What is the role of immunomodulatory therapy in the treatment of ophthalmologic manifestations of ankylosing spondylitis?

Updated: May 15, 2020
  • Author: Jean Deschênes, MD, FRCSC; Chief Editor: Hampton Roy, Sr, MD  more...
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Immunomodulatory therapy is often useful in patients who are unresponsive to short courses of corticosteroids, in patients with chronic uveitis, or in patients who develop adverse effects from corticosteroid therapy.

A number of agents have been used, including methotrexate, azathioprine, cyclosporin A, mycophenolate mofetil, cyclophosphamide, and chlorambucil. Myelosuppression and secondary infection are among the most common adverse effects of these agents.

Tumor necrosis factor-alpha (TNF-alpha) inhibitors may be useful in patients with the seronegative spondyloarthropathies, including ankylosing spondylitis. Available TNF-alpha inhibitors include infliximab, etanercept, and adalimumab. These agents may be useful in reducing the number of flares of anterior uveitis in patients with ankylosing spondylitis. Adalimumab has been shown to reduce the rate of anterior uveitis flares by at least 50% in a large open-label study. [5, 6, 7, 8] 7 [9]

An ophthalmologist specialized in uveitis, a rheumatologist, an internist, or an oncologist is an essential member of the team in the management of patients treated with immunomodulatory agents.

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