The role of infliximab in rheumatoid arthritis associated non infectious ocular inflammatory disease

McAlister, J C, Konstantopoulos, Aristides, Ardjomand, Navid, Dansingani, K, Anderson, David F. and Hossain, Parwez (2008) The role of infliximab in rheumatoid arthritis associated non infectious ocular inflammatory disease. Clinical and Experimental Dermatology, 36 (suppl 2), A709. (doi:10.1111/j.1442-9071.2008.01849.x).

Abstract

Purpose: To evaluate the safety and efficacy of standard DMARD compared with biologic immunosuppression agents for the treatment of Rheumatoid arthritis (RA) associated ocular surface inflammatory disease.Methods: Retrospective analysis of a cohort of 16 patients with RA undergoing immunosuppression for ocular surface associated non infectious inflammatory disease was under-taken. Patients were split equally between standard DMARD therapy alone or the addition of biologic immunosuppres-sant, Infliximab, to induce ocular disease remission. Disease activity was assessed clinically and with Visante imaging. Serological assessment of ESR, CRP and Rheumatoid ELISA titre was also evaluated. Initial and repeat surgical interven-tions and time to remission were also analysed.Results: A median follow up after onset of ocular disease was recorded for Standard (30 months) and Infliximab groups (53 months). Average follow up on Infliximab was 15 months. Infliximab induced remission within 2 weeks (1–8), standard DMARD therapy took 9 months (4–20). The standard DMARD treated group fared worse for mortality (22% v 0%) and ocular loss (11% v 0%) compared to the Infliximab treated group.Severity of the ocular morbidity but not the level of any raised systemic inflammatory markers correlated with final mortality.Conclusions: Infliximab was safe and well tolerated. Rapid and total remission of the ocular inflammatory disease occurred with Infliximab only. Surgical intervention, ocular morbidity and mortality were all more prominent in the ‘standard DMARD’ group though still less than in compara-ble published literature. This data provides evidence for the use of biologics for ocular manifestations of severe RA over current standard DMARD therapy alone.

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Contributors

Author: Parwez Hossain

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