ABSTRACT
OBJECTIVE: The aim of this study was to assess the efficacy of anti-TNF-α therapy in refractory uveitis due to Behçet's disease (BD). METHODS: We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load. RESULTS: Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (s.d. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-α drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-α therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 µm] and 35 (49 eyes) had cystoid macular oedema (OCT>300 µm) that improved from 420 µm (s.d. 119.5) at baseline to 271 µm (s.d. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases. CONCLUSION: Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antibodies, Monoclonal/therapeutic use , Behcet Syndrome/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Uveitis/drug therapy , Adalimumab , Adolescent , Adult , Aged , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized/administration & dosage , Antibodies, Monoclonal, Humanized/adverse effects , Behcet Syndrome/complications , Biological Products/adverse effects , Biological Products/therapeutic use , Child , Drug Administration Schedule , Drug Resistance , Drug Therapy, Combination , Female , Follow-Up Studies , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Infliximab , Male , Middle Aged , Prednisone/administration & dosage , Prednisone/therapeutic use , Treatment Outcome , Uveitis/etiology , Young AdultABSTRACT
Hemos estudiado una población de 171 pacientes diagnosticados de distrofia simpático refleja (DSR). En esta población la DSR tiene, en gran medida, un origen secundario; siendo el traumatismo el más frecuente. El terreno predisponente más habitual es el psicológico. La DSR predomina en las extremidades inferiores. La mayor parte de las DSR han llegado en fase caliente. En general, la evolución ha sido satisfactoria con AINES, calcitonina y rehabilitación. En suma, nuestro estudio pone de manifiesto la gran heterogeneidad de este síndrome (AU)
We followed a total of 171 patients diagnosed with Reflex Sympathetic Dystrophy (RSD). This enigmatic condition normally has a secondary origin, being trauma the unleashing cause in most cases. Psychological predisposition plays a major role in developing the clinical state, which affects lower extremities more frequently. In this series, patients were first seen during the acute «warm» phase and the final outcome was generally good after a period of treatment with non-steroidal anti-inflammatory drugs (NSAID), calcitonin and physical therapy. However, a comprehensive review of the literature revealed the heterogeneity of this condition (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Reflex Sympathetic Dystrophy/diagnosis , Reflex Sympathetic Dystrophy/therapy , Calcitonin/therapeutic use , Guanethidine/therapeutic use , Sympathectomy/methods , Reflex Sympathetic Dystrophy/epidemiology , Reflex Sympathetic Dystrophy , Prospective StudiesABSTRACT
We followed a total of 171 patients diagnosed with Reflex Sympathetic Dystrophy (RSD). This enigmatic condition normally has a secondary origin, being trauma the unleashing cause in most cases. Psychological predisposition plays a major role in developing the clinical state, which affects lower extremities more frequently. In this series, patients were first seen during the acute "warm" phase and the final outcome was generally good after a period of treatment with non-steroidal anti-inflammatory drugs (NSAID), calcitonin and physical therapy. However, a comprehensive review of the literature revealed the heterogeneity of this condition.
