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New Onset of Uveitis During Anti-Tumor Necrosis Factor Treatment for Rheumatic Diseases

https://doi.org/10.1016/j.semarthrit.2011.05.005Get rights and content

Uveitis may be associated with various inflammatory diseases. Previous reports suggested that tumor necrosis factor (TNF) blockers, especially anti-TNF monoclonal antibodies, may reduce the incidence of uveitis flares in some inflammatory diseases. Under these circumstances, de novo occurrence, ie, new onset of the first episode of uveitis under anti-TNF therapy, is uncommon.

Objectives

The aim of this study was to collect cases of new onset of uveitis under anti-TNF therapy, using a nationwide network, to describe these cases, and to gather with cases reported in the literature.

Methods

All French rheumatologists, pediatric rheumatologists, and internal medicine practitioners registered on the Club Rhumatismes et Inflammation web site were contacted in an attempt to declare the cases of new onset of uveitis, diagnosed by an ophthalmologist, in patients treated with TNF blockers. The analysis of the literature was performed through PubMed database and manual research.

Results

Thirty-one cases were recorded, 19 men, mean age 43 (5-70) years, occurring in ankylosing spondylitis (19 cases), psoriatic arthritis (4 cases), rheumatoid arthritis (6 cases), juvenile idiopathic arthritis (2 cases). The TNF blocker at the time of uveitis was etanercept 23 times, adalimumab 3 times, infliximab 5 times, with a mean total duration of exposure to anti-TNF agents of 27 (4-96) months at uveitis occurrence. Most of the patients were good responders to TNF blockers at the time of uveitis onset. Analysis of the literature revealed 121 similar cases published in English.

Conclusion

Uveitis occurs de novo under anti-TNF therapy mainly in spondyloarthropathies, but also in rheumatoid arthritis and juvenile idiopathic arthritis patients and more frequently under etanercept.

Section snippets

Methods

This is a descriptive, retrospective study.

National Survey

Thirty-one cases were recorded, 19 men and 12 women, mean age 43 (5-70) years (Table 1). Other causes of uveitis were excluded (eg, infection). The underlying disease was ankylosing spondylitis (19 cases, 10/12 HLA-B27 positive), psoriatic arthritis (4 cases), rheumatoid arthritis (6 cases), juvenile idiopathic arthritis (2 cases) (Table 2). The mean duration of the disease was 15 (1.5-35) years. The TNF blocker at time of uveitis onset was etanercept 23 times (6 cases after infliximab),

Discussion

In this survey, we gathered 31 cases of new onset of uveitis occurring during anti-TNF therapy, and 121 of such cases available in the English literature. Our series is in accordance with the pooled data of the literature.

Etanercept is the most frequent TNF blocker involved in these cases (23/31 in our series; 103/121 in the literature), suggesting that soluble TNF receptor may be more at risk than monoclonal antibodies regarding the new onset of uveitis. In fact some differences have been

Conclusion

Uveitis occurs de novo under anti-TNF therapy mainly in spondylarthritides, but also in JIA and 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, at least for adult patients. This illustrates a new possibility of a potential paradoxical effect of anti-TNF agents, and rheumatologists and ophthalmologists should be aware of this event.

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    The authors have no conflicts of interest to disclose.

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