Treatment of recurrent anterior uveitis with infliximab in patient with ankylosing spondylitis
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CLINICAL INVESTIGATION
Treatment of recurrent anterior uveitis with infliximab in patient with ankylosing spondylitis Junko Matsuda • Toshikatsu Kaburaki Shigeto Kobayashi • Jiro Numaga
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Received: 14 December 2011 / Accepted: 28 August 2012 Ó Japanese Ophthalmological Society 2012
Abstract Background We describe a HLA-B27-positive Japanese man with recurrent severe anterior uveitis OU and ankylosing spondylitis (AS) who was successfully treated with infliximab. Case A 25-year-old HLA-B27-positive Japanese man presented with recurrent anterior uveitis OU. The symptoms were consistent with typical HLA-B27-associated uveitis, whereas the subsequent course, which consisted of frequent episodes of recurrent severe anterior uveitis, was atypical. Although the patient was treated with intensive topical corticosteroids, cycloplegic treatment, sub-Tenon triamcinolone acetonide injections, systemic corticosteroids and immunosuppressive agents, recurrence of the anterior uveitis persisted. Over 8 years there were 14 documented episodes of recurrent anterior uveitis OD and 10 OSs. At age 33, the patient was diagnosed with AS after a radiographic examination. We began infusions of infliximab (2.5 mg/kg) at 0, 2 and 6 weeks, and then every 8 weeks thereafter. The recurrent uveitis disappeared, and the immunosuppressive agents and oral corticosteroids were tapered and discontinued without relapse. All drugs
J. Matsuda (&) J. Numaga Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaetyo, Itabashi-ku, Tokyo 173-0015, Japan e-mail: [email protected] T. Kaburaki Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan S. Kobayashi Department of Rheumatology, Juntendo University, Koshigaya Hospital, Saitama, Japan
other than infliximab were successfully stopped in October 2010. During the follow-up period, there were no adverse events. Conclusion A case of severe recurrent anterior uveitis OU in a patient with AS with infliximab was successfully treated. This is the first report describing the efficacy of infliximab in AS-associated uveitis in Japan. Keywords Ankylosing spondylitis Anterior uveitis Hla-B27 Infliximab Tumor necrosis factor inhibitor
Introduction Infliximab is a 149-kDa chimeric IgG1 monoclonal antibody composed of human constant and murine variable regions that recognizes tumor necrosis factor-a (TNF-a). It has been approved for use in cases of rheumatoid arthritis, ankylosing spondylitis (AS), psoriatic arthritis, plaque psoriasis and Crohn’s disease. In addition, infliximab is being increasingly administered for refractory inflammatory eye diseases, such as uveitis of Behc¸et’s disease. We treated a Japanese patient with AS using infliximab, which improved recurrent severe anterior uveitis. To the best of our knowledge, such a result has not been previously reported in Japan.
Case report In 2001, a 25-year-old Japanese man was referred for treatment of recurrent anterior uveitis OU that was unresponsive to medical therapy. He e
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