Hamdan Abel, Sharma Sumit, Baynes Kimberly, Hajj Ali Rula A, Lowder Careen Y, Srivastava Sunil K
Cole Eye Institute, Cleveland Clinic, 2022 E 105th St I Building, Cleveland, OH, 44106, USA.
Department of Rheumatology, Cleveland Clinic, Cleveland, OH, USA.
J Ophthalmic Inflamm Infect. 2024 Jul 30;14(1):35. doi: 10.1186/s12348-024-00403-3.
BACKGROUND/AIMS: Anti-tumor necrosis factor (Anti-TNF) agents have proven beneficial for the treatment of chronic non-infectious uveitis, yet rare neurological complications and demyelinating disease can occur with their use. Management of uveitis and neurological disease after developing these rare complications is not well understood. We sought to identify these specific cases and their outcomes through a retrospective observational case series.
Electronic Medical Record (EMR) chart review of 394 non-infectious uveitis patients on anti-TNF therapy focused on identifying patients seen by uveitis specialists at a single institution who were on anti-TNF therapy and had developed neurological symptoms. Cases were reviewed for subsequent management and outcomes of both their neurologic and ocular inflammatory disease.
Five (5) patients were included following complaints of neurological symptoms while on anti-TNF therapy. Subsequent demyelinating diagnosis, acute treatment, and long-term course were described. All five patients continue to be inactive at around three years of anti-TNF discontinuation.
Unidentified rare neurological symptoms and demyelinating disease associated with the use of anti-TNF agents can be detrimental to patient treatment outcomes. Emphasis is given on possible avoidance and early identification of exacerbating underlying disease through a detailed neurologic history and use of imaging when suspicion is high. Patients may have no evidence of higher neurological risk prior to starting an anti-TNF treatment. Discontinuation of an anti-TNF agent and subsequent control of disease is possible with alternative immunosuppressive treatments.
背景/目的：抗肿瘤坏死因子（抗TNF）药物已被证明对治疗慢性非感染性葡萄膜炎有益，但使用这些药物时可能会出现罕见的神经系统并发症和脱髓鞘疾病。发生这些罕见并发症后葡萄膜炎和神经系统疾病的管理尚不清楚。我们试图通过一项回顾性观察性病例系列研究来识别这些特定病例及其结果。
对394例接受抗TNF治疗的非感染性葡萄膜炎患者的电子病历（EMR）进行审查，重点是识别在单一机构接受葡萄膜炎专科医生诊治、正在接受抗TNF治疗且出现神经系统症状的患者。对这些病例的神经系统和眼部炎症性疾病的后续管理及结果进行了审查。
5例患者在接受抗TNF治疗期间出现神经系统症状后被纳入研究。描述了随后的脱髓鞘诊断、急性治疗及长期病程。所有5例患者在停用抗TNF约三年后病情仍未复发。
与使用抗TNF药物相关的未识别的罕见神经系统症状和脱髓鞘疾病可能对患者的治疗结果不利。强调通过详细的神经系统病史以及在高度怀疑时使用影像学检查来尽可能避免和早期识别潜在疾病的加重。患者在开始抗TNF治疗前可能没有更高神经系统风险的证据。停用抗TNF药物并通过替代免疫抑制治疗控制疾病是可行的。
