Recalcitrant psoriatic uveitis and anti-tumor necrosis factor-α monoclonal antibodies: experience from a psoriasis referral center.

ABSTRACT

BACKGROUND: The incidence of non-infectious uveitis on a background of psoriasis is estimated to be 7-20%. The use of tumor necrosis factor-α (TNF-α) inhibitors as a treatment for refractory uveitis is emerging. METHODS: The psoriasis outpatient database at our referral center was searched for patients with concurrent diagnoses of psoriasis and uveitis. The medical records of the patients identified were reviewed for the use of TNF-α inhibitors. RESULTS: Five patients (three women and two men) were identified. All of them suffered moderate to severe psoriasis and chronic, bilateral uveitis. The patient with the most severe ocular inflammation was the only patient positive for human leukocyte antigen B27 (HLA-B27) and the only one to suffer from psoriatic arthritis. All patients had received treatment with adalimumab and had been evaluated at three and six months. Their psoriasis had responded excellently, and in four patients, uveitis had shown the complete remission of inflammation at six months. The fifth patient (HLA-B27+) exhibited improved uveitis activity but not complete remission at six months. CONCLUSIONS: Uveitis is an entity that should be considered when evaluating psoriasis patients with ocular complaints, even in the absence of arthritis. Anti-TNF-α monoclonal antibodies and adalimumab in particular seem to represent a promising therapeutic avenue for the treatment of refractory psoriatic uveitis. Larger randomized clinical trials are needed to confirm our conclusions.