Targeted therapies for uveitis in spondyloarthritis: A narrative review - 01/10/24
Highlights |
• | Biologics are recommended in SpA-related uveitis in cases of frequent relapses (>2–3/year) despite conventional systemic treatment. |
• | Infliximab and adalimumab (TNF inhibitors) have demonstrated profound success in controlling SpA-related uveitis flares. |
• | Paradoxical uveitis has been described in patients treated with etanercept. |
• | Possible other therapies include IL-17, IL-12/23, IL-22 antagonists, and JAK inhibitors. |
• | Close collaboration is required between ophthalmologists and internists/rheumatologists to control both ocular and rheumatic inflammation with the most appropriate biologic. |
Abstract |
Spondyloarthritis (SpA) encompasses a group of chronic inflammatory disorders of the joints frequently associated with uveitis in almost a quarter of cases. SpA-related uveitis typically affects the eye anterior chamber with sudden onset, causing pain, redness, photophobia, and blurred vision. Ophthalmologists will describe an acute anterior unilateral uveitis. Most patients present with episodic acute anterior non-granulomatous uveitis and retain excellent visual acuity. However, systemic treatments are recommended in the event of frequent relapses (2–3/year) or in rare cases of sight-threatening with ocular complications. The improved understanding of the pathogenesis of SpA has led to the management of this disease by biologics. Here, we review the main data regarding the opportunity to target specific components in inflammatory pathways for the treatment of SpA-related uveitis. These therapies are recommended for long-term control when uveitis relapses occur too frequently despite conventional systemic treatments. Significant benefits have been obtained with the tumor necrosis factor-α inhibitors (TNFis), particularly infliximab and adalimumab. Paradoxically, a high number of uveitis occurrences have been shown on etanercept. Mixed results have been demonstrated with interleukin-17 antagonists (secukinumab) and interleukin-12/interleukin-23 antagonists (ustekinumab) in cases of failure of TNFis. JAK inhibitors seem to be a valuable class of medications for these patients in the future. Although SpA-related uveitis is typically managed with conventional local and/or systemic treatments, these biological/targeted therapies may provide avenues to control both the underlying SpA and uveitis manifestations. Thus, a close collaboration between patients, rheumatologists, internists, and ophthalmologists is needed to optimally manage ocular inflammation in SpA.
Le texte complet de cet article est disponible en PDF.Keywords : Uveitis, Spondyloarthritis, HLA-B27, Biological therapy, Biologics, TNF
Plan
Vol 91 - N° 5
Article 105697- septembre 2024 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?