ABSTRACT
BACKGROUND: Juvenile idiopathic arthritis (JIA)-associated uveitis typically presents as a silent chronic anterior uveitis and can lead to blindness. Adherence to current screening guidelines is hampered by complex protocols which rely on the knowledge of specific JIA characteristics. The Multinational Interdisciplinary Working Group for Uveitis in Childhood identified the need to simplify screening to enable local eye care professionals (ECPs), who carry the main burden, to screen children with JIA appropriately and with confidence. METHODS: A consensus meeting took place in January 2023 in Barcelona, Spain, with an expert panel of 10 paediatric rheumatologists and 5 ophthalmologists with expertise in paediatric uveitis. A summary of the current evidence for JIA screening was presented. A nominal group technique was used to reach consensus. RESULTS: The need for a practical but safe approach that allows early uveitis detection was identified by the panel. Three screening recommendations were proposed and approved by the voting members. They represent a standardised approach to JIA screening taking into account the patient's age at the onset of JIA to determine the screening interval until adulthood. CONCLUSION: By removing the need for the knowledge of JIA categories, antinuclear antibody positivity or treatment status, the recommendations can be more easily implemented by local ECP, where limited information is available. It would improve the standard of care on the local level significantly. The proposed protocol is less tailored to the individual than the 'gold standard' ones it references and does not aim to substitute those where they are being used with confidence.
ABSTRACT
INTRODUCTION: Ibrutinib is a small-molecule drug approved for the treatment of haematological disorders and is known to be associated with visual disturbances, but uveitis has not yet been reported as an adverse effect of this medication. We present two cases of ibrutinib-associated severe uveitis in patients with chronic lymphocytic leukaemia. CASE DESCRIPTION: Our first case is a 65-year-old woman who presented with acute onset of bilateral fibrinous anterior uveitis 1 day after starting ibrutinib. Her vision was hand movements in the right eye and 20/120 in the left with hyperaemic discs and subretinal fluid. Ibrutinib was stopped and she experienced a significant improvement under local and oral steroid treatment. The second case is a 64-year-old male with subacute onset of bilateral hypertensive anterior uveitis with pupillary seclusion and right eye hyphaema. He was on ibrutinib for the past 9 months. His vision at presentation was 20/80 and 20/60 for the right and left eye, respectively. He responded poorly to local steroid treatment until ibrutinib was stopped due to cardiac side-effects, after which his uveitis resolved and treatment was stopped. CONCLUSION: The temporal association between changes in ibrutinib treatment and our patients' ocular inflammation suggests a causative link. Ibrutinib increases Th1-based immune responses which is proposed as a mechanism for drug-induced uveitis. Its antiplatelet effect may explain the fibrinous nature of the inflammation and hyphaema.
Subject(s)
Uveitis, Anterior , Uveitis , Adenine/analogs & derivatives , Aged , Female , Humans , Hyphema , Inflammation , Male , Middle Aged , Piperidines , Uveitis/chemically induced , Uveitis/diagnosis , Uveitis/drug therapy , Uveitis, Anterior/chemically induced , Uveitis, Anterior/diagnosis , Uveitis, Anterior/drug therapy , Vision DisordersABSTRACT
Esse estudo parte do pressuposto de que o mindfulness poderia estar relacionado com a intimidade conjugal. Investigou-se o papel discriminante da intimidade em dois grupos de indivíduos com maiores e menores níveis de mindfulness. Partiparam 281 sujeitos, maiores de 18 anos, em relacionamento estável e em coabitação. Os mesmos responderam à Escala Filadélfia de Mindfulness e à Escala de Avaliação Pessoal de Intimidade em Relacionamentos (PAIR). Os resultados indicaram que os fatores da intimidade avaliados (comunicação, validação pessoal e abertura ao exterior) discriminaram o grupo com maiores níveis de mindfulness. O estudo sugere que indivíduos com maiores níveis de mindfulness possuem maior facilidade de desenvolver intimidade em seus relacionamentos, contribuindo para o entendimento do papel considerável dessa habilidade na conjugalidade.
This study assumes that mindfulness could be related to conjugal intimacy. The discriminating role of intimacy was investigated in two groups of individuals with higher and lower levels of mindfulness. 281 subjects, over 18 years old, participated in a stable relationship and cohabitation. They responded to the Philadelphia Mindfulness Scale and the Personal Relationship Intimacy Scale in Relationships (PAIR). The results indicated that the factors of intimacy evaluated (communication, personal validation and openness to the outside) discriminated against the group with the highest levels of mindfulness. The study suggests that individuals with higher levels of mindfulness have an easier time developing intimacy in their relationships, contributing to the understanding of the considerable role of this ability in conjugality.
Este estudio asume que la atención plena podría estar relacionada con la intimidad conyugal. El papel discriminador de la intimidad se investigó en dos grupos de individuos con niveles más altos y más bajos de atención plena. 281 sujetos, mayores de 18 años, participaron en una relación estable y en convivencia. Respondieron a la Escala de atención plena de Filadelfia y la Escala de intimidad en las relaciones personales (PAIR). Los resultados indicaron que los factores de intimidad evaluados (comunicación, validación personal y apertura al exterior) discriminaban al grupo con mayores niveles de mindfulness. El estudio sugiere que las personas con niveles más altos de atención plena tienen más facilidad para desarrollar la intimidad en sus relaciones, lo que contribuye a comprender el papel considerable de esta capacidad en la conyugalidad.
