TCZ appears to be a useful therapy for severe refractory JIA-associated uveitis.

Objective: To assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA). Methods:Multicenter study of SpA-related uveitis refractory to at least one immunosuppressive drug. The main outcome variables were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness.Results: Fifteen patients (13 men/2 women; 18 affected eyes; mean age 39±6 years) were evaluated. The underlying SpA subtypes were ankylosing spondylitis (n=8), psoriatic arthritis (n=6) and non-radiographic axial SpA (n=1). The ocular involvement patterns were recurrent anterior uveitis in 8 patients and chronic anterior uveitis in 7.Before GLM they have received methotrexate (n=13), sulfasalazine (n=6), pulses of methylprednisolone (n=4), azathioprine (n=3), leflunomide (n=2) and cyclosporine (n=1). Ten of them had also been treated with TNF-α blockers; etanercept (n=7), adalimumab (n=7), infliximab (n=6), and certolizumab (n=1). GLM was given at the standard dose (50 mg/sc/monthly) as monotherapy (n=7) p=0.03). Only minor side effects were observed after a mean follow-up of 23±7 months. Conclusions:Our results indicate that GLM may be a useful therapeutic option in refractory SpA-related uveitis.

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TCZ was effective in two patients with BSCR refractory to anti-TNF-α agents.

Background Non infectious aortitis may present as an idiopathic isolated condition or associated with a wide spectrum of diseases. Aortitis often presents with nonspecific symptoms leading in many cases to an inappropriate diagnostic delay. Objectives Our aim was to analyze the clinical features and outcome of patients with aortitis in order to improve the diagnosis of this entity. Methods We studied 32 patients (22 women and 10 men) with a mean age of 68 years (range, 45-87 years) at the time of diagnosis. The median interval from the clinical onset to the diagnosis was 21 months. F18-FDG PET scan was the usual radiological method for diagnosing aortitis. Results The underlying conditions were: giant cell arteritis (n=13 cases); isolated polymyalgia rheumatica (PMR) (n=11); Sjögren syndrome (n=2), Takayasu arteritis (TakA) (n=1); sarcoidosis (n=1), ulcerative colitis (n=1), psoriatic arthritis (n=1), and idiopathic aortitis (n=2). The most common clinical manifestations at diagnosis were: PMR features, often atypical in the clinical presentation (n=23 patients, 72%); diffuse lower limb pain (n=16 patients, 50%); constitutional symptoms (n=12 patients, 37%), inflammatory back pain (n=9 patients, 28%) and fever (n=7 patients, 22%). In most of the cases, serum acute phase reactants were increased, with a median erythrocyte sedimentation rate of 46 mm/1st hour and a median serum C-reactive protein of 1.5 mg/dL. Conclusions In conclusion, aortitis is not an uncommon disease. The diagnosis is often a challenge for the clinician. The presence of PMR features, in particular when they are atypical, unexplained low back or limb pain, constitutional symptoms along with increased acute phase reactants should be considered “red flags” to suspect the presence of an underlying aortitis. Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2978

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Objectives Syphilitic Uveitis (SU) may be the first manifestation of syphilis. SU may be indistinguishable morphologically from other etiologies causing uveitis. Our aim was to study and describe the SU as first manifestation of syphilis. Methods We describe 11 patients with SU diagnosed at our Hospital from 2006 to 2013. Diagnosis was based on active uveitis and specific microbiological test. To evaluate neurological involvement, a lumbar puncture was performed in 9 patients. Results Eleven patients (3 women/8 men) with a mean age of 45.8±13.8 years (range 26 -70) were diagnosed as having SU. First syphilitic manifestation was uveitis (n=9) and mucocutaneous lesions (n=2). The pattern of uveitis were: posterior (n=6), panuveitis (n=3), and anterior (n=2). Ocular involvement was unilateral (n=8) and bilateral (n=3). The median diagnostic delay was 0,75 months (IQR 0-2) (range 0-12). Positive serology of HIV (n=3) and neurosyphilis (n=2) were observed. Treatment was based on penicillin G (4 million-units/4h/i.v.) for 14 days (n=8) and for 21 days (n=2), and doxicillin 100 mg/12h for 28 days, because of allergic condition (n=1). We had a relapse in one case treated initially with benzathine penicillin/1.2 MU/i.m x 3 day, and then with penicillin G 4MU/4h ev x 21 days. The median of visual acuity improved from 0,1 (IQR 0,05-0,3; range 0-0.8) to 0.6 (IQR 0,05-0,9; range 0,05-1) after treatment. The main ocular complications of SU were complete unilateral ocular blindness (n=3), retina detachment (n=2), cataract (n=1), and increased ocular tension (n=1). Conclusions It is recommended to include SU in the differential diagnosis of uveitis. Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias”PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3879

BackgroundSystemic treatments used in ocular involvement in Behçet's disease are corticosteroids, synthetic and biological immunosuppressants. Because of irreversible ophthalmic complications, it's a priority to know the efficacy of these drugs.ObjectivesTo analyze the efficacy and safety of biological therapy vs cyclosporine A (CyA), azathioprine (AZA) or placebo in reducing the rate of uveitis and improving the visual prognosis of Behçet's.MethodsA systematic search of literature on MEDLINE,EMBASE,and Cochrane Central Register of Controlled Trials was conducted from inception to July 2015.A hand search was performed by reviewing the references of the included studies and the international congress.Criteria for study selection:1)adults with Behçet's-uveitis,2)Biological therapies,3)placebo or active comparator with CyA or AZA,4)outcome measures to evaluate effectiveness as a number (no) of recurrence of uveitis,visual prognosis,cystic macular edema, retinal vasculitis,vitritis,hypopyon,etc; and/or adverse events.Meta-analyses,systematic reviews,clinical trials and observational studies of>10 patients with comparator were included.The selection,review and evaluation of quality of the articles was independently conducted by 2 reviewers.The Oxford Level of Evidence scale was used to determine the quality of the studies.ResultsOf 195 articles,5 met the inclusion criteria:2retrospective observational studies and 3randomized clinical trials in 235 patients with Behçet and refractory uveitis.Age range was 12–69 years with male dominance,and follow up was 1–72 months.Evidence with infliximab (IFX) (2 studies) is weak and suggests more effective than CyA in reducing the rate of uveitis in short-term (6m) and more effective than CyA+AZA or methotrexate (MTX) to reduce the no. of retinal vasculitis relapse,and severe complications and to improve visual acuity in long term (LE4).The weak and insufficient evidence of rituximab (RTX) associated with MTX (1study) suggested similar efficacy to cyclophosphamide (CYM) associated with AZA, improving the total adjusted rate of disease activity without improvement in short-term visual acuity (6m)(LE 3b).Regarding secukinumab and daclizumab vs placebo (1 study respectively), the small but acceptable level of evidence suggests ineffectiveness in reducing relapses and in the improvement of visual acuity,with sparing effect on immunosuppressants in short-term for secukinumab (LE2a-2b). Available evidence reveals few significant adverse events. All studies could be applicable in clinical practice.ConclusionsWith the limited evidence found, IFX appears to be safe and more effectiveness than CyA alone or in combination with other immunosuppressants in reducing short term uveitis relapse and the number of severe long-term complications.RTX is similar to CYM paired with AZA in improving rates of inflammatory activity in short term.Secukinumab as well as daclizumab is not effective in reducing relapses of uveitis but could spare immunosuppressants.The results of this review support the benefit...