Improvement of Cytological Grade and Tear Production in Ankylosing Spondylitis Patients Under Anti-TNF Therapy: A Long-Term Follow-up

Fany Usuba¹, Carla GS Saad², Priscila Novaes¹, Ruth Santo¹, Julio CB Moraes², Eloisa Bonfa³ and Milton Alves⁴, ¹Ophtalmology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ²Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ³Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, ⁴Ophtalmolgy Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: Ankylosing spondylitis (AS), anti-TNF therapy and dry eyes, Sjogren's syndrome

Session Information

Date: Monday, October 22, 2018

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster II: Clinical/Epidemiology Studies

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Clinical expression and pathophysiology of dry eye disease (DED) have recently changed and pro-inflammatory cytokines, such as TNF-α, may play a role in the multifactorial mechanism of DED. Few studies evaluated the effect of TNF blockage in DED and there are no data regarding this complication in ankylosing spondylitis (AS). The aim of the study is to analyze the ocular surface (OS) in AS patients according to the DED severity grade and conjunctival impression cytology (IC) and the effect of anti-TNF therapy in a subgroup of patients with a one-year follow-up.

Methods: Thirty-six AS patients and 39 controls with strict exclusion criteria for DED were enrolled at study entry, and 14 were followed prospectively post-anti-TNF therapy at 3months (3M), and 12 months (12M). AS disease parameters were performed for all patients. Ocular evaluation included OS Index Disease questionnaire, Schirmer I test, break-up time, vital staining, and conjunctival IC. DED severity grade was also applied.

Results: AS patients presented higher frequency of DED (80.5% vs. 43.6%, p=0.01), a worse score of severity [1(0-3) vs. 0(0-1), p=0.001], and a higher frequency of altered IC (55.5% vs. 12.8%, p=0.007) when compared to controls. The 14 patients under anti-TNF therapy presented an improvement in all clinical AS disease activity parameters throughout the one-year treatment (p<0.05). A concomitant increase in the Schirmer test was also observed [BL:10(2-35) mm, 3M:17.5(4-35) mm and 12M:20(4-30) mm, respectively, p=0.04] as well as a significant amelioration in the altered IC to a normal IC was noticed (p=0.006).

Conclusion: DED is a frequent and under-diagnosed ocular disease in AS patients. The long-term parallel improvement of disease activity and OS parameters in AS patients receiving anti-TNF therapy suggests that the OS is an additional target of systemic inflammation in AS.

Disclosure: F. Usuba, None; C. G. Saad, None; P. Novaes, None; R. Santo, None; J. C. Moraes, None; E. Bonfa, Fundação de Amparo à Pesquisa do Estado de São Paulo, 2,Conselho Nacional de Desenvolvimento Científico e Tecnológico, 2; M. Alves, None.

To cite this abstract in AMA style:

Usuba F, Saad CG, Novaes P, Santo R, Moraes JC, Bonfa E, Alves M. Improvement of Cytological Grade and Tear Production in Ankylosing Spondylitis Patients Under Anti-TNF Therapy: A Long-Term Follow-up [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/improvement-of-cytological-grade-and-tear-production-in-ankylosing-spondylitis-patients-under-anti-tnf-therapy-a-long-term-follow-up/. Accessed .

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