Diagnostic Categorization According to the First International Workshop on Ocular Sarcoidosis (FIWOS) Criteria in a Series of 11 Patients

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(B) Multiple chorioretinal lesions in peripheral retina." ] ] ] "textoCompleto" => "IntroductionSarcoidosis is a multisystem disorder of unknown cause, characterized by noncaseating granulomatous inflammation.<a class="elsevierStyleCrossRef" href="#bib0075">1</a> It affects the parenchyma of almost any organ, and thoracic symptoms are those most frequently observed. Overall, 30%–60% of the patients have eye involvement. It is usually bilateral uveitis, although, uveitis can occasionally develop in the absence of systemic disease, or could be the predominant manifestation with no significant extraocular impact.<a class="elsevierStyleCrossRefs" href="#bib0080">2–4</a> In clinical practice, the diagnosis of systemic sarcoidosis is based on the combination of clinical, radiographic and histopathological findings. The diagnostic criteria proposed by the First International Workshop on Ocular Sarcoidosis (FIWOS) were recently validated.<a class="elsevierStyleCrossRef" href="#bib0095">5</a> These criteria classify ocular sarcoidosis as definite (uveitis and positive biopsy), presumed (bilateral hilar lymphadenopathy and uveitis without biopsy), probable (3 ocular signs and 2 laboratory findings without biopsy or bilateral hilar lymphadenopathy) and possible (4 ocular signs and 2 laboratory findings with a negative biopsy), in accordance with specific ophthalmological and laboratory findings.<a class="elsevierStyleCrossRef" href="#bib0100">6</a> The latter are especially useful when there is no biopsy or the biopsy is negative.ObjectivesThe purpose was to categorize those patients with a diagnosis of ocular sarcoidosis from 2009 to 2014 in Hospital Universitario Donostia, in the province of Guipúzcoa in northern Spain, using the diagnostic and validated criteria of the FIWOS.Material and MethodsWe retrospectively reviewed the case reports of the patients diagnosed with ocular sarcoidosis. The diagnosis of sarcoidosis was based on a combination of the clinical, radiographic and histological criteria of the FIWOS, as well as the exclusion of other granulomatous diseases like tuberculosis.The variables recorded were patient age and sex, presence of systemic manifestations, anatomical location of the inflammation, tuberculosis screening, positive test for angiotensin-converting enzyme, lymph node biopsy, chest radiographic findings and treatment. To classify uveitis we used the anatomical classification of the Standardization of Uveitis Nomenclature (SUN) Working Group<a class="elsevierStyleCrossRef" href="#bib0105">7</a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). We excluded patients who had a positive result on the Quantiferon® test. Using these findings, we categorized the patients according to the FIWOS.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>ResultsWe found a total of 11 patients with a diagnosis of sarcoid uveitis, 7 women (63.6%) and 4 men (36.3%). The median age±standard deviation was 58±20.5 years. In 7 patients (63.6%), the eye was the first organ to be affected: 5 of them later developed the systemic clinical signs and 2 had only ocular clinical features. Four patients (36.3%) began with extraocular systemic manifestations, which, in order of frequency, were: bilateral hilar lymphadenopathy in 81.8%, respiratory manifestations in 36.3%, peripheral lymphadenopathy in 18.1%, parotitis in 27.2% and erythema nodosum in 9%. The locations of inflammation most frequently observed were chronic bilateral panuveitis in 54.5%, unilateral chronic anterior uveitis in 27.2% and bilateral chronic anterior uveitis in 18.1%. When the patients were categorized, 4 (36.3%) had a definite diagnosis of sarcoidosis, 5 patients (45.4%) had a presumed diagnosis, 1 patient (9%) had a probable diagnosis and 1 patient (9%) had a possible diagnosis of sarcoidosis.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the above-mentioned variables in the patients diagnosed with ocular sarcoidosis.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionThe diagnosis of systemic sarcoidosis is presently based on a combination of clinical and radiographic findings, together with the histological confirmation and the exclusion of other granulomatous diseases, such as tuberculosis.<a class="elsevierStyleCrossRef" href="#bib0110">8</a> In clinical practice, the determination of the angiotensin-converting enzyme level, serum calcium, plain chest X-ray, scintigraphy and screening tests, like Mantoux or Quantiferon®, initially indicate involvement of systemic sarcoid. Ocular involvement in sarcoidosis is presented by up to half of the patients and may even be the initial manifestation of the disease. Sarcoidosis can affect the lacrimal glands and cause keratoconjunctivitis sicca, involving the iris, as well, causing different forms of uveitis and even the development of optic neuritis when it affects the posterior pole. The anatomical location of inflammation in sarcoid uveitis mainly, and chronically, involves the posterior segment. It frequently consists of recurrent bilateral uveitis, and can even cause generalized involvement in the form of bilateral panuveitis associated with retinal vasculitis.<a class="elsevierStyleCrossRefs" href="#bib0115">9,10</a> The findings most frequently observed in uveitis associated with sarcoidosis include mutton fat keratic precipitates, iris nodules, tent-shaped peripheral anterior synechiae, vitreous opacities like “snowballs”, multiple peripheral chorioretinal lesions and nodular periphlebitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Moreover, there were other ocular signs that could indicate sarcoid involvement, especially if evaluated in the presence of ancillary tests that are positive for sarcoidosis<a class="elsevierStyleCrossRefs" href="#bib0125">11–14</a> (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The diagnostic criteria proposed by the FIWOS were validated in 2010. They include several ophthalmological signs indicative of sarcoidosis and comprise ancillary tests<a class="elsevierStyleCrossRef" href="#bib0095">5</a> (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). These criteria do not include invasive procedures and are useful, in clinical practice, when there is no confirmatory biopsy or when the biopsy is negative.