THU0388 UVEITIS IN AXIAL SPONDYLOARTHRITIS: FREQUENCY AND RELATIONSHIP TO BIOLOGICAL THERAPY. SINGLE CENTER UNIVERSITY STUDY OF 255 PATIENTS
Authors: I. González-Mazón, L. Sanchez-Bilbao, J. Rueda-Gotor, D. Martinez-Lopez, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2020)

Background: Uveitis is one of the most frequent extra articular manifestation of spondyloarthritis (SpA). Biological therapy, especially monoclonal TNF inhibitors, may be useful to prevent and to treat uveitis. However, other biologics had been related to paradoxical uveitis. Objectives: Our aim was to assess a) the epidemiological and clinical features of uveitis associated to SpA and b) its relationship with biological treatment used in SpA. Methods: An observational study of patients who developed uveitis form a cohort of 255 consecutive unselected patients with axial SpA (axSpA) classified according to the ASAS criteria. They were divided into: a) ankylosing spondylitis (AS) according to New York modified criteria (n= 193) b) non-radiographic axSpA (nr-axSpA) (n= 62). All these patients were followed in a single reference University Hospital. Results: We studied 255 patients with axSpA (151 men/104 women); mean age 37.8±10.6 years. In 36 (31 in AS; 5 in nr-axSpA) (14.2%) patients at least one episode of uveitis was observed after a follow-up 12.4±4.5 years. The mean age at onset of uveitis was 45.7±14.2 years. The diagnosis of uveitis preceded SpA diagnosis in 5 patients, but most of them occurred after a median of 6 [2-15] years of follow-up. Pattern of uveitis was anterior and acute in all cases, and unilateral in 83%. Median of anterior chamber cells was 1 [1-2] cells. Comparison of baseline characteristics and clinical features between patients who developed uveitis and those who did not is shown in table. Almost all patients who developed uveitis were HLAB27 positive. In these patients a lower frequency of enthesitis and inflammatory bowel disease was observed. Table. Uveitis N= 36 Non uveitis N= 219 p Baseline general features Age, years (mean±SD ) 45.7 ± 14.2 44.7 ± 12.1 0.49 Sex, n (m/w) (% ) 21/15 (58.3/41.7) 130/89 (59.4/40.6) 0.91 HLAB27, positive n (% ) 35 (97.2) 130 (59.4) 0.00 Anti-TNF, n Adalimumab 3 53 0.06 Certolizumab 1 4 0.79 Golimumab 1 11 0.87 Infliximab 1 29 0.13 Etanercept 0 12 0.31 Disease Characteristics Follow-up of AxSpa, year (mean±SD ) 13.64 ± 7.6 12.16 ± 9.73 0.33 AS, n (% ) 31 (86.1) 162 (74.0) 0.12 nr-AxSp, n (% ) 5 (13.9) 57 (26.0) 0.12 Peripheral arthritis, n (% ) 9 (25.0) 67 (30.6) 0.49 Hip affection, n (% ) 3 (8.3) 15 (6.8) 0.97 Enthesitis, n (% ) 9 (25.0) 81 (37.0) 0.16 Dactylitis, n (% ) 2 (5.5) 14 (6.4) 0.85 Psoriasis, n (% ) 4 (11.1) 24 (11.0) 0.79 Inflammatory bowel disease, n (% ) 1 (2.8) 15 (6.8) 0.57 Family history, n (% ) 12 (33.3) 58 (26.5) 0.39 6 patients with uveitis received anti-TNF therapy and suffered from 7 episodes of uveitis after 5.6±4 years of treatment, meanwhile only 1 out of the 3 patients who were treated with anti IL-17 did a single episode of uveitis after 4.2±1.9 of follow-up. Patients treated with secukinumab developed 2.72 episodes of uveitis/100 patients/year, meanwhile those who received monoclonal anti TNF presented 2.53 episodes/100 patients / year. Conclusion: The most frequent clinical pattern of uveitis was acute unilateral anterior. Almost all of them were HLA B27 positive. No differences were found in cumulative incidence between secukinumab and monoclonal anti-TNF. Disclosure of Interests: Iñigo González-Mazón: None declared, Lara Sanchez-Bilbao Grant/research support from: Pfizer, Javier Rueda-Gotor: None declared, David Martinez-Lopez: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD