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