Ab0157c ocular Causes of the Initiation of Systemic Therapyin Patients With Spondyloarthritis (Spa) and Uveitis

Abstract

Background:Uveitis is the most frequent extra-axial manifestation in Spondyloarthritis (SpA). Even though, the criteria for the initiation of systemic therapy in patients with SpA are well defined, they are not when dealing with eye involvement.Objectives:The main objective of this study is to determine which patients require treatment with systemic therapy (ST), understood as such the disease-modifying drugs (sulfasalazine and methotrexate) and the biological drugs (anti-TNF-α), due to ocular involvement.Methods:This is an observational retrospective study carried out in the University Health Care Complex of León with patients diagnosed with SpA who have some episode of uveitis throughout the course of their disease and who are being treated with ST.Results:We studied 28 patients, 67.9% men and 32.1% women, with a mean age at diagnosis of 34.48 ± 12.69 years. All patients had axial involvement and 64.3% had peripheral involvement. The initial ST was sulfasalazine (SSZ) in 50% of the patients, methotrexate (MTX) in 21.4% and anti-TNFα in 28.6%. Within those treated with antiTNFα, 50% was treated with adalimumab and the other 50% with golimumab (25%) and infliximab (25%). A 78.57% of the patients required a second systemic therapy to control the disease; a 50% required a third treatment and only 3 patients needed a fourth systemic drug that, in all cases, was adalimumab. The patients who started the ST were exclusively due to uveitis in 32.1% and both due to uveitis and SpA in 35.7%. When they need a second systemic treatment, it is still owing to an ophthalmological cause in 28.6% of the patients, and both due to ocular activity and SpA, in 33.4%. Nevertheless, when these patients require a third anti-TNFα, it is usually due to SpA (57.1%). A 10.7% of patients requiring a fourth ST was because of uveitis. 66.7% of the patients who started the ST due to uveitis were treated that way because of the uveitis severity. 60.7% of the patients with uveitis presented complications in the form of vitritis (70.6%), panuveitis (11.8%), hypopyon (5.9%), keratic precipitates (35.3%), fibrin (41.2%), synechiae (5.9%), pupillary membrane (23.5%), IOP increase (41.2%) and cataract (17.6%). The macular involvement was observed in 17.9% of the cases in the form of macular oedema (40%), papillary oedema (40%), epiretinal atrophy (20%), neurosensory detachment (20%) and epiretinal membrane (40%). In 61.9% of the patients, the ST started due to refractoriness, with the average number of uveitis after the initiation of systemic therapy of 4.32 ± 2.25 uveitis. When exclusive eye involvement is present, the treatment with SSZ is usually initiated (6 patients), although 2 patients required from the start the anti-TNFα and 1 MTX. The average number of uveitis in patients with BASDAI <4 is 5.27 CI 95% (3.90-6.63) versus 3.23 CI 95% (2.41-4.05) of patients with BASDAI> 4 (p <0.05); while in patients without peripheral involvement is of 5.60 CI 90% (3.75-6.85) compared to 3.78 of the patients with peripheral involvement CI 90% (2.71-4.85) (p <...