Multi-modal Imaging in Etanercept-induced Uveitis: A Case Series

Abstract

Introduction: To report with multi-modal imaging the clinical course of 3 patients with new-onset uveitis following treatment with etanercept. Methods: Retrospective case-note reviews were conducted of 3 patients previously established on etanercept who developed new-onset acute uveitis. Results and Discussion: Three patients were assessed with a mean age of 44.3 (43-47). Etanercept was indicated for the treatment of ankylosing spondylitis in two patients and psoriatic arthritis in 1 patient. Duration of etanercept treatment ranged from 7 to 10 years; however, in two cases, treatment recently changed to an etanercept biosimilar agent. Two patients were diagnosed with bilateral panuveitis and one patient had chronic relapsing anterior uveitis. Infection screen was negative in all three patients. 2 patients developed cystoid macular oedema as viewed on Spectral Domain OCT. Fundus fluorescein angiography was performed in one patient who demonstrated bilateral retinal vasculitis. All three patients were started on systemic and topical treatment. One patient received sub-tenon triamcinolone injection. Etanercept was discontinued for all patients. 1 of 3 patients lost vision at 7 months. 2 patients demonstrated long-term remission and one patient required intravitreal steroid implantation to stabilize an ongoing intraocular inflammation. Two patients who had complete remission were commenced on Adalimumab while the third patient was commenced on Secukinumab. Conclusion: The clinical course of uveitis developing paradoxically following etanercept treatment is variable. Multi-modal imaging is useful for the clinician that helps in diagnosing and monitoring associated macular oedema and retinal ischaemia. Cessation of etanercept and systemic corticosteroid treatment are often required to prevent ocular morbidity.