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Autoimmun Rev. 2018 Apr;17(4):331-343. doi: 10.1016/j.autrev.2017.10.018. Epub 2018 Feb 7.

Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis).

Author information

1
Hospices Civils de Lyon, Croix-Rousse Hospital, Department of Internal Medicine, Lyon, France. Electronic address: pierre.grumet@chu-lyon.fr.
2
Hospices Civils de Lyon, Croix-Rousse Hospital, Department of Ophthalmology, Lyon, France.
3
Hospices Civils de Lyon, Croix-Rousse Hospital, Department of Internal Medicine, Lyon, France.
4
Department of Ophthalmology, Quinze-Vingts Hospital, Paris, France.
5
Department of Internal Medicine, Quinze-Vingts Hospital, Paris, France.
6
Department of Internal Medicine, Saint Joseph Saint Luc Hospital, Lyon, France.
7
Department of Ophthalmology, Val d'Ouest Hospital, Lyon, France.
8
Department of Ophthalmology, Hospital Montpellier, France.
9
Department of Internal Medicine, Hospital Montpellier, France.
10
Department of Ophthalmology, Pierre-Paul Riquet Hospital, Toulouse, France.
11
Department of Internal Medicine, Purpan University Hospital, Toulouse, France.
12
Department of Internal Medicine, North Hospital, Saint-Étienne, France.
13
Department of Ophthalmology, North Hospital, Saint-Étienne, France.
14
Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France.
15
Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France.
16
Department of Ophthalmology, Archet Hospital, Nice, France.
17
Department of Internal Medicine, Archet Hospital, Nice, France.
18
Department of Internal Medicine, Gabriel-Montpied Hospital, Clermont-Ferrand, France.
19
Department of Ophthalmology, Gabriel-Montpied Hospital, Clermont-Ferrand, France.
20
Department of Internal Medicine, General Hospital, Dijon, France.
21
Department of Ophthalmology, General Hospital, Dijon, France.
22
Department of Ophthalmology, University Hospital, Rennes, France.
23
Department of Internal Medicine, Saint Joseph Hospital, Marseille, France.
24
Hospices Civils de Lyon, Pole IMER, Lyon, France.
25
Department of Ophthalmology, Bicêtre Hospital, Kremlin-Bicêtre, France.

Abstract

PURPOSE:

ULISSE is the only study that prospectively assessed the efficiency of a standardized strategy, compared to an open strategy for the etiologic diagnosis of uveitis. Our aim was to evaluate the diagnostic yield of the tests prescribed in the ULISSE study to clarify their relevance.

METHODS:

ULISSE is a non-inferiority, prospective, multicenter and cluster randomized study. The standardized strategy is a two-steps strategy: in the first step, common standard tests were performed, and in the second step, tests were guided by the clinical and anatomic type of uveitis. We reported the relevance of the diagnostic tests used in the standardized strategy, as well as the profitability of the tests that were prescribed to more than twenty patients in each group. Based on diagnostic criteria, either an ophthalmologist, or an internist, established the profitability of a test by considering whether the test lead to a diagnosis or not.

RESULTS:

Among the 676 patients included (standardized 303; open 373), a diagnosis was made for 152 (50.4%) in the standardized group and 203 (54.4%) in the open group. The most common entities were HLA-B27 associated uveitis (22%), spondyloarthritis (11%), sarcoidosis (18%), tuberculosis (10.7%) and herpes virus infections (8.5%). Among the first step's systematic tests, tuberculin skin test was the most contributive investigation (17.1%), followed by chest X-ray (8.4%), C reactive protein and ESR (6.6% and 5.1%), complete blood count (2.2%) and VDRL (2.0%). The second step's most often contributive tests were: HLA B27 (56.3%), chest-CT (30.3%) and angiotensin converting enzyme (ACE) (16.5%). HLA B27 and ACE were significantly more contributive in the standardized group than in the open group. Immunological tests were never contributive. Among the free investigations, or among the investigations guided by clinical or paraclinical findings, the most often contributive tests were: Quantiferon® (24%), electrophoresis of serum protein (7.8%) and sacroiliac imagery (46.4%). Intracellular serologies (1.7%), serum calcium (2.1%) and hepatic tests (3.3%) were exceptionally contributive. Among the third intention tests, labial salivary gland biopsies were contributive in 17.9% of cases, but the profitability of other invasive investigations (anterior chamber tap, vitrectomy, bronchoscopy and lumbar puncture) or specialized imagery (18F-FDG PET, Brain MRI) could not be determined since these test were rarely performed.

CONCLUSION:

Only a few diagnostic tests are useful for the etiological assessment of uveitis. They are often cheap, simple, more often guided by the clinical findings, and lead to an etiological diagnosis in most patients. On the other hand, some tests are never or exceptionally contributive, such as immunological tests or intracellular serologies. Further studies are required to evaluate the profitability of third intention imagery and invasive investigations.

KEYWORDS:

Diagnosis; Epidemiology; Etiology; Recommendations; Standardized strategy; Uveitis

PMID:
29427823
DOI:
10.1016/j.autrev.2017.10.018
[Indexed for MEDLINE]

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