Service d'Ophtalmologie, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Centre de Référence Maladies Rares en Ophtalmologie, OPHTARA, Le Kremlin-Bicêtre.
Service d'Ophtalmologie, Assistance Publique - Hôpitaux de Paris, Hôpital Bichat et Fondation Ophtalmologique Rothschild, Centre de Référence Maladies Rares en Ophtalmologie, OPHTARA, Paris.
Rheumatology (Oxford). 2021 Nov 3;60(11):5413-5418. doi: 10.1093/rheumatology/keab093.
Peripheral ulcerative keratitis (PUK) is a severe corneal condition associated with uncontrolled RA. Tocilizumab (TCZ) is used to control RA, however, episodes of paradoxical ocular inflammation have been reported in TCZ-treated patients. We report a case series of PUK in TCZ-treated RA patients with ophthalmological and systemic findings and discuss the potential underlying mechanisms.
Four patients (six eyes), 47-62 years of age, were included. At the onset of PUK, the median duration of RA was 13 years [interquartile range (IQR) 3-13] and the median treatment with TCZ was 9 months (IQR 3-14). Two patients had active disease [28-joint DAS (DAS28) >3.2] and the disease was controlled in two patients (DAS28 ≤3.2).
TCZ was initially replaced by another immunomodulatory treatment in all patients and later reintroduced in two patients without PUK recurrence. Corneal inflammation was controlled in all cases with local and systemic treatments, with severe visual loss in one eye.
PUK may occur in patients with long-standing RA after a switch to TCZ and can be interpreted, depending on the context, as insufficient efficacy or a paradoxical manifestation. These cases highlight the urgent need for reliable biomarkers of the efficacy and paradoxical reactions of biologics.
周边溃疡性角膜炎（PUK）是一种与未控制的类风湿关节炎（RA）相关的严重角膜疾病。托珠单抗（TCZ）用于控制 RA，但在 TCZ 治疗的患者中已报告出现矛盾性眼部炎症的发作。我们报告了一系列在 TCZ 治疗的 RA 患者中出现 PUK 的病例，包括眼科和系统发现，并讨论了潜在的潜在机制。
纳入了 4 名（6 只眼）年龄为 47-62 岁的患者。在 PUK 发病时，RA 的中位病程为 13 年[四分位距（IQR）3-13]，TCZ 的中位治疗时间为 9 个月[IQR 3-14]。2 名患者有活动性疾病[28 关节 DAS（DAS28）>3.2]，2 名患者的疾病得到控制（DAS28 ≤3.2）。
所有患者最初均将 TCZ 替换为另一种免疫调节剂治疗，后来在没有 PUK 复发的 2 名患者中重新引入。所有患者均通过局部和全身治疗控制了角膜炎症，1 只眼出现严重视力丧失。
在转换为 TCZ 后，患有长期 RA 的患者可能会发生 PUK，并且可以根据具体情况解释为疗效不足或矛盾表现。这些病例突出表明迫切需要可靠的生物制剂疗效和矛盾反应的生物标志物。