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Ocular and systemic manifestations of sarcoidosis, as well as the ancillary tests, show a great variability, a fact that complicates the diagnosis. With our work, we have put into practice the FIWOS criteria, which enabled us to categorize the patients with systemic clinical signs indicative of sarcoidosis together with other ocular manifestations and positive ancillary tests. Because of the heterogeneity of this disease, not all the patients fulfilled the diagnostic criteria for sarcoidosis; for this reason, after the diagnostic categorization, we see that, after satisfying the clinical and ophthalmological criteria and that of the ancillary tests, the patients’ disorder was classified as sarcoidosis. Most of our patients, coinciding with the literature, were women (63.6%). Ocular problems were the initial symptom in 7 of the overall group and most of them had ocular manifestations indicative of sarcoid disease. Tuberculin tests were negative in all of the patients and only 3 patients had a compatible lymph node biopsy. Those who had not undergone a biopsy for the classification criteria, after categorization, had a “presumed” diagnosis of sarcoidosis. The ophthalmological data showed that the most common anatomical location was chronic bilateral panuveitis, affecting 54.5% of the patients. In second place, unilateral chronic anterior uveitis, with 27.2%, was the most frequent form. Most of the patients began with clinical manifestations of uveitis, developing the systemic clinical disease later on. After the categorization of the patients, the diagnosis of sarcoidosis was definite in 4 patients, presumed in 5, probable in 1 and possible in 1 other patient.The present study is especially interesting for rheumatologists who work in collaboration with ophthalmologists in uveitis clinics, as sarcoidosis is an uncommon disease, it is best to standardize criteria for the correct diagnosis of this disorder. We should also point out that the use of these criteria enables the diagnosis without the need for a biopsy, which could be iatrogenic or difficult in certain patients.These criteria categorize patients with data indicative of sarcoidosis and who, because of the variability in the clinical course and organic involvement, have not been categorized as patients with sarcoid disease. The sarcoid ocular involvement plays a very significant role for categorization and, for this reason, it is important to stress a detailed ophthalmological examination in search of ocular signs indicative of a granulomatous inflammatory disease.Ethical DisclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.FundingNone.Conflicts of InterestThe authors declare they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres798090" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec796065" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres798089" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec796066" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objectives" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Material and Methods" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical Disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of Interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-10" "fechaAceptado" => "2015-12-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec796065" "palabras" => array:7 [ 0 => "Sarcoidosis" 1 => "Uveitis" 2 => "Sarcoid uveitis" 3 => "Inflammatory uveitis" 4 => "Panuveitis" 5 => "Diagnostic criteria" 6 => "First International Workshop on Ocular Sarcoidosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec796066" "palabras" => array:7 [ 0 => "Sarcoidosis" 1 => "Uveítis" 2 => "Uveítis sarcoidea" 3 => "Uveítis inflamatoria" 4 => "Panuveítis" 5 => "Criterios diagnósticos" 6 => "First International Workshop on Ocular Sarcoidosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveCategorization of patients diagnosed with ocular sarcoidosis during the period 2009–2014. MethodsThe medical records of patients with ocular sarcoidosis were reviewed and variables were collected to categorize the patients according to the criteria of the FIWOS. ResultsWe found 11 patients, 7 women and 4 men, with sarcoid uveitis; the median age was 58 years. Bilateral panuveitis was the most common pattern (54.5%), followed by chronic anterior uveitis (27.2%). The diagnosis of sarcoidosis was definitive in 4 patients (36.3%), presumed in 5 (45.4%), probable in 1 (9%) and possible in 1 (9%). ConclusionsOcular sarcoidosis was diagnosed in more than half of the patients who had no confirmatory biopsy. Bilateral panuveitis and chronic anterior uveitis were the patterns most frequently observed." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoCategorizar a los pacientes con diagnóstico de sarcoidosis ocular en el período comprendido entre 2009 y 2014. MétodosSe revisaron las historias clínicas de los pacientes con sarcoidosis ocular y se recopilaron las variables para categorizar a los pacientes según los criterios del FIWOS. ResultadosSe encontró a un total de 11 pacientes con uveítis sarcoidea, 7 mujeres y 4 hombres, con una mediana de edad de 58 años. El patrón de panuveítis bilateral crónica fue el más frecuente en un 54,5%, seguido de la uveítis anterior crónica unilateral, con 27,2%. El diagnóstico de sarcoidosis fue definitivo en 4 pacientes (36,3%), presunto en 5 pacientes (45,4%), probable en un paciente (9%) y posible en un paciente (9%). ConclusionesMás de la mitad de los pacientes sin biopsia confirmatoria fueron diagnosticados de sarcoidosis ocular. La panuveítis bilateral crónica y la uveítis anterior crónica fueron los patrones predominantes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Meneses CF, Egües CA, Uriarte M, Errazquin N, Valero Jaimes A, Maíz O, et al. Categorización diagnóstica según los criterios del First International Workshop on Ocular Sarcoidosis (FIWOS) en una serie de 11 pacientes. Reumatol Clin. 2017;13:25–29." