Validation of a brief questionnaire measuring positive mindset in patients with uveitis

Aim: Illness may impact the positivity of a person’s mindset. However, patients with visual impairment, such as uveitis, may struggle to complete questionnaires. The aim of this study was to validate a brief and simple measure of positive mindset in people with uveitis. Method: This study was a cross-sectional survey of 200 people with uveitis. The Positive Mindset Index (PMI) questionnaire uses six items to measure a patient’s happiness, confidence, sense of being in control, stability, motivation, and optimism. Results: Exploratory factor analysis revealed a well-fitting unidimensional factor structure (KMO = .898), with strong factor loadings (from .616 to .721) and excellent internal reliability (Cronbach’s α = .926). The PMI showed strong concurrent validity with the mental health subscale of the SF-36 (r = .789) and good construct validity relative to the physical health subscale of the SF-36 (r = .468). Excellent test-retest reliability was seen (r = .806). Patients taking 10 mg or more corticosteroid daily had significantly lower PMI scores than those on a lower dose or no dose (t (170) = 2.298, p < .023). Conclusion: The PMI has good face validity and sound psychometric properties. It is a very brief and simple measure, thus user-friendly for patients with visual impairment, as well as researchers and others using the scale

Birdshot chorioretinopathy: current knowledge and new concepts in pathophysiology, diagnosis, monitoring and treatment

Birdshot chorioretinopathy (BCR) is a rare form of chronic, bilateral, posterior uveitis with a distinctive clinical phenotype, and a strong association with HLA-A29. It predominantly affects people in middle age. Given its rarity, patients often encounter delays in diagnosis leading to delays in adequate treatment, and thus risking significant visual loss. Recent advances have helped increase our understanding of the underlying autoimmune mechanisms involved in disease pathogenesis, and new diagnostic approaches such as multimodality imaging have improved our ability to both diagnose and monitor disease activity. Whilst traditional immunosuppressants may be effective in BCR, increased understanding of immune pathways is enabling development of newer treatment modalities, offering the potential for targeted modulation of immune mediators. In this review, we will discuss current understanding of BCR and explore recent developments in diagnosis, monitoring and treatment of this disease. Synonyms for BCR: Birdshot chorioretinopathy, Birdshot retinochoroiditis, Birdshot retino-choroidopathy, Vitiliginous choroiditis. Orphanet number: ORPHA179 OMIM: 605808

Adalimumab vs placebo as add-on to Standard Therapy for autoimmune Uveitis: Tolerability, Effectiveness and cost-effectiveness-a protocol for a randomised controlled trial (ASTUTE trial).

IntroductionAdalimumab is an effective treatment for autoimmune non-infectious uveitis (ANIU), but it is currently only funded for a minority of patients with ANIU in the UK as it is restricted by the National Institute for Health and Care Excellence guidance. Ophthalmologists believe that adalimumab may be effective in a wider range of patients. The Adalimumab vs placebo as add-on to Standard Therapy for autoimmune Uveitis: Tolerability, Effectiveness and cost-effectiveness (ASTUTE) trial will recruit patients with ANIU who do and do not meet funding criteria and will evaluate the effectiveness and cost-effectiveness of adalimumab versus placebo as an add-on therapy to standard care.Methods and analysisThe ASTUTE trial is a multicentre, parallel-group, placebo-controlled, pragmatic randomised controlled trial with a 16-week treatment run-in (TRI). At the end of the TRI, only responders will be randomised (1:1) to 40 mg adalimumab or placebo (both are the study investigational medicinal product) self-administered fortnightly by subcutaneous injection. The target sample size is 174 randomised participants. The primary outcome is time to treatment failure (TF), a composite of signs indicative of active ANIU. Secondary outcomes include individual TF components, retinal morphology, adverse events, health-related quality of life, patient-reported side effects and visual function, best-corrected visual acuity, employment status and resource use. In the event of TF, open-label drug treatment will be restarted as per TRI for 16 weeks, and if a participant responds again, allocation will be switched without unmasking and treatment with investigational medicinal product restarted.Ethics and disseminationThe trial received Research Ethics Committee (REC) approval from South Central - Oxford B REC in June 2020. The findings will be presented at international meetings, by peer-reviewed publications and through patient organisations and newsletters to patients, where available.Trial registrationISRCTN31474800. Registered 14 April 2020

Development and Validation of Quality-of-Life Questionnaires for Birdshot Chorioretinopathy

Birdshot chorioretinopathy (BCR) is a rare form of chronic posterior uveitis, usually requiring long-term, systemic immunosuppression.1 The severe impact of the disease on acuity, visual field, color discrimination, and electrodiagnostics is well-documented,1 ; 2 but studies on quality of life (QoL) have been limited. Furthermore, existing QoL tools fail to capture the unique and wide range of symptoms associated with BCR and BCR medications