Phoebe Lin (editor) - Treatment of Non-infectious Uveitis

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The history of the therapeutic approach to inflammation, in general, and to uveitis, in particular, contains many curios. Aspirin was synthesized in 1897, and for decades, it was virtually the only known pill that reliably treated inflammation. In the 1930s, the theory that uveitis resulted from an occult infection inspired some to recommend hysterectomy or prostatectomy as treatment for uveitis [1]. Another popular approach during this era was fever therapy as could be induced by typhoid vaccine [2]. Philip Hench from the Mayo Clinic began to use adrenal derivatives to treat rheumatoid arthritis in 1948 and received the Nobel Prize for this discovery only 2 years later. Hench died of suicide, and many believe that much of his depression resulted from the realization that cortisone therapy was fraught with toxicities that he had never appreciated on the basis of the short-term studies for which he was appropriately honored. Methotrexate is now a popular immunosuppressive whose mechanism of action is partially due to poisoning leukocytes. It was developed to treat leukemia. The suggestion that methotrexate should be used to treat inflammation was greeted by many with skepticism.

In the 1950s, growing up in Portland, Oregon, I would make hospital rounds with my father. He had been trained by Hench and then came west to become arguably the first rheumatologist in the state. But his bag of therapeutic magic for rheumatoid arthritis was nearly empty. A mainstay was the injection of gold, based in part on the concept that heavy metals could be toxic to bacteria like tuberculosis. As I write today, the contribution of tuberculosis to certain inflammations within the eye still often provokes heated debate. My fathers most effective therapies might have been bedrest and his ever optimistic personality which continually encouraged improvement. Our current rheumatology fellows have never met a patient who received gold therapy even though that was standard of care when I did my rheumatology fellowship in the late 1970s.

Editors, Phoebe Lin and Eric Suhler, have assembled a collection of manuscripts which thoroughly describe the state of the art for noninfectious uveitis therapy in 2018. Each contribution is written by an expert or experts. It is impossible for me to hold the volume without thinking how much has changed since I founded a uveitis clinic in a tertiary medical center in 1985. Even more pleasant to imagine is how much more will change thanks to the careers of the editors, authors, and readers of this collection.