No abstract

No abstract

No abstract

Background Intense ocular inflammation can cause an early and irreversible structural and functional damage. Objectives Treatment with high-dose intravenous methylprednisolone (IVMP) can induce a rapid improvement in multiple inflammatory conditions including uveitis. Methods A multicenter study of 104 patients (169 eyes) with severe ocular inflammation treated with IVMP attended in uveitis units of 11 hospitals. The most frequent underlying syndromes were: idiopathic uveitis (n=21), Vogt-Koyanagi-Harada (n=26), Behçet (n=19), spondyloarthritis (n=4), Sjögren syndrome (n=2), psoriatic arthritis (n=2) and multiple Sclerosis (n=2). The patients were evaluated at baseline and on days 2-5, 7, 15 and 30 after treatment with IVMP. Results 104 patients (59 women/45 men) were studied with a mean age of 42.27±14.42 years (range 8-76 years) receiving doses of IVMP, which ranged from 0.25 to 1 gram per day for 2-5 consecutive days. They all had active and severe intraocular inflammation at baseline. The inflammatory ocular patterns were: panuveitis (n=61), posterior uveitis (n=35), anterior uveitis (n=3), scleritis (n=3) and intermediate uveitis (n=2). Bilateral ocular involvement was observed in 65 patients (62.5%). After IVMP treatment, the inflammation of the anterior chamber, the vitritis and visual acuity experienced rapid and statistically significant improvement from the second day. However, the improvement of retinal vasculitis, choroiditis/chorio-retinitis and macular edema was more slowly achieved, gaining statistical significance from the first week. Optical coherence tomography (OCT) showed a macular thickening (>250μ) in 90 eyes at baseline, with normalization in 30% of affected eyes at day 15 and in 50% of affected eyes at day 30 (p<0.05). IVMP therapy was well tolerated and no notable side effects were reported. Conclusions Our study suggests that IVMP is an effective and safe remission induction therapy in severe ocular inflammation. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4735

Objectives To assess the efficacy of anti-TNFα drugs in Sarcoid Uveitis (SU) refractory to conventional synthetic immunosuppressive drugs (CSISDs). Methods Multicenter study (12 hospitals) of refractory SU to oral corticosteroids and at least one CSISD. Ocular inflammation was evaluated according to “SUN-2005”, and macular thickness by OCT. Results are expressed as mean ± SD (normal distribution), or as median [25th-75th interquartile range (IQR)] (not normally distributed) and Comparison by Wilcoxon test. Results We studied 16 patients/27 eyes (7men/9women) with a mean age of 38.4±17.2 years (range 13-76). They showed: elevated Angiotensin-Converting Enzyme (56.2%), bilateral hiliar lymphadenopathy (56.2%), lung parenchymal involvement (43.7%), and involvement of other organs (56.2%). A biopsy confirmed sarcoidosis in the 31.2% of cases. The most frequent pattern of uveitis was bilateral chronic remitting panuveitis and the most frequent ocular inflammatory findings were mutton-fat keratic precipitates and snow balls in vitreous. Besides oral corticosteroids and before anti-TNFα, patients had received i.v. methylprednisolone (n=1), methotrexate (n=12), cyclosporine A (n=5), or azathioprine (n=3). The first anti-TNFα was: adalimumab (n=9; 56.3%) (40 mg/sc/2 weeks) and infliximab (n=7; 43.7%) (5 mg/kg/i.v./every 4-8 weeks), and was used in combination (n=13) with MTX (n=10), AZA (n=2) and mycophenolate mofetil (n=1). Infliximab was successfully switched to golimumab (n=2) due to intolerance. The mean duration of anti-TNFα was 27.7±16.8 months. The results with anti-TNFα after 2 years were: Visual acuity: from a mean of 0.6±0.3 to 0.8±0.2 (p=0.03); Tyndall: from a median of 1 [IQR: 0-3] to 0 [IQR: 0-2] (p=0.017) and vitritis: from a median of 0 [IQR: 0-3] to 0 [IQR: 0-1] (p=0.03). Six patients (7 eyes) with cystoid macular edema (CME) (OCT>300μ) at baseline, improved from 372±58.3 to 241±1.4 microns at 2 years (p=0.17). Conclusions Anti-TNF therapy seems effective in SU refractory to CSISDs. Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias”PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from“Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3829