Uveitis

Ankylosing spondylitis is the radiographic axial spondyloarthritis: a chronic, HLA-B27-associated inflammatory disease of the sacroiliac joints, spine, and entheses presenting with inflammatory back pain before age 45. Sacroiliitis on pelvic radiograph or MRI establishes the diagnosis. First-line treatment is continuous scheduled NSAIDs with active exercise, escalating to a tumor necrosis factor inhibitor, then an interleukin-17 inhibitor, when NSAIDs fail.

Reactive arthritis is a sterile, human leukocyte antigen B27 (HLA-B27)-associated spondyloarthritis that follows a genitourinary or enteric infection by 1 to 4 weeks, producing asymmetric lower-limb oligoarthritis, enthesitis, and the urethritis-conjunctivitis-arthritis triad. It is a clinical diagnosis of a culture-negative joint. First-line treatment is an NSAID such as piroxicam for at least 2 weeks, escalating to glucocorticoids and then sulfasalazine or a tumor necrosis factor (TNF) inhibitor for disease persisting beyond 3 to 6 months.

Psoriatic arthritis (PsA) is a seronegative spondyloarthritis that develops in up to 30% of patients with psoriasis, producing asymmetric oligoarthritis or distal interphalangeal joint disease, dactylitis, enthesitis, nail dystrophy, and axial involvement. Diagnosis is clinical, supported by the CASPAR criteria. Limited peripheral disease is treated with an NSAID or intra-articular glucocorticoid, more active disease with methotrexate, a tumor necrosis factor inhibitor, or an interleukin-17 inhibitor.

Behcet disease is a variable-vessel vasculitis, the only vasculitis that can involve arteries and veins of any size, marked by recurrent oral and genital ulceration, uveitis, skin lesions, and pathergy. There is no confirmatory laboratory test; diagnosis is clinical. Treatment is organized by organ severity, from colchicine for mucocutaneous disease to urgent immunosuppression and tumor necrosis factor inhibitors for sight-, organ-, or life-threatening involvement.

Sarcoidosis is a multisystem granulomatous disease of unknown cause defined by noncaseating granulomas, most commonly involving the lungs and hilar lymph nodes. Most patients are asymptomatic or have a self-limited course staged by chest radiograph; symptomatic organ-threatening disease is treated with systemic glucocorticoids, with methotrexate or another steroid-sparing agent added for glucocorticoid-refractory or glucocorticoid-intolerant disease.

Juvenile idiopathic arthritis is arthritis beginning before age 16 and persisting at least 6 weeks with no other identifiable cause, spanning oligoarticular, polyarticular, systemic, enthesitis-related, and psoriatic subtypes. Diagnosis is clinical and antibody-subtyped; treatment starts with an NSAID and escalates through methotrexate to a biologic, while antinuclear-antibody-positive oligoarticular disease requires routine slit-lamp screening for silent chronic anterior uveitis.

Sjogren syndrome is a systemic autoimmune exocrinopathy in which lymphocytic infiltration of the lacrimal and salivary glands causes keratoconjunctivitis sicca and xerostomia, occurring alone (primary) or alongside another rheumatologic disease such as rheumatoid arthritis or lupus (secondary). Diagnosis combines the anti-Ro (SSA) and anti-La (SSB) antibody panel, objective dryness testing, and labial salivary gland biopsy under the 2016 ACR/EULAR classification criteria. Management centers on sicca-directed therapy, pilocarpine or cevimeline for xerostomia and topical cyclosporine for keratoconjunctivitis, with hydroxychloroquine or immunosuppression for extraglandular disease.

Syphilis is a sexually transmitted infection with the spirochete Treponema pallidum that progresses through painless chancre (primary), disseminated rash and condyloma lata (secondary), latent, and tertiary stages including neurosyphilis, diagnosed by paired nontreponemal and treponemal serology and treated with a single dose of intramuscular benzathine penicillin G for early disease.

Cytomegalovirus is a ubiquitous herpesvirus that is usually asymptomatic or causes a heterophile-negative mononucleosis-like illness in healthy hosts, but reactivates to cause retinitis, colitis, pneumonitis, or encephalitis in transplant recipients and patients with AIDS; treatment is systemic ganciclovir or valganciclovir, with foscarnet and cidofovir reserved for resistance or intolerance.

Toxoplasmosis is infection with the protozoan Toxoplasma gondii, acquired from undercooked meat or cat feces, causing a mononucleosis-like illness in immunocompetent hosts, reactivation encephalitis with ring-enhancing brain lesions in advanced HIV, and a severe congenital syndrome after maternal primary infection in pregnancy. Diagnosis in CNS disease is largely presumptive on serology, imaging, and empiric treatment response, and management is pyrimethamine-sulfadiazine-leucovorin, with prevention centered on CD4-based prophylaxis and food/cat-litter precautions in pregnancy.

Acute angle-closure glaucoma is a pupillary-block emergency in which sudden closure of the iridocorneal angle blocks aqueous outflow, causing severe eye pain, halos, and rapidly rising intraocular pressure that can blind the eye within hours if not treated. Diagnosis is clinical plus tonometry and gonioscopy; treatment is immediate topical and systemic IOP-lowering therapy followed by laser peripheral iridotomy.

Conjunctivitis is inflammation of the conjunctiva from viral, bacterial, or allergic causes presenting with red eye, discharge, and preserved vision, diagnosed clinically by discharge character and managed with supportive care, targeted topical antibiotics, or topical antihistamine/mast-cell-stabilizer therapy.

Cataract is age-related or secondary opacification of the crystalline lens causing painless, progressive glare and vision loss, diagnosed clinically by lens opacity and a diminished red reflex, and treated definitively with phacoemulsification and intraocular lens implantation when vision-impairing.

Rhegmatogenous retinal detachment is a surgical emergency in which a full-thickness retinal break lets liquefied vitreous separate the neurosensory retina from the retinal pigment epithelium, presenting with flashes, floaters, and an advancing visual field curtain. Diagnosis is by dilated indirect ophthalmoscopy with scleral depression, and treatment is prompt surgical reattachment, most urgent while the fovea is still spared.

Optic neuritis is inflammatory demyelination of the optic nerve, usually a presenting event of multiple sclerosis, causing subacute painful monocular vision loss with a relative afferent pupillary defect. Confirm with MRI orbits/brain and treat with IV methylprednisolone followed by an oral prednisone taper, never oral prednisone alone.