SAT0276 Uveitis during anti-tnf therapy in patients with axial spondyloarthritis: a paradoxical event or disease manifestation?

Background Although widely recognised as extra-articular manifestations of axial spondyloarthritis (axSpA), uveitis developing throughout anti-TNFα treatment is difficult to be classified as disease related or paradoxical event. Objectives We aimed to evaluate the incidence of new onset or relapsing uveitis in patients with axSpA receiving TNF inhibitors. Methods We performed a cross-sectional retrospective study evaluating 126 consecutive active axSpA exposed to TNFα inhibitors according to the local recommendations, followed-up in a single rheumatology department. Patients identified with uveitis were systematically assessed based on a predefined protocol comprising (i) data about uveitis ( de novo or flare; unique episode or recurrence; acute or chronic; anterior, posterior, intermediary or panuveitis; uni or bilateral; outcomes), (ii) responsible medication (drug exposure prior to uveitis, biologic-naive or experimented axSpA, continuation or switching to another biologic) and (iii) rheumatic condition (activity, response to treatment, extra-articular manifestations, disease duration). Results 91 biologic naive axSpA and 35 receiving more than one anti-TNF α were recruited; among them, 318 patient-years exposed to etanercept, 225.37 patient-years to adalimumab, 113.52 patient-years to infliximab, 30.49 patient-years on golimumab. A history of uveitis was found in 27.77% (35 cases). We reported 12 patients developing at least one episode of uveitis during biologic treatment (7 de novo , 10 recurrent uveitis); etanercept was mostly associated with uveitis (8 episodes, 2.51 per 100 patient-years), but also monoclonal antibodies, 3 with golimumab (9.83 per 100 patien-years), 2 under infliximab (1.76 per 100 patien-years), surprisingly, 3 with adalimumab (1.33 per 100 patien-years). Only 3 axSpA had uveitis before starting anti-TNFs. Uveitis was described irrespective of the prior exposure to biologics, mainly in bio-experimented patients, 9 aged between 26 and 72, with disease duration of 6 to 38 years, occurring any-time during biologics (2–116 months). Acute anterior uveitis was commonly reported, only one case of complicated panuveitis. 3 cases (one infliximab, two golimumab) had benefit with switching to another TNF blocker, but in most reported cases uveitis was solved without anti-TNF α interruption. Further, continuation of the same anti-TNF α did not cause relapse in some cases. The underlying SpA was well controlled (ASDAS-CRP) when uveitis, patients being classified as responders compared to previous visit, suggesting paradoxical uveitis. Conclusions Although rare, new onset or flare of uveitis may occur during anti-TNF therapy in axSpA. Surprisingly, not only TNF receptor but also monoclonal antibodies were responsible, etanercept being involved mainly in new onset uveitis. Disclosure of Interest None declared