveitis in patients with MS have generally found that intermediate uveitis is the most common manifestation. Consequently, it is difficult to predict the risk of developing MS after uveitis and over what period of time any such risk is increased. In contrast, the risk of developing MS after optic neuritis (based on a combination of demographic information, ophthalmic features, neurological signs and symptoms, and MRI findings) is much better understood.[13–15]

This review summarizes the published literature on uveitis in patients with MS. The authors describe the demographics, clinical features and histopathology of MS-associated uveitis, as well as genetic factors in this disease and the risk for developing MS in patients with pars planitis. The authors have tried to differentiate between patients with MS-associated uveitis and those with pars planitis, only some of whom will ultimately develop MS. Finally, the authors will review potential therapeutic options and considerations in treating both MS and uveitis concurrently.

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