Advances in the treatment of uveitis in patients with spondyloarthritis - is it the time for biologic therapy?
Advances in the treatment of uveitis in patients with spondyloarthritis - is it the time for biologic therapy?
复制标题
脊柱关节炎患者葡萄膜炎的治疗进展——现在是生物治疗的时候了吗？
DOI：
10.22336/rjo.2018.17
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
L. Voinea
中科院分区：
文献类型：
--
作者：
Traian;M. Trandafir;M. Dimăncescu;R. Ciuluvică;V. Popescu;D. Predețeanu;Sinziana Istrate;L. Voinea
脊柱关节炎(SpA)是一组异质性疾病，包括强直性脊柱炎(AS)、银屑病关节炎(PSA)、反应性关节炎(REA)、炎症性肠病相关性脊柱炎(IBD-SpA)和未分化脊柱性关节炎(UNSPA)。这组疾病有几个临床、影像和遗传特征；为了早期诊断和迅速治疗，需要将这些疾病整合到SPA组中。葡萄膜炎是spa最常见的关节外表现。人类白细胞抗原B27相关性急性前葡萄膜炎(AAU)是SpA组中最常见的葡萄膜炎形式。在SpA组中，HLAB27相关AAU的总患病率约为30%，而在伴有HLAB27相关AAU的患者中，SPA的总患病率超过50%。在SpA患者中，HLAB27相关的AAU的临床表现和演变有几个不同之处，了解这一点对于最佳治疗决策非常重要。肿瘤坏死因子α不仅在SpA的发病机制中起着非常重要的作用，而且在以HLAB27相关的免疫反应为特征的免疫反应中也发挥着重要的作用。有大量证据表明肿瘤坏死因子α在SpA和人类白细胞抗原B27相关的急性萎缩性胃炎中的作用，多项研究表明，抗肿瘤坏死因子α药物不仅对风湿症状有效，而且对眼部损害也有效。用局部或全身糖皮质激素和免疫抑制药物(柳氮磺吡啶、甲氨蝶呤、硫唑嘌呤等)常规治疗人类白细胞抗原B27相关性AAU为了减轻眼部炎症伴随着许多副作用，其中一些副作用非常严重，甚至危及生命。因此，新的治疗方法，特别是抗肿瘤坏死因子α药物的生物治疗，为这些患者的治疗打开了新的机遇。值得强调的是，抗肿瘤坏死因子α抗体制剂(英夫利昔单抗、阿达单抗、高利单抗)可能比可溶性肿瘤坏死因子α受体(依那西普)更有效地降低SPA患者发生HLAB27相关性AAU的风险。这篇综述是由一组眼科医生和风湿科医生进行的，他们最近在抗肿瘤坏死因子治疗SpA患者的葡萄膜炎方面取得了丰硕的经验，目的是让眼科医生社区意识到这种生物疗法，并认为现在是使用它的合适时机。缩写：AU=前葡萄膜炎；AAU=急性前葡萄膜炎；AS=强直性脊柱炎；ASAS=脊柱性关节炎协会评估；DBP=维生素D结合蛋白；ESSG=欧洲脊柱关节病研究小组；HLAB27=人类白细胞抗原B27；IBD=炎症性肠病；PSA=银屑病关节炎；REA=反应性关节炎；SPA=脊椎炎；TLRS=Toll样受体；肿瘤坏死因子α=肿瘤坏死因子α；UNSPA=未分化脊椎炎。
Spondyloarthritis (SpA) is a heterogeneous group of diseases that includes ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), inflammatory bowel disease-associated spondyloarthritis (IBD-SpA), and undifferentiated spondyloarthritis (unSpA). This group of diseases shares several clinical, imaging, and genetic features; the integration of these diseases in the group of SpA is needed for an early diagnosis and a prompt treatment. Uveitis is the most common extra-articular manifestation of SpA. HLA-B27-associated acute anterior uveitis (AAU) is the most frequent form of uveitis encountered in the SpA group. The general prevalence of HLA-B27-associated AAU in the group of SpA is about 30% and the general prevalence of SpA in patients with HLA-B27-associated AAU is over 50%. There are several differences in the clinical picture and evolution of HLA-B27-associated AAU in patients with SpA and knowing this is very important for the best therapeutic decision. Tumor necrosis factor α (TNFα) is a very important mediator not only in the pathogenic mechanisms of SpA, but also in the immune reactions that characterize HLA-B27-associated AAU in SpA. There is much evidence of the role of TNFα in SpA and HLA-B27-associated AAU, multiple studies showing efficacy of anti-TNFα drugs not only on rheumatic manifestations but also on ocular involvement. Conventional therapy of HLA-B27-associated AAU with local or systemic glucocorticoids and immunosuppressive drugs (sulfasalazine, methotrexate, azathioprine, etc.) in order to diminish the ocular inflammation is associated with many side effects, some of them being very severe and even life threatening. Therefore, new treatments, especially biologic therapy with anti-TNFα drugs, open a new opportunity for the treatment of these patients. It is very important to emphasize that antibody anti-TNFα agents (infliximab, adalimumab, golimumab) may be more efficient than soluble receptors of TNFα (etanercept) in decreasing the risk of HLA-B27-associated AAU in patients with SpA. The aim of this review made by a group of ophthalmologists and rheumatologists with recent and fruitful experience regarding the anti-TNF treatment of uveitis in patients with SpA is to make the community of ophthalmologists aware of this biologic therapy and that it is the right time to use it. Abbreviations: AU = anterior uveitis; AAU = acute anterior uveitis; AS = ankylosing spondylitis; ASAS = Assessment of SpondyloArthritis Society; DBP = vitamin D binding protein; ESSG = European Spondyloarthropathy Study Group; HLA-B27 = human leukocyte antigen B27; IBD = inflammatory bowel disease; PsA = psoriatic arthritis; ReA = reactive arthritis; SpA = spondyloarthritis; TLRs = Toll-like receptors; TNFα = tumor necrosis factor α; unSpA = undifferentiated spondyloarthritis