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.
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
Background
Hypersensitivity vasculitis (HV) and Henoch-Schönlein purpura (HSP) are the most common entities included within the category of cutaneous vasculitis (CV). Palpable purpura and histological changes characterized by the presence of leukocytoclastic vasculitis are common in both conditions. Because of that, considerable overlap between them is often seen. It is especially true when the CV occurs in adults.
Objectives
Our aim was to assess the main clinical differences between HV and HSP in a wide and unselected series of adults with CV from a defined population.
Methods
We reviewed the clinical records of 297 consecutive adults (age>20years) seen at a single center between January 1975 and December 2012 that were classified as having HSP or HV according to the criteria proposed by Michel et al.1.
Results
Based on the inclusion criteria 102 adult patients (71 men/31 women) were classified as HSP and 195 (104 men/91 women) as HV. The mean age was similar in both groups (55.8±16.5 years in HSP and 56.8±18.3 years in HV). Precipitating events, usually an upper respiratory tract infection and/or drug intake, were more frequently observed in HV. Both at the beginning of the disease and when the CV was established clinical manifestations were more frequent in patients with HSP than in those with HV. It was the case for gastrointestinal (57.4% vs. 6.8%; p<0.001), joint (51.5% vs. 36.6%; p=0.01) and renal involvement (86.3% vs. 18.3%; p<0.001). Corticosteroid (56.7% vs. 22%; p<0.001) and cytotoxic drug (19.4% vs. 3.2%; p<0.001) use was also more common in patients with HSP. After a median follow-up of 15.5 (interquartile range- IQR; 3-37) months in HSP and 4 (IQR; 2-12) months in HV, the outcome was better in HV than in HSP. In this regard, complete recovery (72.6% vs. 85.4%; p=0.01) was more commonly observed in HV while residual renal involvement (15.3% vs. 4.2%; p<0.001) was more common in HSP. The disease relapsed in 35.3% of patients with HSP and in 24.4% with HV (p=0.07).
Conclusions
Our results confirm the claim that these two diseases presenting with similar cutaneous involvement are certainly two separate entities with greater systemic involvement and less favorable outcome in HSP.
References
Michel BA, Hunder GG, Bloch DA, Calabrese LH. Hypersensitivity vasculitis and Henoch-Schönlein purpura: a comparison between the two disorders. J Rheumatol. 1992; 19: 721-728.
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.3002
Background
Cutaneous vasculitis (CV) encompasses a wide group of entities characterized by skin blood vessels inflammation. Cutaneous single-organ vasculitis (CSOV) was recently defined according to Chapel Hill-2012 criteria as a CV limited to skin. To our knowledge, there is not any published report on CSOV.
Objectives
Our aim was to characterize CSOV from a wide series of CV.
Methods
We study CSOV from a series of 766 patients with CV from a single university center. CSOV was diagnosed according to Chapel Hill-2012 criteria. The following conditions were required: a) a skin biopsy showing characteristic leukocytoclastic vasculitis and b) vasculitis limited to skin.
Results
We study 60 patients (26 women and 34 men) with a mean age ± SD of 55.70±16.25 years who fulfilled the Chapel Hill-2012 definition for CSOV. The main precipitating events were drug intake (26 patients, 52%) and a previous infection (17 patients, 34%). The main clinical manifestations were cutaneous (100%, palpable purpura in 81.7%) and fever (11 cases, 18.33%). The analytical findings were leukocytosis (mean; 13009±1082x109/L) and elevated ESR (mean, 40.2±22.7 mm/1st hour). In most patients pharmacological therapies were not required (73.33%). In the remaining patients the drugs used were nonsteroidal anti-inflammatory drugs (13.3%), corticosteroids (15%), antihistaminic drugs (3.3%) and colchicine (1,7%). After a median follow-up of 4 months [IQR:2-13] a complete recovery was observed in all the cases and relapses were observed in 5 (8.3%) patients.
Conclusions
CSVO according to Chapel Hill-2012 criteria is a benign syndrome.
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.2706
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