Current perspectives on demyelination and associated uveitis: From pathogenesis to biological therapies.

Abstract

Uveitis associated with demyelinating diseases, particularly multiple sclerosis (MS), has gained increasing attention in recent years. Advances in diagnostic modalities, such as the widespread use of brain magnetic resonance imaging, have facilitated deeper investigation into the pathophysiology of uveitis and revealed stronger associations with MS. Additionally, recent genome-wide association studies and progress in immunology have further expanded our understanding of the complex relationship between these conditions. Of particular interest is the emerging recognition of drug-induced MS, especially linked to tumor necrosis factor-alpha (TNF-α) inhibitors. While TNF-α inhibitors are commonly employed in the treatment of uveitis, accumulating evidence suggests they may carry risks of inducing or exacerbating central nervous system demyelination. This evolving landscape necessitates a careful review of current literature to identify new associations, evaluate the strength of existing evidence, and guide clinical decision-making. Special focus is needed on the optimal use of biological therapies and management strategies for refractory uveitis in the context of MS when conventional treatments fail. This narrative review aims to synthesize recent findings, highlight emerging challenges, and provide practical insights for clinicians managing this complex interplay between uveitis and demyelinating diseases.