The Latest News in Rheumatology
9/27/2002
Eye Problems Associated with Autoimmune Diseases
Contribution
of Individual Spa Therapies in the Treatment of Chronic Pain
Ultrasonography
of Entheseal Insertions in the Lower Limb in Spondyloarthropathy
People with spondyloarthropathies and other autoimmune diseases can
experience serious eye problems as a complication of the disease. In some
circumstances, patients' knowledge of the signs and symptoms may help prevent irreversible
eye damage.
Authors Sayjal J. Patel, LT, MC, USNR and Diane C. Lundy, Capt. MC, USN from
the Naval Medical Center in San Diego, California, discussed their findings in
an article published in the September 2002 issue of the American Family
Physician titled "Ocular Manifestations of Autoimmune
Disease."
They claim that early and accurate diagnosis with prompt treatment or a
referral to an ophthalmologist may prevent systemic and ocular
disabilities.
Uveitis is the most common ocular problem of the spondyloarthropathies, occurring
in approximately 25% of patients with ankylosing spondylitis, up to 37% of patients with
reactive arthritis, in approximately 20% of patients with psoriatic arthritis,
and in up to 9% of patients with spondylitis of inflammatory bowel disease.
Complications include glaucoma, cataracts, or blindness.
Uveitis symptoms include red eye, pain, photophobia (sensitivity to light),
and blurred vision. In addition to seeking medical attention from an
ophthalmologist, treatment may include cycloplegics, topical steroids, and
immunosuppressives.
While people with ankylosing spondylitis mainly have problems with uveitis, reactive and
psoriatic arthritis patients may also suffer from conjunctivitis or keratitis.
Keratoconjunctivitis symptoms include dry eye, burning, pain, blurred vision,
pruritus, foreign-body sensation, mucous thread, and crusting about the eyelids.
Common ophthalmologist treatments include sunglasses, room humidifiers, tear
substitutes, or surgery.
Keratitis symptoms include pain with photophobia, foreign body sensation,
tearing, red eye, and decreased vision. Ophthalmologists may prescribe NSAIDs,
topical/oral/IV steroids, immunosuppressives, or surgery to help correct the
problems.
In addition to care by an ophthalmologist, certain mild ocular diseases can be
treated with simple methods, such as lubrication drops applied hourly, sleeping
with the head elevated, wearing sunglasses during the daytime, and taping
eyelids closed at night. Systemic corticosteroid therapy or radiotherapy is
reserved for more severe cases, and surgery may be required in patients with
sudden visual loss or extensive corneal damage.
Overall, the authors suggest that anyone suspecting they have ocular disease
seek immediate medical attention, and inform the ophthalmologist of current
medical conditions (such as spondylitis).
According to a recent article published in The Clinical Journal of Pain
2002, Gerhard Strauss-Blache, Ph.D., and colleagues evaluated whether
spa therapies impacted the well being and pain in a sample of patients with
chronic back pain.
153 patients with chronic back pain undergoing inpatient spa therapy in Bad
Tatzmannsdorf, Austria, participated in the study. A spa physician prescribed
two or more of the following treatments for each patient: mud packs, carbon
dioxide baths, massages, exercise therapies, spinal traction, and
electrotherapy.
They measured the patients' general pain, back pain, negative mood, and
health satisfaction to help determine whether the individual spa therapies had
an impact.
Results: Patients showed significant improvements in all four of the
above measures, but they found that only 1-11% of the change of the four
measures could be explained by the type and number of therapies received.
On a short-term basis, mud packs and exercise were associated with a greater
improvement in mood. Greater frequency of massage therapy and carbon dioxide
baths was associated with a smaller improvement in health satisfaction.
On a long-term basis, exercise therapy and spinal traction were associated
with a greater reduction in back pain.
The researchers conclude that in addition to individual therapies, other
factors relating to spa therapy as a whole must contribute to overall treatment
outcome. These results support the importance of appropriate exercise therapy
for people with chronic back pain.
Researchers PV Balint and colleagues from the Centre for Rheumatic Diseases,
Glasgow Royal Infirmary in Scotland compared ultrasonography to regular
clinical examination in detecting a feature common to spondylitis patients--
enthesopathy-- of the lower limb. Enthesopathy is inflammation that occurs where the ligaments and tendons attach to the bone.
35 patients with SpA (27 ankylosing spondylitis; 7 psoriatic arthritis; 1
reactive arthritis) underwent both clinical examination (physician analysis) and
ultrasonography examination.
Results: On clinical examination, the doctors found 22% of the
patients' lower limb entheseal sites were abnormal, while ultrasonography examination showed that 56%
sites were abnormal. Ultrasonography appears to be a much better detector of
enthesopathy of the lower limb in spondylitis patients.