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 587 "Ancho" => 1600 "Tamanyo" => 118400 ] ] "descripcion" => array:1 [ "en" => "(A) Sequelae of anterior uveitis with tent-shaped peripheral anterior synechiae. (B) Multiple chorioretinal lesions in peripheral retina." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary site of inflammation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Includes \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Anterior uveitis</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Anterior chamber</td><td class="td" title="table-entry " align="left" valign="top">Iritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Iridocyclitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterior cyclitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Intermediate uveitis</td><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Vítreous</td><td class="td" title="table-entry " align="left" valign="top">Pars planitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior cyclitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyalitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Posterior uveitis</td><td class="td" title="table-entry " rowspan="5" align="left" valign="top">Retina or choroid</td><td class="td" title="table-entry " align="left" valign="top">Focal, multifocal or diffuse choroiditis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chorioretinitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retinochoroiditis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retinitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neuroretinitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Panuveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anterior chamber, vitreous and retina or choroid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1338595.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Anatomical Classification of Uveitis (Sun Working Group, 2005)." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "ACE, angiotensin-converting enzymes; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BHL, bilateral hilar lymphadenopathy; BRV, bilateral retinal vasculitis; ID, identification; KP, mutton fat keratic precipitates; M, man; QTF, Quantiferon®; X-ray, radiography; W, woman." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ID \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Systemic clinical signs \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anatomical location of inflammation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical signs of ocular sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ancillary tests \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis of ocular sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="8" align="left" valign="top">Initial signs of ocular sarcoidosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Respiratory and neurological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic bilateral panuveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BRV Vitritis Chorioretinitis Periphlebitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (+) ACE (−) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Definite \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parotitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic bilateral panuveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BRV Chorioretinitis Periphlebitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (+) ACE (+) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Definite \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parotitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral chronic anterior uveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">KP Vitritis Iris nodules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (−) ACE (+) AST and ALT (−) Lysozyme (−) X-ray−no alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Probable \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Parotitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral chronic anterior uveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">KP Vitritis Iris nodules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (-) QTF (−) Biopsy (−) ACE (−) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Presumed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral chronic anterior uveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">KP Vitritis Iris nodules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (−) ACE (−) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Presumed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic bilateral panuveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vitritis Chorioretinitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (+) ACE (+) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Definite \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral chronic anterior uveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vitritis Iris nodules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (+) ACE (+) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Definite \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="8" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="8" align="left" valign="top">Inittial signs of systemic sarcoidosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic