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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the letter published by Mart&#237;n Guill&#233;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> very attentively&#46; They presented a case of uveitis associated with treatment with bisphosphonates&#44; and we would like to comment on our experience with this adverse effect&#44; which we help might contribute to the proper identification of these cases&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a retrospective observational study in which we included the cases of uveitis that developed <span class="elsevierStyleItalic">de novo</span> during treatment with bisphosphonates&#46; The study was performed in the emergency department of Hospital Universitario Ram&#243;n y Cajal in Madrid&#44; between January 2003 and December 2012&#46; The variables analyzed included age&#44; sex&#44; indication for antiresorptive therapy&#44; comorbidities&#44; type of bisphosphonate&#44; time between starting treatment and the onset of uveitis&#44; clinical manifestation&#44; associated ocular inflammatory signs and symptoms and outcome&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There were 18 cases of uveitis associated with bisphosphonates&#44; all in women&#44; with a mean age at the time of diagnosis of 64&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;3 years &#40;range&#58; 38&#8211;82&#41;&#59; 61&#37; had taken alendronate and 39&#37; had received risedronate&#46; The indication for treatment was primary osteoporosis in 10 cases and secondary in 6&#46; In 5 cases &#40;27&#37;&#41;&#44; there was a history of autoimmune disease&#44; but without episodes of ocular inflammation prior to taking the bisphosphonate&#59; the diagnoses were inflammatory bowel disease with or without associated spondyloarthritis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; adult-onset Still&#39;s disease &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and primary biliary cirrhosis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; The time between starting treatment and the development of uveitis was 30&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 months &#40;range&#58; 8&#8211;63&#41;&#46; All the patients had unilateral &#40;89&#37;&#41; or bilateral &#40;11&#37;&#41; acute anterior uveitis&#44; and the most widespread clinical presentation was the association of pain and ocular inflammation &#40;56&#37;&#41;&#46; In 2 &#40;11&#37;&#41;&#44; there were other concomitant ocular inflammatory disorders &#40;superficial punctate keratitis &#91;SPK&#93; and follicular conjunctivitis&#44; respectively&#41;&#44; and 10 patients &#40;56&#37;&#41; developed complications &#40;cataracts 22&#37;&#44; synechiae 16&#37;&#44; vitreous detachment 16&#37; and macular edema 5&#37;&#41;&#46; Retrospectively&#44; we learned that&#44; prior to uveitis&#44; 3 patients had had other episodes of ocular inflammation during bisphosphonate therapy&#44; corresponding to scleritis&#44; episcleritis and SPK&#47;blepharitis&#44; respectively&#46; All of the aforementioned patients received treatment with topical corticosteroids and cycloplegic agents&#46; Bisphosphonate therapy was discontinued because of the ocular event in only 1 case &#40;6&#37;&#41; and for another cause in 2 &#40;11&#37;&#41;&#44; and was maintained in the rest &#40;83&#37;&#41;&#46; During the follow-up period&#44; after the first episode of uveitis &#40;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;4 months&#41;&#44; remission was achieved in 72&#37; of the cases and recurrent disease in 28&#37;&#59; however&#44; 44&#37; developed other ocular inflammatory events&#44; including conjunctivitis&#44; SPK and blepharitis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our series&#44; most of the cases of uveitis associated with bisphosphonates occurred in women over the age of 60 years&#44; with no previous history of autoimmunity or any other predisposing ocular disease&#46; This profile coincides with that reported in the study of the cohort of Canadian veterans by Etminan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> All of the patients had received oral aminobisphosphonates&#44; generally for a long period of time&#44; until the adverse effect developed&#46; In the published cases&#44; there is an ample range from the initiation of the drug until the onset of uveitis&#44; which goes from less than 24<span class="elsevierStyleHsp" style=""></span>h to several months&#44; and is shorter with intravenous administration and longer with oral medication&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a> In our series&#44; there was also a high frequency of other associated ocular inflammatory signs and symptoms&#46; Bisphosphonates have been related to a wide variety of ocular disorders&#44; mostly inflammatory&#44; including conjunctivitis&#44; scleritis&#44; episcleritis&#44; keratitis&#44; orbital inflammatory disease and retrobulbar neuritis&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a> Bisphosphonate therapy was discontinued in only 1 of our patients because of uveitis&#44; whereas&#44; it was maintained in the majority&#44; and this may have contributed to the rates of recurrence and the development of other ocular inflammatory disorders and sequelae&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although the development of uveitis during bisphosphonate therapy is an uncommon adverse event&#44; it is important that clinicians who prescribe these agents recognize this association&#44; and that patients be informed about its signs and symptoms for its early diagnosis and treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest concerning the publication of this article&#46;</p></span></span>"
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Letter to the Editor
Response to: Uveitis due to Bisphosphonates: A Rare Side Effect?
Respuesta a: Uveítis por bifosfonatos: ¿un raro efecto secundario?
Walter Alberto Sifuentes-Giraldoa,
Corresponding author
albertosifuentesg@gmail.com

Corresponding author.
