Abstract
Ankylosing spondylitis (AS) is presented with axial and peripheral articular involvement. Uveitis is a severe and rather specific manifestation of AS. Biologics targeting tumor necrosis factor (TNF) α are effective on both articular and ocular manifestations of disease. The occurrence of uveitis in patients that never had eye involvement or the relapse of uveitis is described during anti-TNFα treatment. The frequency of these events is slightly higher during therapy with etanercept. The available TNFα blockers show different pharmacokinetics and pharmacodynamics yielding different biological effects. There is an ongoing debate whether uveitis during anti-TNFα has to be considered as paradoxical effect or an inadequate response to therapy. Here, we present a case report and review what the evidences for the two hypotheses are.
Highlights
Ankylosing spondylitis (AS) is presented with axial and peripheral articular involvement
Inhibitors of TNFα are very effective in all SpA and AS manifestations
Monoclonal antibodies appear to be more effective in controlling uveitis compared to the soluble tumor necrosis factor (TNF) receptor ETA
Summary
Ankylosing spondylitis (AS) is the most important among spondyloarthritis (SpA), a family of chronic inflammatory conditions with common epidemiology, immunogenetics, clinics, and radiological features. SpA present mostly with peripheral arthritis, dactylitis, enthesitis, and, extra-articular manifestations The burden of these manifestations includes uveitis, psoriasis, inflammation of the pulmonary parenchyma and of the pleura, neuropathies, gastrointestinal inflammation, urogenital involvement, cardiac valvular pathologies, myocardium and conduction tissue dysfunction, renal involvement with microhematuria, IgA-associated glomerulonephritis, and secondary, amyloidosis, generalized, and periarticular osteoporosis [4]. Uveitis incidence correlates linearly with the disease duration up to 20 years and reaches a plateau It is significantly associated with cervical pain, prior diagnosis of inflammatory bowel disease, Short Form-36 (SF36), physical impairment, and disease debut after an infection. In animal models deficiency of either interferon-γ or IL-1 receptor antagonist leads to higher ocular inflammation Notwithstanding these evidences, the most important effects are likely due to HLA-B27 positivity and TNFα expression
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