bilateral panuveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vitritis Chorioretinitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (−) ACE (−) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Presumed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Respiratory Peripheral lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic bilateral panuveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vitritis Chorioretinitis Periphlebitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (−) ACE (−) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Presumed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Erythema nodosum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral chronic anterior uveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">KP Chorioretinitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (−) ACE (−) AST and ALT (−) Lysozyme (−) X-ray with BHL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Presumed \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">W \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Peripheral lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic bilateral panuveitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">KP Vitritis Iris nodules Chorioretinitis synechiae \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mantoux (−) QTF (−) Biopsy (−) ACE (+) AST and ALT (−) Lysozyme (−) X-ray – no alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Possible \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1338592.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and Clinical Characteristics, Anatomical Location of Uveitis, Signs of Ocular Sarcoidosis, Ancillary Tests, Diagnosis and Treatment of the Series Presented." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Location \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Description \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lacrimal glands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Keratoconjunctivitis sicca, lacrimal hypertrophy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Orbit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diffuse unilateral orbital inflammation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Eyelid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granuloma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Conjunctiva \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Granuloma, conjunctivitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sclerotic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Scleritis, episcleritis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cornea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Interstitial keratitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Optic nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Optic neuropathy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1338593.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Involvement of the Eye and Its Neighboring Structures, Except for the Iris." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BCG, Bacillus Calmette-Guérin." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraocular signs indicative of ocular sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1. Mutton fat keratic precipitates and/or iris nodules (Koeppe/Bussaca) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2. Trabecular meshwork nodules and/or tent-shaped peripheral anterior synechiae \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3. Vitreous opacities with “snowballs” or a string of pearls \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4. Multiple peripheral chorioretinal lesions (active and/or atrophic) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5. Segmental and/or nodular periphlebitis and/or macroaneurysms in an inflamed eye \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6. Nodules or granulomas in the optic disc and/or solitary choroidal nodule \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7. Bilateral inflammation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ancillary tests suggestive of ocular sarcoidosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1. Negative tuberculin test in a BCG-vaccinated patient or in one who had a positive result on a previous Mantoux test \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2. Elevated angiotensin-converting enzyme and/or elevated lysozyme level \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3. Chest X-ray showing bilateral hilar lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4. Unexpected findings in liver enzyme tests \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5. Chest tomography in patients with a negative X-ray \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1338594.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Diagnostic Criteria of the First International Workshop on Ocular Sarcoidosis (FIWOS)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Sterling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Rheumatology" "paginaInicial" => "1392" "paginaFinal" => "1400" "edicion" => "6th ed." 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Nussenblatt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2005" "volumen" => "40" "paginaInicial" => "509" "paginaFinal" => "516" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0110" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Iannuzzi" 1 => "B. Rybicki" 2 => "A. 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Diagnostic Categorization According to the First International Workshop on Ocular Sarcoidosis (FIWOS) Criteria in a Series of 11 Patients

Categorización diagnóstica según los criterios del First International Workshop on Ocular Sarcoidosis (FIWOS) en una serie de 11 pacientes

Carlos F. Menesesa,

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carlosfrancisco.menesesvillalba@osakidetza.net

Corresponding author.

