THU0574 Characterization of Eye Sarcoidosis with or without Systemic Involvement:Application of IWOS Criteria in An Uveitis Unit
Authors: H. Sánchez Pérez, D. Άngel Pereira, M. García González, I. Ferraz Amaro, E. Trujillo, P. Rocha Cabrera, M. Losada Castilla, E. Delgado Frías, B. Rodriguez Lozano
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Sarcoidosis (Sa) eye involvement is the most common extrapulmonary manifestation and is the initial presentation in 5–20% of cases. The definitive diagnosis is histopathological.The sensitivity (S) of the conjunctival biopsy is low,so Ocular Sa (OSa) diagnostic criteria (C) were proposed: IWOS (First International Workshop on Ocular Sarcoidosis), with high S and specificity (1/0.95). However, they have been poorly validated <h3>Objectives</h3> To apply the IWOS C. and to analyze their consistency with the suspected diagnosis of OSa.To discuss differential features between patients with OSa and those with systemic involvement <h3>Methods</h3> Observational cross-sectional study.Clinical records from patients with (presumed) Sa diagnosis who had been followed during the last 10 years in a multidisciplinar Uveitis Unit of a 3rd level hospital (Ophthalmology/Rheumatology) were reviewed.Clinical variables and complementary tests results were analyzed.IWOS C. were applied if OSa was suspected.For statistical analysis we use:Chi-square test and Kappa coefficient <h3>Results</h3> 71 patients were included:47 OSa,13 with ocular-systemic involvement (OS-Sa) and 11 with systemic involvement (SSa). Women/Men 57%/43%, mean follow-up time 9.42 years (±8.55), with no intergroup differences.Significant differences between patients with OSa vs. OS-Sa/SSa were observed:mean age at diagnosis (40.23±18.18 vs. 57.54±17.65/48.27 ±17 years, p=0.01); mean ESR (16.74±12.73 vs. 26.38±15./19.4±31.55 mm/h, p=0.01); mean CRP (3.58±4.29 vs. 8.12±8.11/10.24±14.37 mg/L, p=0.03); CT abnormalities (16.6% vs. 90%/92%, p=0.001); positive biopsy (0% vs. 88/100%, p=0.002); general, joint, respiratory and skin symptoms (OSa 6–12% vs SSa 15–50%, p=0.002). ACE was increased in 74.6%, with a mean value of 71.98±33.59 U/L, with no intergroup differences. Altered lacrimal scintigraphy was more often found in the OSa subset (26.7%) vs. OS-Sa/SSa (23.1%/0%), without statistical significance. Comparing OSa vs. OS-Sa patients, ocular involvement was as follows: anterior segment involvement 48% vs 61.5%, intermediate segment 21.3% vs. 15.4%, posterior segment 8.5% vs 0%, panuveitis 10.6% vs. 7.7%, mixed involvement 10.6% vs. 15.4% (p=0.001). If OSa, bilateral involvement was present in 60% of patients, unilateral involvement was more frecuent in OS-Sa (76%), p=0.06.There were no significant differences regarding uveitis9s presentation, course and number of crisis and specific intraocular findings. Applying IWOS Criteria and comparing OSa vs OS-Sa we can classify: Definite OSa 0% vs. 69.2%, Presumed OSa 23.4% vs. 7.7%, Probable OSa 14.9% vs. 15.4% and Possible OSa 2.1% vs. 0%; not fulfilling criteria: 59.6% vs. 7.7% (p=0.001). The kappa coefficient between suspicion of OSa/OS-Sa and not fulfilling/fulfilling criteria was 0.30 (p=0.003). <h3>Conclusions</h3> We could classify as Presumed OSa in 25% and as Probable OSa in 15% of patients with suspected OSa but who hadn9t undergo a biopsy. We excluded the diagnosis in 60%. There wasn9t a good consistency between the suspected diagnosis/IWOS C. fulfillment,nevertheless they are a useful tool in clinical practice.OSa patients were younger and had lower ESR/CRP levels. Involvement of the anterior ocular segment was the most frequent one, bilateral in OSa and unilateral in OS-Sa <h3>Disclosure of Interest</h3> None declared