Zu Hoerste Melissa Meyer, Walscheid Karoline, Tappeiner Christoph, Zurek-Imhoff Beatrix, Heinz Carsten, Heiligenhaus Arnd
Department of Ophthalmology and Ophtha-Lab at St. Franziskus Hospital, Hohenzollernring 74, 48145, Muenster, Germany.
Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Graefes Arch Clin Exp Ophthalmol. 2018 Oct;256(10):1985-1992. doi: 10.1007/s00417-018-4082-x. Epub 2018 Aug 1.
To investigate the effect of methotrexate (MTX) or sulfasalazine (SSZ) on the course of HLA-B27-positive, remitting acute anterior uveitis (AAU).
Forty-six patients with HLA-B27-positive AAU with or without associated systemic rheumatic disease either receiving MTX (n = 20), SSZ (n = 13), or no systemic immunomodulating treatment (Ctrl; n = 13) were studied retrospectively. Best-corrected visual acuity (BCVA), AAU relapse rate, and occurrence of uveitis-related ocular complications were analyzed at baseline (BL) and at 12-month follow-up (FU).
Groups did not differ regarding age, gender, and presence of associated systemic diseases. BCVA at baseline was significantly worse in patients receiving MTX (logMAR 0.39 ± 0.4) than in those treated with SSZ (0.17 ± 0.2; P = 0.05) or in controls (Ctrl; 0.14 ± 0.2; P = 0.009). At the 12-month endpoint, MTX treatment was associated with significantly improved BCVA (0.18 ± 0.4 logMAR; P = 0.004). In contrast, BCVA did not significantly change in patients treated with SSZ (0.17 ± 0.3 logMAR) or in the controls (0.11 ± 0.2 logMAR). The annual uveitis relapse rate significantly decreased with MTX (BL 3.6 ± 2.4 relapses to FU 0.7 ± 0.8; P = 0.0001) and SSZ (BL 3.6 ± 1.9 to FU 1.8 ± 2.4, P < 0.01), but not in the controls (BL 1.9 ± 1.4 vs 1.9 ± 1.7 FU). The complication rate was slightly reduced with MTX (BL 1.75 ± 1.2 complications present versus FU 1.3 ± 1.2, P = 0.09) but not with SSZ (BL 0.9 ± 0.8 to FU 1.3 ± 1.4; P = 0.4) or in the controls (BL and FU 1.0 ± 0.95; P = 0.7).
MTX and SSZ reduced the uveitis relapse rate in HLA-B27-positive AAU patients, with MTX showing a beneficial effect on AAU-related macular edema.
研究甲氨蝶呤（MTX）或柳氮磺胺吡啶（SSZ）对 HLA - B27 阳性的缓解期急性前葡萄膜炎（AAU）病程的影响。
回顾性研究 46 例 HLA - B27 阳性的 AAU 患者，这些患者伴有或不伴有相关的系统性风湿性疾病，分别接受 MTX 治疗（n = 20）、SSZ 治疗（n = 13）或未接受系统性免疫调节治疗（对照组；n = 13）。在基线期（BL）和 12 个月随访期（FU）分析最佳矫正视力（BCVA）、AAU 复发率以及葡萄膜炎相关眼部并发症的发生情况。
三组在年龄、性别和相关系统性疾病的存在方面无差异。接受 MTX 治疗的患者基线期 BCVA（logMAR 0.39 ± 0.4）显著差于接受 SSZ 治疗的患者（0.17 ± 0.2；P = 0.05）或对照组（0.14 ± 0.2；P = 0.009）。在 12 个月的终点时，MTX 治疗与 BCVA 显著改善相关（0.18 ± 0.4 logMAR；P = 0.004）。相比之下，接受 SSZ 治疗的患者（0.17 ± 0.3 logMAR）和对照组（0.11 ± 0.2 logMAR）的 BCVA 无显著变化。MTX 组（基线期 3.6 ± 2.4 次复发至随访期 0.7 ± 0.8 次复发；P = 0.0001）和 SSZ 组（基线期 3.6 ± 1.9 次复发至随访期 1.8 ± 2.4 次复发，P < 0.01）的葡萄膜炎年复发率显著降低，但对照组（基线期 1.9 ± 1.4 次复发与随访期 1.9 ± 1.7 次复发）未降低。MTX 组并发症发生率略有降低（基线期 1.75 ± 1.2 例有并发症至随访期 1.3 ± 1.2 例，P = 0.09），但 SSZ 组（基线期 0.9 ± 0.8 例至随访期 1.3 ± 1.4 例；P = 0.4）和对照组（基线期和随访期均为 1.0 ± 0.95 例；P = 0.7）未降低。
MTX 和 SSZ 降低了 HLA - B27 阳性 AAU 患者的葡萄膜炎复发率，MTX 对与 AAU 相关的黄斑水肿显示出有益作用。
