FRI0288 OPHTHALMOLOGICAL MANIFESTATIONS AND ENDOTHELIN-1 PLASMA LEVELS IN PATIENTS WITH SYSTEMIC NECROTIZING VASCULITIS (SNV)
Authors: Liubov Petelytska, Oleg Iaremenko, Kateryna Iaremenko
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Inflammatory eye disease is described in 50% to 60% of patients with ANCA-positive vasculitis and in 10–20% of patients with polyarteritis nodosa, and for 8% to 16% of patients it is an initial manifestation [1,2]. Endothelin-1 (ET-1) as a potential participant in the local regulation of intraocular pressure, ocular blood vessel tone, and iris smooth muscle tone, suggesting that it may be an important mediator in the development of ocular pathologic conditions [3]. The lower ET-1 plasma levels were found in the optic neuropathy [4]. Objectives: to provide a more complete description of the ocular disease in patients with systemic necrotizing vasculitis (SNV), to evaluate the serum level of ET-1 in patients with SNV with and without eye involvement. <h3>Methods:</h3> The study included 36 patients with SNV (polyarthritis nodosa - 8, ANCA - associated vasculitis - 28) and healthy controls (n=26). The 17 patients with SNV had ophthalmological manifestations. Clinical activities of patients were calculated according to the Birmingham Vasculitis Activity Score (BVAS). The serum levels of ET-1 (pmol/L) were determined by immunoassay analysis using the kits of Biomedica. The outcomes of this study were the differences in marker levels between SNV patients with and without eye involvement and healthy controls estimated by analysis of the absolute changes in marker levels and the areas under receiver operating characteristic (ROC) curves (AUC). <h3>Results:</h3> The ocular manifestation of patient with SNV included episcleritis (n=10), anterior uveitis (n=3), ischaemic optic neuritis (n=3) and occlusive retinal vasculitis (n=1). All patients had active disease (BVAS&gt;11). There were no significant differences of BVAS, ESR and CRP between SNV patients with and without eye involvement. In 14% patients with SNV eye involvement was an initial manifestation. The level of ET-1 (M ± σ) in group of SNV patients with eye involvement (n=17) was 0.28 ± 0.13 and did not differ significantly from the control group (0.27 ± 0.10, p&gt; 0.05). At the same time, in patients without eye involvement (n=19), it was significantly elevated (0.36 ± 0.34) compared with control group and with group of SNV patients with eye involvement (p &lt; 0,001). ROC analysis showed that the AUC for ET-1 is 0.5±0.10 (p=0.98), which indicates not acceptable capacity for ET-1 differentiate groups of patients with ocular involvement and patients without ocular involvement (sensitivity - 59%, specificity - 57%). <h3>Conclusion:</h3> The most common ocular manifestation in patients with SNV was episcleritis, which occurred in almost one third of patients. The serum levels of ET-1 were decreased in patients with SNV with eye involvement compared with patients without eye involvement, but this cannot be used for diagnostic purposes. <h3>References:</h3> [1] Pakrou N, Selva D, Leibovitch I. Wegener's granulomatosis: ophthalmic manifestations and management. Semin Arthritis Rheum. 2006;35(5):284–92. [2] Pagnoux, C., Seror, R., Henegar, C., Mahr, A., Cohen, P., Le Guern, V., Bienvenu, B., Mouthon, L., and Guillevin, L. (2010). Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis and Rheumatism, 62, 616–26 [3] Sugiyama T. Involvement of Endothelin-1 in the Pathophysiology of Normal-Tension Glaucoma. International Journal of Ophthalmic Research 2015; 1(2): 36-40 Available from: URL: http://www.ghrnet.org/index.php/ijor/article/view/1221. [4] Ohguro I, Ohguro H, Ohkuro K, Nakazawa M: Study of contribution of low levels of plasma endothelin-1 concentrations to pathogenesis of glaucomatous optic neuropathy. Hirosaki Med J, 2006; 57: 59–64 <h3>Disclosure of Interests:</h3> None declared