How do you decide between initiating systemic immunosuppressive therapy versus controlling the uveitis with local treatment in a patient with HLA-B27 positive uveitis and a history of spondyloarthropathy?  

I find that most, but not all, HLA-B27 iritis can be controlled with topical therapies. To do so requires eliminating other causes of inflammation. Many patients have GI inflammation due to gluten and dairy, despite not having classic celiac disease or lactose intolerance. Reducing their intake, mo...