SAT0276 Uveitis during anti-tnf therapy in patients with axial spondyloarthritis: a paradoxical event or disease manifestation?
Authors: C. Ancuta, C. Pomirleanu, R. Paiu, G. Strugariu, L. Petrariu, C. Bran, E. Ancuta, R. Chirieac
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Although widely recognised as extra-articular manifestations of axial spondyloarthritis (axSpA), uveitis developing throughout anti-TNFα treatment is difficult to be classified as disease related or paradoxical event. <h3>Objectives</h3> We aimed to evaluate the incidence of new onset or relapsing uveitis in patients with axSpA receiving TNF inhibitors. <h3>Methods</h3> We performed a cross-sectional retrospective study evaluating 126 consecutive active axSpA exposed to TNFα inhibitors according to the local recommendations, followed-up in a single rheumatology department. Patients identified with uveitis were systematically assessed based on a predefined protocol comprising (i) <i>data about uveitis</i> (<i>de novo</i> or flare; unique episode or recurrence; acute or chronic; anterior, posterior, intermediary or panuveitis; uni or bilateral; outcomes), (ii) <i>responsible medication</i> (drug exposure prior to uveitis, biologic-naïve or experimented axSpA, continuation or switching to another biologic) and (iii) <i>rheumatic condition</i> (activity, response to treatment, extra-articular manifestations, disease duration). <h3>Results</h3> 91 biologic naïve axSpA and 35 receiving more than one anti-TNF<i>α</i> were recruited; among them, 318 patient-years exposed to etanercept, 225.37 patient-years to adalimumab, 113.52 patient-years to infliximab, 30.49 patient-years on golimumab. A history of uveitis was found in 27.77% (35 cases). We reported 12 patients developing at least one episode of uveitis during biologic treatment (7 <i>de novo</i>, 10 recurrent uveitis); etanercept was mostly associated with uveitis (8 episodes, 2.51 per 100 patient-years), but also monoclonal antibodies, 3 with golimumab (9.83 per 100 patien-years), 2 under infliximab (1.76 per 100 patien-years), surprisingly, 3 with adalimumab (1.33 per 100 patien-years). Only 3 axSpA had uveitis before starting anti-TNFs. Uveitis was described irrespective of the prior exposure to biologics, mainly in bio-experimented patients,<sup>9</sup> aged between 26 and 72, with disease duration of 6 to 38 years, occurring any-time during biologics (2–116 months). Acute anterior uveitis was commonly reported, only one case of complicated panuveitis. 3 cases (one infliximab, two golimumab) had benefit with switching to another TNF blocker, but in most reported cases uveitis was solved without anti-TNF<i>α</i> interruption. Further, continuation of the same anti-TNF<i>α</i> did not cause relapse in some cases. The underlying SpA was well controlled (ASDAS-CRP) when uveitis, patients being classified as responders compared to previous visit, suggesting paradoxical uveitis. <h3>Conclusions</h3> Although rare, new onset or flare of uveitis may occur during anti-TNF therapy in axSpA. Surprisingly, not only TNF receptor but also monoclonal antibodies were responsible, etanercept being involved mainly in new onset uveitis. <h3>Disclosure of Interest</h3> None declared