1. Contribution of diagnostic tests for the etiological assessment of uveitis, data from the ULISSE study (Uveitis: Clinical and medicoeconomic evaluation of a standardized strategy of the etiological diagnosis)
- Author
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Pascal Cathébras, Stéphanie Baillif, Laurent Kodjikian, Laurent Perard, Pierre-Loïc Cornut, Pierre Manoli, Sylvie Bin, Frédéric Mouriaux, Bahram Bodaghi, Sophie Rivière, Emmanuel Héron, Frédéric Chiambaretta, Neila Sedira, Christelle Schneider, Priscille Ollé, Pierre Grumet, David Saadoun, Marc André, Nathalie Tieulie, Marc Labetoulle, Audrey de Parisot, Yvan Jamilloux, Alain M. Bron, Pascal Sève, Philip Bielefeld, Evelyne Decullier, Christiane Broussolle, Stéphanie Vicente, Nicolas Bonin, Grégory Pugnet, Marie-Hélène Errera, Boris Bienvenu, Hospices Civils de Lyon (HCL), Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts (CHNO), Hôpital Saint Joseph, Clinique du Val d'Ouest, Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Pierre-Paul Riquet Hospital, Centre Hospitalier Universitaire de Purpan (CHU Purpan), North Hospital, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital l'Archet, CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Department of Ophthalmology, CHU Pontchaillou [Rennes], and AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
- Subjects
Adult ,Male ,medicine.medical_specialty ,Tuberculosis ,diagnosis ,etiology ,Immunology ,Tuberculin ,law.invention ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Prospective Studies ,[SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs ,030203 arthritis & rheumatology ,medicine.diagnostic_test ,Diagnostic Tests, Routine ,business.industry ,Lumbar puncture ,Complete blood count ,Middle Aged ,standardized strategy ,medicine.disease ,3. Good health ,recommendations ,uveitis ,030221 ophthalmology & optometry ,Etiology ,[SDV.IMM]Life Sciences [q-bio]/Immunology ,Female ,epidemiology ,Sarcoidosis ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Uveitis - Abstract
International audience; [u]PURPOSE:[/u] ULISSE is the only study that prospectively assessed the efficiency of a standardized strategy, compared to an open strategy for the etiologic diagnosis of uveitis. Our aim was to evaluate the diagnostic yield of the tests prescribed in the ULISSE study to clarify their relevance. [u]METHODS:[/u] ULISSE is a non-inferiority, prospective, multicenter and cluster randomized study. The standardized strategy is a two-steps strategy: in the first step, common standard tests were performed, and in the second step, tests were guided by the clinical and anatomic type of uveitis. We reported the relevance of the diagnostic tests used in the standardized strategy, as well as the profitability of the tests that were prescribed to more than twenty patients in each group. Based on diagnostic criteria, either an ophthalmologist, or an internist, established the profitability of a test by considering whether the test lead to a diagnosis or not. [u]RESULTS:[/u] Among the 676 patients included (standardized 303; open 373), a diagnosis was made for 152 (50.4%) in the standardized group and 203 (54.4%) in the open group. The most common entities were HLA-B27 associated uveitis (22%), spondyloarthritis (11%), sarcoidosis (18%), tuberculosis (10.7%) and herpes virus infections (8.5%). Among the first step's systematic tests, tuberculin skin test was the most contributive investigation (17.1%), followed by chest X-ray (8.4%), C reactive protein and ESR (6.6% and 5.1%), complete blood count (2.2%) and VDRL (2.0%). The second step's most often contributive tests were: HLA B27 (56.3%), chest-CT (30.3%) and angiotensin converting enzyme (ACE) (16.5%). HLA B27 and ACE were significantly more contributive in the standardized group than in the open group. Immunological tests were never contributive. Among the free investigations, or among the investigations guided by clinical or paraclinical findings, the most often contributive tests were: Quantiferon(R) (24%), electrophoresis of serum protein (7.8%) and sacroiliac imagery (46.4%). Intracellular serologies (1.7%), serum calcium (2.1%) and hepatic tests (3.3%) were exceptionally contributive. Among the third intention tests, labial salivary gland biopsies were contributive in 17.9% of cases, but the profitability of other invasive investigations (anterior chamber tap, vitrectomy, bronchoscopy and lumbar puncture) or specialized imagery (18F-FDG PET, Brain MRI) could not be determined since these test were rarely performed. [u]CONCLUSION:[/u] Only a few diagnostic tests are useful for the etiological assessment of uveitis. They are often cheap, simple, more often guided by the clinical findings, and lead to an etiological diagnosis in most patients. On the other hand, some tests are never or exceptionally contributive, such as immunological tests or intracellular serologies. Further studies are required to evaluate the profitability of third intention imagery and invasive investigations.
- Published
- 2018