Dr. James Rosenbaum, a rheumatologist and ophthalmologist, discusses the connection between rheumatic disease and eye health, particularly uveitis. He shares his journey into the field of uveitis and highlights the importance of collaboration with ophthalmologists. The podcast explores the antigenic overlaps between joint and eye inflammation, different treatment options for uveitis, and renewed interest in eye disease and its systemic manifestations.
Collaboration between rheumatologists and ophthalmologists is essential in accurately diagnosing, treating, and managing uveitis in patients with rheumatic diseases.
The use of specific medications like corticosteroids, methotrexate, adalimumab, and tofacitinib, as well as optical coherence tomography (OCT) and tocilizumab, can effectively treat refractory uveitis and reduce complications.
Deep dives
The Importance of the Eye in Rheumatic Disease
The podcast episode discusses the significance of the eye in rheumatic diseases. Various diseases, including rheumatoid arthritis, spondyloarthritis, sarcoid, and relapsing polychondritis, can affect the eye in different ways. The speaker emphasizes the expertise of Dr. James Rosenbaum, a renowned rheumatologist and ophthalmologist who has dedicated his career to studying ocular manifestations in rheumatic disease. The episode explores the accidental discovery of Dr. Rosenbaum's interest in inflammatory eye disease and delves into the topic of uveitis, its diagnosis, and its association with underlying systemic conditions. Dr. Rosenbaum shares insights on the diagnosis, treatment, and management of uveitis, highlighting the importance of collaboration between rheumatologists and ophthalmologists.
Understanding Uveitis: Definition and Diagnosis
Dr. Rosenbaum provides a clear explanation of uveitis, which is inflammation of the middle layer of the eye called the uvea. He describes how inflammation disrupts the blood-aqueous barrier, leading to the presence of white blood cells in the eye. The speaker emphasizes that uveitis can be easily visualized using a slit lamp, enabling accurate diagnosis. Dr. Rosenbaum highlights the importance of taking a detailed history and recognizing specific clinical phenotypes to determine the underlying cause of uveitis. He explains that uveitis can be symptomatic or asymptomatic, depending on the specific disease or condition. The speaker also mentions the significance of ruling out infections or lymphoma as causes of uveitis, as well as the role of specific tests such as the chest x-ray and urine analysis.
Treatment and Management of Uveitis
In this segment, Dr. Rosenbaum discusses the treatment and management of uveitis. He explains that anterior uveitis, commonly seen in the clinic, often responds well to topical corticosteroids. The speaker underscores the importance of ophthalmologist-led follow-up due to the potential side effects of corticosteroids, such as elevated intraocular pressure. Dr. Rosenbaum suggests that a rheumatologist's involvement is warranted when local therapy fails or when there is suspicion of an underlying systemic disease. He mentions the use of oral corticosteroids as a quick fix solution but highlights the need for steroid-sparing medications to prevent long-term complications. The speaker also presents the effectiveness of specific medications, including methotrexate, adalimumab, and tofacitinib, in managing refractory uveitis. Furthermore, he discusses the use of optical coherence tomography (OCT) to detect complications like macular edema and the potential benefits of tocilizumab in reducing such complications.
Collaboration Between Rheumatologists and Ophthalmologists
Dr. Rosenbaum emphasizes the importance of collaboration between rheumatologists and ophthalmologists in managing uveitis. He highlights the need for effective communication and shared decision-making to ensure accurate diagnosis, treatment, and monitoring of the condition. The speaker discusses the inherent challenges faced by rheumatologists in assessing treatment efficacy due to their limited ability to directly visualize ocular inflammation. Dr. Rosenbaum underscores the crucial role of ophthalmologists in assessing treatment response based on objective findings and expertise in visualizing eye inflammation. He also encourages rheumatologists to refer patients to ophthalmologists for specialized evaluation and to seek their advice in managing complex cases. The speaker concludes by expressing enthusiasm for the field of rheumatic eye disease and the rewards of interdisciplinary collaboration in patient care.
Our eyes: reflections of the soul, can say more than lips without need of translation and give us a glimpse into stories only a journey can record. Our next guest knows this all too well as he’s made a career of looking at rheumatic disease through a different lens. Quite literally. Join us this week for an illuminating discussion with Dr. James T. Rosenbaum, MD, rheumatologist and author of over 650 peer-reviewed manuscripts. Dr. Rosenbaum is credited as being both one of the world’s most impactful uveitis scientists for the years 2013 to 2023 and the only practicing rheumatologist to have headed a department of ophthalmology. Dr. Rosenbaum helps us put uveitis into focus this week as we discuss what it is, how he treats it, how to determine if those with it have other rheumatic conditions, and which patients with rheumatic disease should seek additional treatment with an ophthalmologist.
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