Letter to the Editor
Treatment of uveitis and ankylosing spondylitis refractory to three tumor necrosis factor alpha inhibitors drugs with golimumab
Tratamiento de uveítis y espondilitis anquilosante refractaria a tres medicamentos inhibidores de factor de necrosis tumoral alfa con golimumab
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array:1 [ 0 => array:2 [ "autoresLista" => "Jose Darío Sánchez López, Paolo Cariati, Miguel Angel Perez de Perveval Tara" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Jose Darío" "apellidos" => "Sánchez López" ] 1 => array:2 [ "nombre" => "Paolo" "apellidos" => "Cariati" ] 2 => array:2 [ "nombre" => "Miguel Angel" "apellidos" => "Perez de Perveval Tara" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X18300251" "doi" => "10.1016/j.reuma.2018.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X18300251?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574319300565?idApp=UINPBA00004M" "url" => 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=> "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Wilson" "apellidos" => "Bautista Molano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Rafael" "apellidos" => "Valle Oñate" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Universidad Militar Nueva Granada, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Militar Central, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Reumatólogo, Hospital Militar Central, Bogotá, Colombia" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de uveítis y espondilitis anquilosante refractaria a tres medicamentos inhibidores de factor de necrosis tumoral alfa con golimumab" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Uveitis is the most common extra-articular manifestation in patients with spondyloarthritis, and is present in 23% of patients with ankylosing spondylitis, and 15.9% of patients with non-radiographic spondyloarthritis,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> with a greater risk for HLA-B27-allele-positive patients with an OR of 4.2 (3.3–5.3).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It presents in up to 41% as a first manifestation of spondyloarthritis, and the 2 key characteristics to aid diagnosis are the presence of anterior recurring uveitis, and back or joint pain.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The most common presentation of uveitis is acute in 88.7%, it is anterior in 90.5%, and unilateral in 87.3%.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Its management includes topical mydriatic agents, sulfasalazine and methotrexate to reduce recurrence.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Treatment with tumor necrosis factor blockers (anti-TNFα) is effective in improving the signs and symptoms of spondyloarthritis and uveitis,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and there are recommendations on the use of monoclonal antibodies such as infliximab and adalimumab as first-line anti-TNFα agents to treat uveitis associated with spondyloarthritis.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> However, there are no recommendations on the management of patients for whom this strategy fails.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 37-year-old woman who presented with a 2-year history of inflammatory lumbar pain; she had a history of an episode of anterior uveitis 8 years earlier in the left eye, which improved with topical management, within extension studies with the presence of HLA-B27, high acute phase reactants, and grade 2 bilateral sacroiliitis found on conventional radiography; a diagnosis was made of ankylosing spondylitis. Management with NSAIDs, methotrexate and sulfasalazine was started, presenting liver and skin toxicity. Due to persistent inflammatory lumber pain with a BASDAI score of 7, and elevated acute phase reactants, the patient was started on etanercept; two years later she presented with uveitis in the right eye and recurrence of her inflammatory lumbar pain. Following the therapeutic failure of infliximab and adalimumab due to recurrence of the uveitis episodes, the patient is being managed with monthly subcutaneous golimumab; clinical improvement of joint disease activity has been achieved and she has had no further episodes of uveitis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">For