Differential efficacy of tumor necrosis factor inhibition in the management of inflammatory eye disease and associated rheumatic disease

Objective. To evaluate the clinical usefulness of tumor necrosis factor (TN F) inhibitors in patients with inflammatory eye disease that is resistant t o conventional immunosuppressive therapies. Methods. Sixteen patients (4 males and 12 females aged 7 to 78 years) who r eceived etanercept (n = 14) or infliximab (n 2) for either inflammatory eye disease or associated joint disease were studied retrospectively to determ ine the effect of these medications on their ocular inflammation. Results. Nine cases of uveitis and 7 cases of scleritis were treated. Syste mic diagnoses included rheumatoid arthritis (n 8), juvenile rheumatoid arth ritis (n = 3), ankylosing spondylitis (n = 1), and psoriatic spondylarthrop athy (n = 1). Three patients had uveitis without associated systemic diseas e. Although 12 of 12 patients with active articular inflammation (100%) exp erienced improvement in joint disease, only 6 of 16 with ocular inflammatio n (38%) experienced improvement in eye disease. Five patients developed inf lammatory eye disease for the first time while taking a TNF inhibitor. No p atient discontinued treatment because of adverse drug effects. Conclusion. TNF inhibitors are well tolerated immunosuppressive medications that may benefit certain subgroups of patients with inflammatory eye disea se, but they appear to be more effective in controlling associated inflamma tory arthritis.