Methotrexate: an option for preventing the recurrence of acute anterior uveitis

Abstract

Aims To evaluate the efficacy of methotrexate (MTX) in preventing the recurrence of acute anterior uveitis (AAU). Methods This prospective, open, longitudinal study included patients from June 2002 to March 2005 who had either three or more episodes of AAU in the previous year, or a recurrence of AAU within 3 months before starting the trial. We excluded uveitis of infectious origin, masquerade syndromes, and patients with contraindications to MTX. The response criteria were defined as an absence of symptoms and the presence of a normal ophthalmologic examination. The study outcome compared the number of flare-ups of uveitis over an MTX-treated for 1 year to the number of flare-ups of the same group during the previous year without MTX. Results A total of 571 patients with uveitis were evaluated during the period of the study, and 10 fulfilled the inclusion criteria. One patient refused the treatment, and nine completed the study. The mean number of recurrences in the pre-MTX year was 3.4 (SD: 0.52), which was significantly reduced to 0.89 (SD: 1.17) in the year of treatment (P ¼ 0.011). Conclusion MTX treatment seems to reduce the number of flare-ups in patients with recurrent AAU.

Uveitis in spondyloarthritis including psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease

“…Data, which are usually anecdotal, also support the concept that a monoclonal antibody to TNF is more effective than a soluble receptor for treating uveitis in most patients [21]. Sulfasalazine [22,23], methotrexate [24], and perhaps oral nonsteroidals anti-inflammatory drugs [25] can also help to reduce the frequency or intensity of attacks of uveitis in B27-positive patients. These drugs have less cost and less risk than biologic therapies.…”

Demographic, clinical, laboratory and treatment characteristics of spondyloarthritis patients with and without acute anterior uveitis

“…In addition, the group with AAU was receiving less methotrexate because most of them were AS patients, and this medication has no proven effect in patients with predominance of axial involvement. The value of methotrexate in cases of AAU and SpA is controversial and based on small studies, 15 since most studies on uveitis have not classified the uveitis treatment according to etiology. 16,17 A negative relationship was found between skin disease (psoriasis) and the presence of AAU.…”

Tumour necrosis factor inhibitor treatment and occurrence of anterior uveitis in ankylosing spondylitis: results from the Swedish biologics register

“…Observational studies have suggested that sulfasalazine (SSZ) may prevent recurrence of AU in patients with AS5 6 and some positive data also exist for methotrexate (MTX)7 and non-steroidal anti-inflammatory drugs (NSAID) 8. Treatment with tumour necrosis factor-α inhibitors (TNFi) has also repeatedly been shown to reduce the occurrence of AU in patients with AS,9–11 with reports including both reduced rates compared with placebo-treated patients,10 12 13 and compared with rates pre-TNFi-treatment 11 14.…”