StemCell Therapy

Objectives:Peripheral ulcerative keratitis (PUK) is a severe corneal condition associated with uncontrolled rheumatoid arthritis (RA). Tocilizumab (TCZ) is used to control RA, however, episodes of paradoxical ocular inflammation have been reported in TCZ-treated patients. We report a case series of PUK in TCZ-treated RA patients with ophthalmological and systemic findings and discuss the potential underlying mechanisms.

Methods:Four patients (6 eyes), aged 47-62 years were included. At the onset of PUK, the median duration of RA was 13 years (3-13), and the median treatment with TCZ was 9 months (3-14). Two patients had active disease (DAS 28 > 3.2) and the disease was controlled in 2 patients (DAS 28 3.2).

Results:TCZ was initially replaced by another immunomodulatory treatment in all patients and later reintroduced in 2 patients without PUK recurrence. Corneal inflammation was controlled in all cases with local and systemic treatments, with severe visual loss in one eye.

Conclusion:To summarize, PUK may occur in patients with long standing RA after a switch to TCZ and can be interpreted, depending on the context, as insufficient efficacy or a paradoxical manifestation. These cases highlight the urgent need for reliable biomarkers of the efficacy/paradoxical reactions for biologics.

Keywords:Peripheral ulcerative keratitis; paradoxical manifestations; rheumatoid arthritis; tocilizumab.

Read more:
Peripheral Ulcerative Keratitis in Rheumatoid Arthritis Patients Taking Tocilizumab: Paradoxical Manifestation or Insufficient Efficacy? - DocWire...

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