Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
New Onset of Uveitis under Anti TNF Therapy. A Nationwide Series.
Wendling, Daniel, Paccou, Julien, Flipo, René-Marc, Dernis, Emmanuelle, Direz, Guillaume, Ferrazzi, Veronique, Guillaume, Séverine
Uveitis may be associated with various inflammatory diseases. Previous reports suggested that TNF blockers, especially anti TNF monoclonal antibodies, may reduce the incidence of uveitis flares in those diseases. Under these circumstances, de novo occurrence, i.e. new onset of the first episode of uveitis under anti TNF therapy is uncommon.
The aim of this study was to collect cases of new onset of uveitis under anti TNF therapy, using a nationwide network, and to describe such cases.
All French rheumatologists and internal medicine practitioners registered on the Club Rhumatismes et Inflammation web site (1,400 physicians) were contacted by 3 electronic newsletters in an attempt to declare the cases of new onset of uveitis, diagnosed by an ophthalmologist, in patients treated with TNF blockers. A previous episode of uveitis before anti TNF therapy was an exclusion criteria. Informations were recorded about the patient (age, gender), the disease (diagnosis, duration), the TNF blocker (type, duration), the uveitis (type, severity, outcome).
Thirteen cases were recorded, 7 men, mean age 43 (570) years. Other causes of uveitis were excluded (e.g. infection). The underlying disease was ankylosing spondylitis (6 cases, 5 HLA-B27 positive), psoriatic arthritis (3 cases), rheumatoid arthritis (2 cases), juvenile spondyloarthritis, psoriatic spondyloarthritis (1 case each). The mean duration of the disease was 13.5 (1.535) years. The TNF blocker at time of uveitis was etanercept 9 times (3 cases after adalimumab), adalimumab 2 times (with previous infliximab and etanercept), infliximab 2 times (one with previous etanercept). The mean duration of exposure to anti TNF agents was 28.3 (465) months at uveitis occurrence. Eleven of the patients were good responders to TNF blockers at time of uveitis onset. Uveitis was acute anterior in 12 cases (bilateral in 2), and one bilateral chronic anterior uveitis. Uveitis was treated locally in 12 cases, and with systemic steroids in one case. The cases of acute anterior uveitis resolved within one month, TNF blocker was stopped in two cases, and maintained in the others. Uveitis recurrence occurred in 5 cases, with sequelae in one case, with a mean follow-up of 16.9 (1 77) months.
Uveitis occurs de novo under anti TNF therapy mainly in spondyloarthropathies, but also in rheumatoid arthritis patients; this new onset seems more frequent under etanercept and uveitis is time-limited without discontinuation of the TNF blocker in most of the cases. This illustrates a new possibility of paradoxical effects of anti TNF agents, and rheumatologists should be aware about this event.
To cite this abstract, please use the following information:
Wendling, Daniel, Paccou, Julien, Flipo, René-Marc, Dernis, Emmanuelle, Direz, Guillaume, Ferrazzi, Veronique, et al; New Onset of Uveitis under Anti TNF Therapy. A Nationwide Series. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :904