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
ObjectivesTo assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA)MethodsMulticenter study of uveitis related to SpA that had been refractory to at least one immunosuppressive drug. The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness in cases of macular edema.ResultsNine patients (9 men) (11 affected eyes) with a mean age ± SD of 42.1±5.25 years (range 32-48) were evaluated. The pattern of ocular involvement was anterior uveitis (n=5) and anterior+intermediate (n=4). According to the course, uveitis was acute (n=1), chronic (n=4) or recurrent (n=4).Besides oral steroids and before GLM onset they had received: intraocular corticosteroids (n=2), immunosupressive conventional drugs: MTX (n=7), AZA (3), SZP (4) and LFN (n=1) and biologic therapy: IFX ev 5mg/kg/6-8 week (n=3), ETN sc 50 mg/week (n=3), and ADA 40mg/2 week (n=2). GLM was started because of lack of efficacy of the previous treatments, at the standard dose of 50 mg/sc/month as a monotherapy (n=5) or combined (n=4) with MTX (n=2), AZA (n=1) and LFN (n=1).Significant improvement of anterior chamber cells was observed (baseline: median 1 [IQR 0-3]), and (0 [0-1]) (p=0.01) and (0 [0-0]) (p=0.01) at 2 weeks and 6 months, respectively. The mean visual acuity also improved from a mean of 0.75±0.24 at baseline to 0.77±0.26 (p=0.1) and 0.85±0.27 (p=0.1) at 3 and 6 months, respectively, and the macular thickness (OCT) from a mean of 280±30 to 263±16 microns at 6 months. Corticosteroids were also tapered from a mean dose of prednisone at baseline of 31±20 mg/day to 27±18 and 14±11 mg/day at 2 weeks and 6 months respectively. After a mean follow-up of 13±7 months, 7 of 9 patients were on remission and the side-effects observed were not severe (injection site erythema in 1 case).ConclusionsGolimumab seems to be effective and safe in refractory uveitis related to SpA.Disclosure of InterestNone declared
BackgroundThe term “cutaneous vasculitis” (CV) includes a wide and heterogeneous spectrum of syndromes with histopathological findings that have in common vascular inflammation and blood vessel damage. Sometimes, CV can be a clinical manifestation of a severe underlying infection and its clinical features may be indistinguishable of a non-infectious CV. However, the treatment is very different: antibiotics in the case of a CV in the setting of a severe bacterial infection and immunosuppressive agents in all other cases.ObjectivesOur objective was to compare the histopathological findings of skin biopsies from patients with CV associated with severe bacterial infection and those with non-infectious CV with more or less systemic involvement.MethodsWe selected 3 groups from a series of patients with CV: group a) CV associated with severe bacterial infection; group b) CV without severe bacterial infection but with systemic involvement, group c) CV without systemic involvement. Only cases with available skin biopsies in optimal conditions for analysis were included. We reviewed the samples by light microscopy using H&E and Schiff periodic acid stains. A comparative study between the group a) with the other two groups (b and c) was performed. Severe bacterial infection was considered when the patient required hospitalization and received antibiotics.ResultsGroup a) was integrated by 12 patients (2 women/10 men; mean age; 56±15 years). The underlying severe bacterial infections were: pneumonia (n=5), meningitis (n=3), urinary tract infection (n=1), infectious arthritis of the knee (n=1), abdominal sepsis (n=1) and mediastinitis (n=1). In the group b) 21 patients were included (10 women/11 men; mean age, 52±18 years). The underlying conditions in this group were: Henoch-Schoenlein purpura (n=9), panarteritis nodosa (n=4), microscopic polyangiitis (n=2), cryoglobulinemia (n=2), neoplasia (n=2), systemic lupus erythematosus (n=1) and Sjögren syndrome (n=1). Finally, in group c) 19 patients were included (12 women/7 men; mean age: 59±24 years). The results of histopathological comparison of group a) with the groups b) and c) are shown in the table.ConclusionsIn this series we observed that patients with CV associated with severe bacterial infection have more tissue neutrophilia and tend to develop more pustular dermatosis. Rather, not lymphocytosis or tissue eosinophilia was observed. However, these results need to be tested in prospective studies with larger number of patients.AcknowledgementsThis 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 InterestNone declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.