Background Relapsing uveitis is serious problem for patients with ankylosing spondylitis (AS). Anti-TNF therapy significantly reduces number of uveitis attacks in AS pts, but it is not always available. There is a need to assess influence of standard DMARDs on incidence of uveitis in AS pts.
Objectives To compare rate of uveitis attacks during combined therapy using sulfaslazine and NSAIDs versus monotherapy by NSAIDs.
Methods 111 pts with AS and uveitis were assessed at the Institute of Rheumathology. 49 used combined therapy by sulfaslazine 2 grams per day and NSAIDs at least 1 year, mean duration - 3,9±2,28 year. 6 of 49 pts had frequently relapsing course: more than 3 episodes of uveitis per year, 43 – not more, than 3. 62 pts used NSAIDs only during whole observation period, mean duration - 7,2±6,4 year, 9 of them had more than 3 episodes of uveitis per year, 53 – not more, than 3. 23 of 49 pts used NSAIDs only at least 1 year prior to combined therapy, 10 with more than 3 episodes of uveitis per year, 13 - not more, than 3.
Results The mean rate of uveitis attacks during monotherapy by NSAIDs for whole group was 2,06±2,04 per year, during combined therapy – less, but not significantly: 1,41±1,83 per year, p=0,08.
Among pts with frequency of attacks 3 and less mean rate during combined therapy was significantly lower, than during monotherapy: 0,99±0,87 and 1,37±0,91 accordingly, p=0,04. For pts with frequently relapsing course of uveitis mean rate of attacks was not significantly different: 5,5±2,7 using combined therapy and 5,7±2,5 using monotherapy, p=0,9.
Among pts, used monotherapy and combined therapy sequentially, significant reducing of uveitis flares was observed in 13 pts, that had not more than 3 attack per year initially: from 1,92±0,96 to 0,4±0,44, p=0,00003. 10 pts with more than 3 attack per year initially had not significant reducing of uveitis flares: from 5,9±3,02 to 5,33±1,1, p=0,6.
Conclusions Combined therapy by sulfaslazine and NSAIDs not reduces significantly number of uveitis attacks in AS pts with frequently relapsing course of uveitis, but significantly reduces among pts with mild disease.
Benitez-Del-Castillo JM, Garcia-Sanchez J, Iradier T, Bañares A. Sulfasalazine in the prevention of anterior uveitis associated with ankylosing spondylitis. Eye (Lond). 2000 Jun;14 (Pt 3A):340-3.
Muñoz-Fernández S, Hidalgo V, Fernández-Melόn J. Sulfasalazine reduces the number of flares of acute anterior uveitis over a one-year period J Rheumatol. 2003 Jun;30(6):1277-957
Disclosure of Interest None declared