, Cristina Clara Macía-Villab, Mónica Vázquez-Díaza
a Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España
b Servicio de Reumatología, Hospital Clínico Universitario de Valladolid, Valladolid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the letter published by Mart&#237;n Guill&#233;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> very attentively&#46; They presented a case of uveitis associated with treatment with bisphosphonates&#44; and we would like to comment on our experience with this adverse effect&#44; which we help might contribute to the proper identification of these cases&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a retrospective observational study in which we included the cases of uveitis that developed <span class="elsevierStyleItalic">de novo</span> during treatment with bisphosphonates&#46; The study was performed in the emergency department of Hospital Universitario Ram&#243;n y Cajal in Madrid&#44; between January 2003 and December 2012&#46; The variables analyzed included age&#44; sex&#44; indication for antiresorptive therapy&#44; comorbidities&#44; type of bisphosphonate&#44; time between starting treatment and the onset of uveitis&#44; clinical manifestation&#44; associated ocular inflammatory signs and symptoms and outcome&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">There were 18 cases of uveitis associated with bisphosphonates&#44; all in women&#44; with a mean age at the time of diagnosis of 64&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;3 years &#40;range&#58; 38&#8211;82&#41;&#59; 61&#37; had taken alendronate and 39&#37; had received risedronate&#46; The indication for treatment was primary osteoporosis in 10 cases and secondary in 6&#46; In 5 cases &#40;27&#37;&#41;&#44; there was a history of autoimmune disease&#44; but without episodes of ocular inflammation prior to taking the bisphosphonate&#59; the diagnoses were inflammatory bowel disease with or without associated spondyloarthritis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; adult-onset Still&#39;s disease &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and primary biliary cirrhosis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; The time between starting treatment and the development of uveitis was 30&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 months &#40;range&#58; 8&#8211;63&#41;&#46; All the patients had unilateral &#40;89&#37;&#41; or bilateral &#40;11&#37;&#41; acute anterior uveitis&#44; and the most widespread clinical presentation was the association of pain and ocular inflammation &#40;56&#37;&#41;&#46; In 2 &#40;11&#37;&#41;&#44; there were other concomitant ocular inflammatory disorders &#40;superficial punctate keratitis &#91;SPK&#93; and follicular conjunctivitis&#44; respectively&#41;&#44; and 10 patients &#40;56&#37;&#41; developed complications &#40;cataracts 22&#37;&#44; synechiae 16&#37;&#44; vitreous detachment 16&#37; and macular edema 5&#37;&#41;&#46; Retrospectively&#44; we learned that&#44; prior to uveitis&#44; 3 patients had had other episodes of ocular inflammation during bisphosphonate therapy&#44; corresponding to scleritis&#44; episcleritis and SPK&#47;blepharitis&#44; respectively&#46; All of the aforementioned patients received treatment with topical corticosteroids and cycloplegic agents&#46; Bisphosphonate therapy was discontinued because of the ocular event in only 1 case &#40;6&#37;&#41; and for another cause in 2 &#40;11&#37;&#41;&#44; and was maintained in the rest &#40;83&#37;&#41;&#46; During the follow-up period&#44; after the first episode of uveitis &#40;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;4 months&#41;&#44; remission was achieved in 72&#37; of the cases and recurrent disease in 28&#37;&#59; however&#44; 44&#37; developed other ocular inflammatory events&#44; including conjunctivitis&#44; SPK and blepharitis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In our series&#44; most of the cases of uveitis associated with bisphosphonates occurred in women over the age of 60 years&#44; with no previous history of autoimmunity or any other predisposing ocular disease&#46; This profile coincides with that reported in the study of the cohort of Canadian veterans by Etminan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> All of the patients had received oral aminobisphosphonates&#44; generally for a long period of time&#44; until the adverse effect developed&#46; In the published cases&#44; there is an ample range from the initiation of the drug until the onset of uveitis&#44; which goes from less than 24<span class="elsevierStyleHsp" style=""></span>h to several months&#44; and is shorter with intravenous administration and longer with oral medication&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4</span></a> In our series&#44; there was also a high frequency of other associated ocular inflammatory signs and symptoms&#46; Bisphosphonates have been related to a wide variety of ocular disorders&#44; mostly inflammatory&#44; including conjunctivitis&#44; scleritis&#44; episcleritis&#44; keratitis&#44; orbital inflammatory disease and retrobulbar neuritis&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a> Bisphosphonate therapy was discontinued in only 1 of our patients because of uveitis&#44; whereas&#44; it was maintained in the majority&#44; and this may have contributed to the rates of recurrence and the development of other ocular inflammatory disorders and sequelae&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although the development of uveitis during bisphosphonate therapy is an uncommon adverse event&#44; it is important that clinicians who prescribe these agents recognize this association&#44; and that patients be informed about its signs and symptoms for its early diagnosis and treatment&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest concerning the publication of this article&#46;</p></span></span>"
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Article information
ISSN: 21735743
Original language: English
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Idiomas
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