RESUMO
PURPOSE: To analyze the efficacy of tocilizumab in uveitic macular edema (ME) resistant to various immunomodulatory drugs. METHODS: Patients received tocilizumab every 4 weeks intravenously. Central foveal thickness (CFT) was assessed by optical coherence tomography (OCT). RESULTS: Five patients (8 eyes) who were ineffectively pretreated with systemic prednisolone, at least one immunosuppressive drug, and at least one biologic drug for uveitic macular edema were included in the study. At 3 months, a response of ME (≥25% reduction in CFT) was observed in 6 eyes (75.0%) of 5 patients. During follow-up, complete resolution of ME was achieved in 5 eyes (62.5%) of 4 patients. Improvement of BCVA was observed in 3 eyes of 3 patients, and stabilization in 3 eyes of 3 patients. Tocilizumab was well tolerated, and no severe side effects occurred. CONCLUSIONS: Treatment with tocilizumab can be considered in chronic uveitic macular edema even if previous immunomodulatory therapy has failed.
Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Edema Macular/tratamento farmacológico , Uveíte/tratamento farmacológico , Adulto , Feminino , Angiofluoresceinografia , Seguimentos , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Infusões Intravenosas , Edema Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Uveíte/fisiopatologia , Acuidade Visual/fisiologia , Adulto JovemAssuntos
Neoplasias Ósseas/sangue , Ablação por Cateter , Fatores de Crescimento de Fibroblastos/biossíntese , Osteomalacia/cirurgia , Síndromes Paraneoplásicas/metabolismo , Sacro/cirurgia , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/cirurgia , Feminino , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos/sangue , Humanos , Osteomalacia/sangue , Osteomalacia/etiologia , Síndromes Paraneoplásicas/sangue , Síndromes Paraneoplásicas/cirurgia , Fosfatos/sangue , Deficiência de Vitamina D/sangue , Adulto JovemRESUMO
OBJECTIVE: Recent publications have shown a negative influence of SLE on female ovarian reserve. Other authors have not found a significant impact of Crohn's disease or early RA on anti-Müllerian hormone (AMH) levels. This study aimed to investigate the potential effect of Behçet's disease (BD), RA and SpA on ovarian reserve as reflected by serum AMH levels. METHODS: Serum samples from 33 RA, 32 SpA and 30 BD patients without previous cytotoxic treatment were analysed and compared with age-matched, healthy controls. AMH was quantified using a standard ELISA with a standard value of 1-8 ng/ml; values <1 ng/ml defined a reduced ovarian reserve. RESULTS: Median age was 26, 28.5 and 33 years and median disease duration was 6, 5.9 and 7 years for RA, SpA and BD patients, respectively. Compared with healthy controls, patients had significantly reduced AMH levels, with a median value for RA of 1.8 ng/ml (control 2.4 ng/ml; P = 0.009), for SpA of 1.5 ng/ml (control 2.3 ng/ml; P = 0.013) and for BD of 1.1 ng/ml (control 1.9 ng/ml; P = 0.007). HLA-B27 had a negative influence on ovarian reserve in SpA patients, whereas other serological parameters did not in the other diseases. CONCLUSION: This is the first study to show a reduced ovarian reserve in patients with RA, SpA or BD. Together with our findings in SLE, we conclude a negative influence of chronic rheumatic diseases on ovarian reserve.