Falappone P C F, Iannone F, Scioscia C, Grattagliano V, Covelli M, Lapadula G
DIMIMP--Sezione di Reumatologia, Università degli studi di Bari, Bari.
Reumatismo. 2004 Jul-Sep;56(3):185-9.
Uveitis is a severe manifestation of rheumatic diseases since it can lead to visual impairment and even blindness. Ocular involvement is frequently a clinical challenge because its occurrence often requires changes of the therapeutic strategy. There are growing evidence that tumor necrosis factor alpha (TNFalpha) inhibitors may be an effective treatment of refractory uveitis. Purpose of this study was to evaluate the efficacy and safety of TNFalpha blocking agents in patients with seronegative spondylo-arthropathies (SNSA) and Behcet disease (BD) associated relapsing uveitis.
Five consecutive patients with chronic or relapsing uveitis were prospectively studied. Two patients with SNSA had recurrent anterior uveitis and three patients had BD associated uveitis (one anterior, two posterior uveitis). All of the patients were taking systemic and topical corticosteroids and three of them were also treated with DMARDs (methotrexate, cyclosporine, sulphasalazine) without clinical benefit. Four patients received infliximab, an anti-TNFalpha monoclonal antibody, at a dosage of 5 mg/kg body weight and one patient was treated with etanercept, a TNFalpha receptor p75-Fc fusion protein, at a dosage of 25 mg twice weekly.
Both infliximab and etanercept induced a marked improvement in uveitis and none relapse was observed throughout all the study. Systemic corticosteroids were progressively tapered and stopped in all patients. Also methotrexate and sulphasalazine were discontinued, while cyclosporine dose has been reduced by 30%. No side effects were observed.
Therapy with TNFalpha blockers, infliximab and etanercept, was effective and safe in the treatment of rheumatic disease associated uveitis. A complete remission was achieved even in patients with severe steroid resistant uveitis. Further controlled studies on larger number of patients are needed to better define the different forms of ocular involvement that can benefit from the therapy with TNFalpha inhibitors.
葡萄膜炎是风湿性疾病的一种严重表现，因为它可导致视力损害甚至失明。眼部受累常常是一个临床挑战，因为其发生往往需要改变治疗策略。越来越多的证据表明，肿瘤坏死因子α（TNFα）抑制剂可能是治疗难治性葡萄膜炎的有效方法。本研究的目的是评估TNFα阻断剂在血清阴性脊柱关节病（SNSA）和白塞病（BD）相关复发性葡萄膜炎患者中的疗效和安全性。
对连续5例慢性或复发性葡萄膜炎患者进行前瞻性研究。2例SNSA患者患有复发性前葡萄膜炎，3例患者患有BD相关葡萄膜炎（1例前葡萄膜炎，2例后葡萄膜炎）。所有患者均接受全身和局部皮质类固醇治疗，其中3例还接受了改善病情抗风湿药（DMARDs，甲氨蝶呤、环孢素、柳氮磺胺吡啶）治疗，但无临床获益。4例患者接受英夫利昔单抗（一种抗TNFα单克隆抗体）治疗，剂量为5mg/kg体重，1例患者接受依那西普（一种TNFα受体p75-Fc融合蛋白）治疗，剂量为25mg，每周两次。
英夫利昔单抗和依那西普均使葡萄膜炎明显改善，在整个研究过程中均未观察到复发。所有患者全身皮质类固醇逐渐减量并停用。甲氨蝶呤和柳氮磺胺吡啶也停用，而环孢素剂量减少了30%。未观察到副作用。
TNFα阻滞剂英夫利昔单抗和依那西普治疗风湿性疾病相关葡萄膜炎有效且安全。即使是对类固醇耐药的严重葡萄膜炎患者也实现了完全缓解。需要对更多患者进行进一步的对照研究，以更好地确定可从TNFα抑制剂治疗中获益的不同眼部受累形式。