, César A. Egüesa, Miren Uriartea, Nerea Errazquina, Alejandro Valero Jaimesa, Olga Maíza, Joaquín Belzuneguia, Ana Blancob

a Servicio de Reumatología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain

b Servicio de Oftalmología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Sequelae of anterior uveitis with tent-shaped peripheral anterior synechiae&#46; &#40;B&#41; Multiple chorioretinal lesions in peripheral retina&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcoidosis is a multisystem disorder of unknown cause&#44; characterized by noncaseating granulomatous inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> It affects the parenchyma of almost any organ&#44; and thoracic symptoms are those most frequently observed&#46; Overall&#44; 30&#37;&#8211;60&#37; of the patients have eye involvement&#46; It is usually bilateral uveitis&#44; although&#44; uveitis can occasionally develop in the absence of systemic disease&#44; or could be the predominant manifestation with no significant extraocular impact&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2&#8211;4</span></a> In clinical practice&#44; the diagnosis of systemic sarcoidosis is based on the combination of clinical&#44; radiographic and histopathological findings&#46; The diagnostic criteria proposed by the First International Workshop on Ocular Sarcoidosis &#40;FIWOS&#41; were recently validated&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> These criteria classify ocular sarcoidosis as definite &#40;uveitis and positive biopsy&#41;&#44; presumed &#40;bilateral hilar lymphadenopathy and uveitis without biopsy&#41;&#44; probable &#40;3 ocular signs and 2 laboratory findings without biopsy or bilateral hilar lymphadenopathy&#41; and possible &#40;4 ocular signs and 2 laboratory findings with a negative biopsy&#41;&#44; in accordance with specific ophthalmological and laboratory findings&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> The latter are especially useful when there is no biopsy or the biopsy is negative&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0010" class="elsevierStylePara elsevierViewall">The purpose was to categorize those patients with a diagnosis of ocular sarcoidosis from 2009 to 2014 in Hospital Universitario Donostia&#44; in the province of Guip&#250;zcoa in northern Spain&#44; using the diagnostic and validated criteria of the FIWOS&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We retrospectively reviewed the case reports of the patients diagnosed with ocular sarcoidosis&#46; The diagnosis of sarcoidosis was based on a combination of the clinical&#44; radiographic and histological criteria of the FIWOS&#44; as well as the exclusion of other granulomatous diseases like tuberculosis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The variables recorded were patient age and sex&#44; presence of systemic manifestations&#44; anatomical location of the inflammation&#44; tuberculosis screening&#44; positive test for angiotensin-converting enzyme&#44; lymph node biopsy&#44; chest radiographic findings and treatment&#46; To classify uveitis we used the anatomical classification of the Standardization of Uveitis Nomenclature &#40;SUN&#41; Working Group<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; We excluded patients who had a positive result on the Quantiferon<span class="elsevierStyleSup">&#174;</span> test&#46; Using these findings&#44; we categorized the patients according to the FIWOS&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">We found a total of 11 patients with a diagnosis of sarcoid uveitis&#44; 7 women &#40;63&#46;6&#37;&#41; and 4 men &#40;36&#46;3&#37;&#41;&#46; The median age<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation was 58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;5 years&#46; In 7 patients &#40;63&#46;6&#37;&#41;&#44; the eye was the first organ to be affected&#58; 5 of them later developed the systemic clinical signs and 2 had only ocular clinical features&#46; Four patients &#40;36&#46;3&#37;&#41; began with extraocular systemic manifestations&#44; which&#44; in order of frequency&#44; were&#58; bilateral hilar lymphadenopathy in 81&#46;8&#37;&#44; respiratory manifestations in 36&#46;3&#37;&#44; peripheral lymphadenopathy in 18&#46;1&#37;&#44; parotitis in 27&#46;2&#37; and erythema nodosum in 9&#37;&#46; The locations of inflammation most frequently observed were chronic bilateral panuveitis in 54&#46;5&#37;&#44; unilateral chronic anterior uveitis in 27&#46;2&#37; and bilateral chronic anterior uveitis in 18&#46;1&#37;&#46; When the patients were categorized&#44; 4 &#40;36&#46;3&#37;&#41; had a definite diagnosis of sarcoidosis&#44; 5 patients &#40;45&#46;4&#37;&#41; had a presumed diagnosis&#44; 1 patient &#40;9&#37;&#41; had a probable diagnosis and 1 patient &#40;9&#37;&#41; had a possible diagnosis of sarcoidosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the above-mentioned variables in the patients diagnosed with ocular sarcoidosis&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis of systemic sarcoidosis is presently based on a combination of clinical and radiographic findings&#44; together with the histological confirmation and the exclusion of other granulomatous diseases&#44; such as tuberculosis&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> In clinical practice&#44; the determination of the angiotensin-converting enzyme level&#44; serum calcium&#44; plain chest X-ray&#44; scintigraphy and screening tests&#44; like Mantoux or Quantiferon<span class="elsevierStyleSup">&#174;</span>&#44; initially indicate involvement of systemic sarcoid&#46; Ocular involvement in sarcoidosis is presented by up to half of the patients and may even be the initial manifestation of the disease&#46; Sarcoidosis can affect