A Non-Infectious Uveitis Multidisciplinary Clinic in a Tertiary Referral Center: Clinical Impact and Added Value

Figures & data

Table 1 Focus Areas of CHULN NIU-Rheumatology Team

Focus Area
Principles for referral	Establishment of guidelines for referral
	Implementation of mechanism that allows identification of all eligible patients
	Prior discussion of patients when there is uncertainty of eligibility
Infrastructure and technology	Dedicated physical location where uveitis appointments occur
	Dedicated physical location where joint clinics occur
	Electronic medical records used in this clinic: Uveite.pt and Reuma.pt that allow to collect data in a standardized way and gather data for research
	Quick access when requesting blood tests for diagnostic purposes
Appointments	Scheduled adult uveitis and pediatric uveitis appointments
	Scheduled joint ophthalmology-rheumatology appointments
Meetings	Weekly dedicated biologics decision clinic
	Phone/video conference discussions organized whenever necessary
Organizational human resources aspects	Team is formed by ophthalmology consultants with special interest and formal education in uveitis with significant support of the Rheumatology team from the same center

Figure 1 Milestones towards a successful ophthalmology-rheumatology multidisciplinary team (MDT). Adapted from Snipelisky, D. et al. How to Develop a Cardio- Oncology Clinic. Heart Fail. Clin. 13, 347–359 (2017), with permission from Elsevier.16

Figure 2 Diagnosis of adult (A) and pediatric patients (B) referred to the CHULN-NIU clinic.

Notes: Other*: Cogan syndrome, mixed connective tissue disease, episcleritis, multiple sclerosis uveitis, Posner-Schlossman syndrome, retinal vasculitis, systemic lupus erythematosus, sarcoidosis, Takayasu syndrome, granulomatosis with polyangiitis, Other‡: idiopathic panuveitis, retinal vasculitis, scleritis.

Abbreviations: SpA, spondyloarthritis; NIU, non-infectious uveitis; HLA, human leucocyte antigen; JIA, juvenile idiopathic-arthritis; RA, rheumatoid arthritis; VKH, Vogt-Koyanagi-Harada syndrome; TINU, tubulointerstitial nephritis and uveitis syndrome; MCTD, mixed connective tissue disease.

Table 2 Demographics and Referrals of the Patients Observed at the CHULN-NIU Clinic (June 2018–June 2020)

	Pediatric (n=53, 18.3%)	Adult (n=237, 81.7%)	All Patients
Age, years	11.1±3.8 (range:2–18)	42.8± 16.8 (range: 19–90)	36.9±19.6 (range: 2–90)
Female	36 (66.7)	136 (57.6)	172 (59.3)
Referral source
Ophthalmology	16 (28.6)	161 (68.2)	177 (61.0)
Rheumatology	35 (64.8)	59 (25.0)	94 (32.4)
Pediatrics	3 (5.6)	0	3 (1.0)
Emergency Medicine	0	9 (3.8)	9 (3.1)
Internal Medicine	0	4 (1.7)	4 (1.4)
Infectious disease department (%)	0	1 (0.4)	1 (0.3)
Occupational Medicine	0	1 (0.4)	1 (0.3)
Other institution	0	1 (0.4)	1 (0.3)

Note: Continuous variables represented as mean±standard deviation, categorical variables represented as absolute frequency (%)

Figure 3 Conventional synthetic DMARD treatment of NIU adult (A) and pediatric (B) patients.

Abbreviations: NIU, non-infectious uveitis; MTX, methotrexate; AZA, azathioprine; MMF, Mycophenolate mofetil; SSA, salazopyrine; CsA, Cyclosporine A; csDMARD, conventional synthetic disease-modifying antirheumatic drugs.

Figure 4 Biologic treatment of adult (A) and pediatric (B) patients.

Abbreviations: NIU, non-infectious-uveitis; IFX, infliximab; ADA, adalimumab; GLM, golimumab; RTX, rituximab; TCZ, tocilizumab; VDZ, vedolizumab; CZP, certolizumab; ETN, etanercept.