BackgroundSome types of ocular surface inflammatory diseases are often related to rheumatic conditions: 37% of scleritis (especially diffuse and necrotizing forms) and 60% of peripheral ulcerative keratitis (PUK). Rheumatoid arthritis (RA) and ANCA-associated vasculitis are the most frequently related conditions. Significant loss of visual acuity can be observed if these ocular diseases are not properly treated. To date, no approved therapies are available. Consequently, the management of these ocular diseases are based on published evidence coming from clinical trials (scarce and often with a low sample size), observational studies and case reports. There are positive efficacy data of rituximab (RTX) for ocular surface inflammatory disease.1–4 ObjectivesTo describe our experience with RTX as a therapy for severe ocular surface inflammatory diseases associated to rheumatic conditions.MethodsThis is a retrospective observational study. It includes patients with severe scleritis or PUK associated to rheumatic diseases diagnosed and managed at our Multidisciplinary Uveitis Clinic between January 2006 and November 2017. We recorded demographic and clinical variables. As outcome variables we used the change in visual acuity and the presence of inflammatory activity by biomicroscopy.ResultsVA: visual acuity, AE: advers events, RA: rheumatoid arthritis, GPA: granulomatosis with polyangiitis, RP: relapsing polychondritis, LTI: latent tuberculous infection, DM: diabetes mellitus, CSC: central serous choroidopathy, MPLN: metilprednisolone, PDN: prednisone, DXM: dexametasone, MTX:methotrexate, CS-A: cyclosporine, LFN: leflunomide, IFX: infliximab, ETN: etanercept, AKR: anakinra TCZ: tocilizumab.ConclusionsAs previously described we consider rituximab as an effective therapy for severe ocular surface inflammatory diseases related to rheumatic conditions when other immunosuppressant drugs fail or are contraindicated.References[1] - Albert M, Beltrán E, Martínez-Costa L. Rituximab in rheumatoid arthritis-associated peripheral ulcerative keratitis. Arch Soc Esp Oftalmol. 2011; 86(4):118–20.[2] - Sims J. Scleritis: presentations, disease associations and management. Postgrad Med J. 2012;88(1046):713–8.[3] - Jabs DA, Mudun A, Dunn JP, Mardsh MJ. Episcleritis and scleritis: clinical features and treatment results. Am J Opthalmol2000;130:469.[4] - Suhler EB, Lim LL, Beardsley RM, Giles TR, Pasadhika S, Lee ST, et al. Rituximab therapy for refractory scleritis: results of a phase I/II dose-ranging, randomized, clinical trial. Ophthalmology. 2014;121(10):1885–91.Disclosure of InterestNone declaredAbstract AB1139 – Table 1RTX for scleritis and PUKAge (ys)GenderOcular diseaseRheumatic diseaseComorbiditiesPrevious treatmentRTX cyclesΔVAInflammatory activityAEFollow up (ms) 155FPUKRAAmiloidosisMTX, CS-A, IFX, MPLN ev1+0.1NoNo132258FScleritisGPAHBV chronic carrier, LTIMPLN ev, PDN1+0.1NoNo19359FScleritisRPDMMTX, CS-A, PDN, DXM io10Diffuse nodular scleritisNo17475MScleritisRPDM, Sweet’s syndrome, myelo displasic syndromeMTX, CS-A, ETN, PDN1...
BackgroundSmoking is described as a classic cardiovascular (CV) risk factor and we also know the beneficial effect on the CV system of smoking cessation. However, there is contradictory data about its effect in patients with rheumatoid arthritis (RA). It is possible that the measure of cumulative exposure to tobacco expressed in pack-year gives us more information than the smoking status.ObjectivesTo explore the relation between smoking exposure, measured in pack-year, and subclinical vascular damage, mortality and vascular events in patients with RA.MethodsObservational ambispective study. We included, consecutively, RA patients controlled in a tertiary hospital. We gathered demographic (sex, age, body mass index [BMI]), clinical (characteristics of RA, classic CV risk factors and history of vascular events) and analytical variables (CRP, ESR). We estimated the modified SCORE. We explored the extracranial branches of the carotid artery with an Esaote MyLab70XVG ultrasound device with a linear probe (7–12mHz) and an automated program measuring intima media thickness (IMT) by radiofrequency (“Quality intima media thickness in real-time, QIMT”), and registered the presence of atheroma plaques (per Mannheim consensus). We determined pulse wave velocity (PWV) by a validated MobilOGraph device. We considered as pathological an IMT >900 μ and a PWV ≥10 m/s and the presence of plaque and/or pathological IMT. We prospectively collected mortality and the development of new vascular events over four years and the current smoking status and exposure calculated in pack-year. Statistical analysis was performed using SPSS 17.0 software.ResultsWe included 198 patients, excluding 15 because of previous CV events. The mean age was 66,5 years (SD 13,44) 76% were women and the mean BMI was 27,35 (SD 4,82). 31,1% were smokers, 43,2% hypertensive, 47,5% dyslipemic and 10,4% were diabetic. The mean duration of RA was 19,95 years (SD 11,88). 76,5% of patients were seropositive and 75,4% had erosions. The mean CRP and ESR were 9,51 mg/L (SD: 32,29) and 13,83 mm/h (SD:14,26), respectively. The mean modified SCORE was 1,81 (SD: 1,81). Regarding the vascular study, 48,1% had atheroma plaques, 32,2% a pathologic PWV [mean value of 9,13 (SD 2,12)], and 16,7% had a pathologic IMT [mean value of 748 μ(DE 168,73)].31.1% of the patients (57) were smokers or former smokers. The average pack-year was 24.17 (SD: 21.37). No relation was found between current or previous use of tobacco and any of the outcome measures described. However, when considering cumulative exposure to tobacco, there was a trend to correlate with higher values of PWV (p=0.07) and a higher plaque presence (p=0.089) was detected. After 4 years of follow-up, 3 deaths were recorded among smoking patients, but a higher incidence of CV events was not detected in relation to cumulative exposure to tobacco (p=0.99).ConclusionsThe quantification of the exposure by pack-year of cigarette smoked could give us more information about vascular damage in patients with RA. The limitation of ou...
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