Optic neuritis in sarcoidosis: clinical features and response to therapy

Abstract

By Rutva Patel, Biological Sciences and Neurobiology

Advisor: Robert P. Baughman

Abstract: Methods: Patients identified at UC Medical Center Sarcoidosis Clinic over past 8 years. Patients with optic neuritis & biopsy confirmed sarcoidosis were identified & demographic information, organ involvement, treatment, and outcome were noted. These were compared to sarcoidosis patients without optic neuritis. Results: Forty (1.7%) of 2260 sarcoidosis patients in our registry had optic neuritis & biopsy confirmed sarcoidosis. This included 25 women & 25 Caucasians, which was not significantly different from the control group. Twenty (50%) of the optic neuritis patients had other eye involvement, usually uveitis, compared to only 678 of the controls (30.5%, Chi square=6.967, p=0.0083). Other neurologic disease was identified in 24 of 40 (60%) of the optic neuritis patients versus 425 of the controls (19.1%, Chi square=41.179, p<0.0001). Current or past treatment for optic neuritis included prednisone in 39 (97.5%), methotrexate in 35 (87.5%), azathioprine in 16 (40%), leflunomide in 8 (20%) and mycophenolate in 3 (7.5%). Fifteen (37.5%) patients received anti-TNF therapy. All 15 received infliximab, with five switch to adalimumab because of reactions to infliximab. Anti-TNF treatment led to stability or improvement in vision in all 15 patients with significant steroid sparing in those on prednisone at time of initiation of anti-TNF therapy. Conclusion: Optic neuritis is a serious but treatable form of neurosarcoidosis. It is associated with other ocular and neurologic manifestations of sarcoidosis. It usually requires second and third line therapy. Anti-TNF therapy led to stabilization or improvement of eye disease with reduction of glucocorticoid use in most patients.