J Ophthalmic Inflamm Infect 2018; 8: 10C15

J Ophthalmic Inflamm Infect 2018; 8: 10C15. presents challenges in the treatment of many illnesses including systemic inflammatory diseases. While randomized controlled trials (RCTs) are the gold standard for developing evidence-based guidelines, often RCTs are difficult or impractical due to many factors, such as cost and patient recruitment. In pregnancy, ethical issues further compound the difficulty of performing RCTs and clinicians are left with clinical judgement and data from case reports to guide their management. Granulomatosis with polyangiitis (GPA) and Beh?ets disease (BD) are two systemic inflammatory diseases that may have ocular involvement and can occur during pregnancy. Ocular GPA occurs in 14C60% of cases1,2 and ocular BD occurs in 29C100% of cases.3,4 It has been shown that various specialties manage diseases differently.5C10 Due to the rarity of these diseases as well as the complexity of pregnancy, we hypothesized that obstetricians, ophthalmologists, and rheumatologists would manage pregnant women with GPA and BD differently. We developed an online survey to evaluate therapeutic strategies of these differing specialties. Methods An online survey was developed that included clinical vignettes of a woman diagnosed with either GPA or BD who was contemplating pregnancy or was currently in the first trimester of pregnancy. The survey included a total of four clinical vignettes with questions relating to the management of these diseases as well as counseling regarding pregnancy. The study was approved as exempt by the Colorado Multiple Institution Review Board (protocol 17C7778) and the requirement for consent was waived by the exempt approval. An invitation to the online questionnaire was distributed to 209 members of the American Uveitis Society, 853 members of the American College of Rheumatology, and 2500 obstetricians via email and social media posts. The electronic invitations contained a link that led the respondents to the online questionnaire. Research Electronic Data Capture software was used to conduct the survey. All data were collected voluntarily and anonymously. The survey respondents were asked to identify whether they were an ophthalmologist, an obstetrician, or a rheumatologist. The survey respondents were questioned on the following vignettes: blockquote class=”pullquote” Scenario 1: You are consulted about a 26-year-old woman, who wishes to get pregnant in the next 12 months, and presents with progressive onset of bilateral lacrimal gland enlargement as well as painful necrotizing scleritis of the right eye. Cycloguanil hydrochloride Sinus and chest CT confirm the Cycloguanil hydrochloride presence of severe mucosal thickening and inflammation of the sinuses without pulmonary disease. Kidney function and urinalysis are normal. Lab testing discloses a positive C-ANCA and PR-3 antibody. A diagnosis of granulomatosis with polyangiitis (GPA; formerly Wegener’s granulomatosis) is made. The respondents were then asked to select the best choice for treatment. Choices included prednisone?+?methotrexate, prednisone + azathioprine, prednisone?+?mycophenolate, prednisone?+?cyclophosphamide, prednisone?+ adalimumab or other tumor necrosis factor (TNF) inhibitor, prednisone?+?rituximab, dexamethasone implant, fluocinolone acetonide implant, subtenon Kenalog? [triamcinolone] injection. The respondents were then asked how they would advise the woman regarding the planned pregnancy. /blockquote blockquote class=”pullquote” Scenario 2: Identical to scenario 1, except the woman was seven weeks pregnant. Cycloguanil hydrochloride The respondents were asked again what, in their opinion was the best choice for treatment and how they would advise the woman regarding pregnancy. Splenopentin Acetate /blockquote blockquote class=”pullquote” Scenario 3: A 26-year-old woman who wishes to get pregnant in the next 12 months presents with her third episode of retinal vasculitis. She has a history of recurrent oral and genital ulcers that are consistent with Beh?ets Disease (BD). Vision is usually 20/30 in both eyes. She has been on prednisone 40mg for the past six weeks. The respondents were then asked what, in their opinion, was the.