patients with spondyloarthritis with episodes of refractory uveitis (as in the case we present), the guidelines of the American College of Rheumatology (ACR)<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> recommend the use of anti-TNFα monoclonal antibodies (infliximab, adalimumab) versus fusion proteins (etanercept)to reduce the recurrence of uveitis. Similarly, the guidelines of the European League Against Rheumatism (EULAR) on axial spondyloarthritis<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> mention that infliximab, adalimumab and certolizumab are effective in preventing uveitis recurrence, while the results with etanercept remain contradictory; to date there have been no published cases on the effectiveness of golimumab for refractory uveitis associated with spondyloarthritis. Likewise on the management of anti-TNFα agents, opthalmology<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> continue to recommend infliximab and adalimubab rather than etanercept, as second-line immunomodulatory agents for inflammatory eye disorders, including posterior uveitis, panuveitis and severe uveitis associated with spondyloarthritis. A recent study by Calvo-Rio et al.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> in which golimumab was used for 15 patients with uveitis associated with spondyloarthritis refractory to least one immunosuppressive drug, reported an improvement in intraocular inflammatory parameters using this therapeutic strategy. On reviewing the study, only one patient shared similar characteristics with our patient, namely, failure of the same anti-TNFα agents (infliximab, adalimumab and etanercept). The study by Yazgan et al.,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> which assessed the use of golimumab for patients with HLA-B27-positive ankylosing spondylitis and recurrent anterior uveitis found complete remission of the ocular involvement, and significantly increased visual acuity (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.002). None of the patients described in this study had similar characteristics to our patient. Therefore our case reinforces the efficacy of golimumab for patients with refractory and recurrent uveitis associated with spondyloarthritis who have already been treated with other anti-TNFα drugs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Chaparro Sanabria JA, Bautista Molano W, Valle Oñate R. Tratamiento de uveítis y espondilitis anquilosante refractaria a tres medicamentos inhibidores de factor de necrosis tumoral alfa con golimumab. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 3 | 8 |
| 2024 October | 81 | 33 | 114 |
| 2024 September | 113 | 38 | 151 |
| 2024 August | 168 | 60 | 228 |
| 2024 July | 151 | 45 | 196 |
| 2024 June | 125 | 37 | 162 |
| 2024 May | 109 | 29 | 138 |
| 2024 April | 103 | 21 | 124 |
| 2024 March | 109 | 35 | 144 |
| 2024 February | 100 | 17 | 117 |
| 2024 January | 78 | 25 | 103 |
| 2023 December | 60 | 30 | 90 |
| 2023 November | 48 | 17 | 65 |
| 2023 October | 105 | 24 | 129 |
| 2023 September | 78 | 35 | 113 |
| 2023 August | 62 | 12 | 74 |
| 2023 July | 65 | 16 | 81 |
| 2023 June | 77 | 18 | 95 |
| 2023 May | 88 | 25 | 113 |
| 2023 April | 69 | 14 | 83 |
| 2023 March | 100 | 15 | 115 |
| 2023 February | 104 | 29 | 133 |
| 2023 January | 83 | 16 | 99 |
| 2022 December | 102 | 34 | 136 |
| 2022 November | 135 | 33 | 168 |
| 2022 October | 130 | 29 | 159 |
| 2022 September | 73 | 25 | 98 |
| 2022 August | 123 | 36 | 159 |
| 2022 July | 79 | 34 | 113 |
| 2022 June | 69 | 49 | 118 |
| 2022 May | 115 | 58 | 173 |
| 2022 April | 125 | 42 | 167 |
| 2022 March | 137 | 46 | 183 |
| 2022 February | 143 | 33 | 176 |
| 2022 January | 122 | 39 | 161 |
| 2021 December | 87 | 40 | 127 |
| 2021 November | 75 | 40 | 115 |
| 2021 October | 101 | 56 | 157 |
| 2021 September | 81 | 46 | 127 |
| 2021 August | 44 | 30 | 74 |
| 2021 July | 46 | 29 | 75 |
| 2021 June | 50 | 35 | 85 |
| 2021 May | 40 | 35 | 75 |
| 2021 April | 77 | 78 | 155 |
| 2021 March | 65 | 27 | 92 |
| 2021 February | 41 | 24 | 65 |
| 2021 January | 40 | 25 | 65 |
| 2020 December | 33 | 23 | 56 |
| 2020 November | 33 | 20 | 53 |
| 2020 October | 19 | 18 | 37 |
| 2020 September | 34 | 16 | 50 |
| 2020 August | 18 | 18 | 36 |
| 2020 July | 19 | 10 | 29 |
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