title: Relevance of diagnostic investigations in patients with uveitis: Retrospective cohort study on 300 patients.
abstract: OBJECTIVE
  The diagnostic workup of uveitis is a challenge due to the wide range of diagnoses and the lack of a well-codified diagnostic procedure. We aimed to evaluate the relevance of diagnostic investigations for the etiological diagnosis of uveitis.
  
  
  METHODS
  Retrospective cohort study of patients referred for etiological diagnosis of uveitis. Uveitis related to ophthalmological diseases or occurring during the course of previously diagnosed diseases were not included.
  
  
  RESULTS
  Three hundred patients were included. Chest CT-scan was suggestive of sarcoidosis in 83 (29%). Features associated with abnormal CT-scan were: snowballs and/or peripheral multifocal choroiditis (PMC) upon ocular examination (P=0.004), blood lymphopenia (P<0.0001), angiotensin converting enzyme (ACE) level>1.5 ULN (P=0.0003). Bronchoscopy showed granuloma in 18 (11%) while alveolar lymphocytosis suggestive of sarcoidosis was reported in 45 (27%). Presence of granuloma on bronchial biopsies was always associated with chest CT-scan abnormalities, whereas 31% of patients with alveolar lymphocytosis had normal CT-scans. Features associated with contributive bronchoscopy were: snowballs and/or PMC (P=0.003), ACE>1.5 ULN (P=0.007), abnormal chest-CT scan (P<0.0001). Salivary gland biopsy revealed granuloma in 12 patients (5%). Cerebral MRI was abnormal in 15 patients (9%) who mostly presented with snowballs and/or retinal vasculitis. Finally, the main causes of uveitis were latent tuberculosis (25%) and sarcoidosis (22%), but 34% remained of undetermined origin. Uveitis relapses were observed in 31% and did not differ between patients with an identified diagnosis and those with idiopathic uveitis.
  
  
  CONCLUSIONS
  Identification of factors associated with abnormal investigations might improve the optimal diagnostic workup adapted to each patient.
authors.affiliation: Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Hadjadj
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Centre de Recherche Epidémiologie et Statistique, INSERM U1153, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Dechartres
authors.affiliation: Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Chapron
authors.affiliation: Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Manal
authors.initials: M
authors.lastname: Assala
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Sawsen
authors.initials: S
authors.lastname: Salah
authors.affiliation: Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dunogué
authors.affiliation: Department of Immunology, Immunochemistry & Autoimmunity Laboratory, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Musset
authors.affiliation: Department of Biochemistry, Hôpital Saint-Antoine, AP-HP, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Baudin
authors.affiliation: Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Groh
authors.affiliation: Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Blanche
authors.affiliation: Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Mouthon
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Monnet
authors.affiliation: Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Le Jeunne
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Brézin
authors.affiliation: Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: benjamin.terrier@aphp.fr.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Terrier
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014605:Uveitis / Q000175:diagnosis*
keywords: Diagnosis; Sarcoidosis; Uveitis