the lacrimal glands and cause keratoconjunctivitis sicca&#44; involving the iris&#44; as well&#44; causing different forms of uveitis and even the development of optic neuritis when it affects the posterior pole&#46; The anatomical location of inflammation in sarcoid uveitis mainly&#44; and chronically&#44; involves the posterior segment&#46; It frequently consists of recurrent bilateral uveitis&#44; and can even cause generalized involvement in the form of bilateral panuveitis associated with retinal vasculitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">9&#44;10</span></a> The findings most frequently observed in uveitis associated with sarcoidosis include mutton fat keratic precipitates&#44; iris nodules&#44; tent-shaped peripheral anterior synechiae&#44; vitreous opacities like &#8220;snowballs&#8221;&#44; multiple peripheral chorioretinal lesions and nodular periphlebitis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Moreover&#44; there were other ocular signs that could indicate sarcoid involvement&#44; especially if evaluated in the presence of ancillary tests that are positive for sarcoidosis<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">11&#8211;14</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The diagnostic criteria proposed by the FIWOS were validated in 2010&#46; They include several ophthalmological signs indicative of sarcoidosis and comprise ancillary tests<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; These criteria do not include invasive procedures and are useful&#44; in clinical practice&#44; when there is no confirmatory biopsy or when the biopsy is negative&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Ocular and systemic manifestations of sarcoidosis&#44; as well as the ancillary tests&#44; show a great variability&#44; a fact that complicates the diagnosis&#46; With our work&#44; we have put into practice the FIWOS criteria&#44; which enabled us to categorize the patients with systemic clinical signs indicative of sarcoidosis together with other ocular manifestations and positive ancillary tests&#46; Because of the heterogeneity of this disease&#44; not all the patients fulfilled the diagnostic criteria for sarcoidosis&#59; for this reason&#44; after the diagnostic categorization&#44; we see that&#44; after satisfying the clinical and ophthalmological criteria and that of the ancillary tests&#44; the patients&#8217; disorder was classified as sarcoidosis&#46; Most of our patients&#44; coinciding with the literature&#44; were women &#40;63&#46;6&#37;&#41;&#46; Ocular problems were the initial symptom in 7 of the overall group and most of them had ocular manifestations indicative of sarcoid disease&#46; Tuberculin tests were negative in all of the patients and only 3 patients had a compatible lymph node biopsy&#46; Those who had not undergone a biopsy for the classification criteria&#44; after categorization&#44; had a &#8220;presumed&#8221; diagnosis of sarcoidosis&#46; The ophthalmological data showed that the most common anatomical location was chronic bilateral panuveitis&#44; affecting 54&#46;5&#37; of the patients&#46; In second place&#44; unilateral chronic anterior uveitis&#44; with 27&#46;2&#37;&#44; was the most frequent form&#46; Most of the patients began with clinical manifestations of uveitis&#44; developing the systemic clinical disease later on&#46; After the categorization of the patients&#44; the diagnosis of sarcoidosis was definite in 4 patients&#44; presumed in 5&#44; probable in 1 and possible in 1 other patient&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The present study is especially interesting for rheumatologists who work in collaboration with ophthalmologists in uveitis clinics&#44; as sarcoidosis is an uncommon disease&#44; it is best to standardize criteria for the correct diagnosis of this disorder&#46; We should also point out that the use of these criteria enables the diagnosis without the need for a biopsy&#44; which could be iatrogenic or difficult in certain patients&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">These criteria categorize patients with data indicative of sarcoidosis and who&#44; because of the variability in the clinical course and organic involvement&#44; have not been categorized as patients with sarcoid disease&#46; The sarcoid ocular involvement plays a very significant role for categorization and&#44; for this reason&#44; it is important to stress a detailed ophthalmological examination in search of ocular signs indicative of a granulomatous inflammatory disease&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical Disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Protection of human and animal subjects</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Confidentiality of data</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Right to privacy and informed consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of Interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Categorization of patients diagnosed with ocular sarcoidosis during the period 2009&#8211;2014&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The medical records of patients with ocular sarcoidosis were reviewed and variables were collected to categorize the patients according to the criteria of the FIWOS&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We found 11 patients&#44; 7 women and 4 men&#44; with sarcoid uveitis&#59; the median age was 58 years&#46; Bilateral panuveitis was the most common pattern &#40;54&#46;5&#37;&#41;&#44; followed by chronic anterior uveitis &#40;27&#46;2&#37;&#41;&#46; The diagnosis of sarcoidosis was definitive in 4 patients &#40;36&#46;3&#37;&#41;&#44; presumed in 5 &#40;45&#46;4&#37;&#41;&#44; probable in 1 &#40;9&#37;&#41; and possible in 1 &#40;9&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ocular sarcoidosis was diagnosed in more than half of the patients who had no confirmatory biopsy&#46; Bilateral panuveitis and chronic anterior uveitis were the patterns most frequently observed&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Categorizar a los pacientes con diagn&#243;stico de sarcoidosis ocular en el per&#237;odo comprendido entre 2009 y 2014&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se revisaron las historias cl&#237;nicas de los pacientes con sarcoidosis ocular y se recopilaron las variables para categorizar a los pacientes seg&#250;n los criterios del FIWOS&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se encontr&#243; a un total de 11 pacientes con uve&#237;tis sarcoidea&#44; 7 mujeres y 4 hombres&#44; con una mediana de edad de 58 a&#241;os&#46; El patr&#243;n de panuve&#237;tis bilateral cr&#243;nica fue el m&#225;s frecuente en un 54&#44;5&#37;&#44; seguido de la uve&#237;tis anterior cr&#243;nica unilateral&#44; con 27&#44;2&#37;&#46; El diagn&#243;stico de sarcoidosis fue definitivo en 4 pacientes &#40;36&#44;3&#37;&#41;&#44; presunto en 5 pacientes &#40;45&#44;4&#37;&#41;&#44; probable en un paciente &#40;9&#37;&#41; y posible en un paciente &#40;9&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">M&#225;s de la mitad de los pacientes sin biopsia confirmatoria fueron diagnosticados de sarcoidosis ocular&#46; La panuve&#237;tis bilateral cr&#243;nica y la uve&#237;tis anterior cr&#243;nica fueron los patrones predominantes&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Sequelae of anterior uveitis with tent-shaped peripheral anterior synechiae&#46; &#40;B&#41; Multiple chorioretinal lesions in peripheral retina&#46;</p>"
        ]
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at1"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Primary site of inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Includes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Anterior uveitis</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Anterior chamber</td><td class="td" title="table-entry  " align="left" valign="top">Iritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Iridocyclitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anterior cyclitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Intermediate uveitis</td><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">V&#237;treous</td><td class="td" title="table-entry  " align="left" valign="top">Pars planitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Posterior cyclitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hyalitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Posterior uveitis</td><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Retina or choroid</td><td class="td" title="table-entry  " align="left" valign="top">Focal&#44; multifocal or diffuse choroiditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chorioretinitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retinochoroiditis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retinitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neuroretinitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Panuveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anterior chamber&#44; vitreous and retina or choroid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Anatomical Classification of Uveitis &#40;Sun Working Group&#44; 2005&#41;&#46;</p>"
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      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ACE&#44; angiotensin-converting enzymes&#59; ALT&#44; alanine aminotransferase&#59; AST&#44; aspartate aminotransferase&#59; BHL&#44; bilateral hilar lymphadenopathy&#59; BRV&#44; bilateral retinal vasculitis&#59; ID&#44; identification&#59; KP&#44; mutton fat keratic precipitates&#59; M&#44; man&#59; QTF&#44; Quantiferon<span class="elsevierStyleSup">&#174;</span>&#59; X-ray&#44; radiography&#59; W&#44; woman&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ID&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Systemic clinical signs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anatomical location of inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical signs of ocular sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ancillary tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnosis of ocular sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">Initial signs of ocular sarcoidosis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Respiratory and neurological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic bilateral<br>panuveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BRV<br>Vitritis<br>Chorioretinitis<br>Periphlebitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#43;&#41;<br>ACE &#40;&#8722;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Definite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Parotitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic bilateral<br>panuveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BRV<br>Chorioretinitis<br>Periphlebitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#43;&#41;<br>ACE &#40;&#43;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Definite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Parotitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bilateral chronic anterior<br>uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">KP<br>Vitritis<br>Iris nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#8722;&#41;<br>ACE &#40;&#43;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray&#8722;no alterations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Parotitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bilateral chronic anterior<br>uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">KP<br>Vitritis<br>Iris nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;-&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#8722;&#41;<br>ACE &#40;&#8722;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presumed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Respiratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unilateral chronic anterior<br>uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">KP<br>Vitritis<br>Iris nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#8722;&#41;<br>ACE &#40;&#8722;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presumed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic bilateral<br>panuveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitritis<br>Chorioretinitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#43;&#41;<br>ACE &#40;&#43;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Definite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unilateral chronic anterior<br>uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitritis<br>Iris nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#43;&#41;<br>ACE &#40;&#43;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Definite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleItalic">Inittial signs of systemic sarcoidosis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Respiratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic bilateral<br>panuveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitritis<br>Chorioretinitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#8722;&#41;<br>ACE &#40;&#8722;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presumed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Respiratory<br>Peripheral lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic bilateral<br>panuveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitritis<br>Chorioretinitis<br>Periphlebitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#8722;&#41;<br>ACE &#40;&#8722;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presumed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Erythema nodosum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Unilateral chronic anterior<br>uveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">KP<br>Chorioretinitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#8722;&#41;<br>ACE &#40;&#8722;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray with BHL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presumed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">W&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Peripheral lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic bilateral<br>panuveitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">KP<br>Vitritis<br>Iris nodules Chorioretinitis synechiae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mantoux &#40;&#8722;&#41;<br>QTF &#40;&#8722;&#41;<br>Biopsy &#40;&#8722;&#41;<br>ACE &#40;&#43;&#41;<br>AST and ALT &#40;&#8722;&#41;<br>Lysozyme &#40;&#8722;&#41;<br>X-ray &#8211; no alterations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Possible&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Scleritis&#44; episcleritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cornea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Optic neuropathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46; Vitreous opacities with &#8220;snowballs&#8221; or a string of pearls&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46; Chest X-ray showing bilateral hilar lymphadenopathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#46; Chest tomography in patients with a negative X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Diagnostic Criteria of the First International Workshop on Ocular Sarcoidosis &#40;FIWOS&#41;&#46;</p>"
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      "titulo" => "References"
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Article information

ISSN: 21735743
Original language: English

DOI:10.1016/j.reumae.2015.12.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	12	27	39
2024 October	61	21	82
2024 September	91	20	111
2024 August	80	38	118
2024 July	52	32	84
2024 June	62	42	104
2024 May	80	32	112
2024 April	85	28	113
2024 March	71	38	109
2024 February	42	27	69
2024 January	49	24	73
2023 December	41	20	61
2023 November	50	34	84
2023 October	56	32	88
2023 September	80	50	130
2023 August	40	18	58
2023 July	48	27	75
2023 June	55	24	79
2023 May	58	30	88
2023 April	58	17	75
2023 March	83	47	130
2023 February	52	26	78
2023 January	42	18	60
2022 December	63	51	114
2022 November	67	32	99
2022 October	68	38	106
2022 September	53	49	102
2022 August	34	65	99
2022 July	31	70	101
2022 June	46	32	78
2022 May	38	50	88
2022 April	46	44	90
2022 March	50	63	113
2022 February	48	27	75
2022 January	58	48	106
2021 December	44	43	87
2021 November	52	48	100
2021 October	58	60	118
2021 September	35	47	82
2021 August	41	35	76
2021 July	37	31	68
2021 June	35	23	58
2021 May	36	33	69
2021 April	118	115	233
2021 March	44	47	91
2021 February	24	29	53
2021 January	33	25	58
2020 December	17	25	42
2020 November	29	21	50
2020 October	23	14	37
2020 September	25	32	57
2020 August	24	21	45
2020 July	15	18	33
2020 June	40	38	78
2020 May	38	29	67
2020 April	14	25	39
2020 March	18	3	21
2020 February	2	0	2
2020 January	2	0	2
2019 October	66	2	68
2019 September	0	3	3
2019 May	2	0	2
2018 December	2	0	2
2018 May	4	0	4
2018 April	31	7	38
2018 March	56	8	64
2018 February	19	0	19
2018 January	20	6	26
2017 December	36	13	49
2017 November	26	6	32
2017 October	28	8	36
2017 September	25	6	31
2017 August	22	16	38
2017 July	35	9	44
2017 June	46	10	56
2017 May	58	19	77
2017 April	48	23	71
2017 March	45	24	69
2017 February	29	25	54
2017 January	4	10	14
2016 December	7	13	20

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