Background: Inflammatory rheumatic diseases often present with extra-articular manifestations, including ocular involvement. Uveitis, a frequent manifestation, accounts for systemic inflammatory rheumatic diseases and significantly impacts quality of life [1]. Notably, HLA-B27-associated spondyloarthropathies and rheumatoid arthritis are leading causes of these conditions. Treatment with anti-TNF agents has shown excellent efficacy, with literature data highlighting infliximab and adalimumab as the most effective options for improving outcomes and reducing relapse rates [2].

Objectives: The objective of this study was to assess the frequency of uveitis episodes in the year prior to admission, related to the rheumatic diseases and type of immunosupression therapy administered, emphasising the biological therapy.

Methods: This is an unicenter, observational, retrospective study from a tertiary rheumatology center, including patients diagnosed with a rheumatic disease, age> 18 years, with hospital admission between January 2023 and December 2024 who had an ocular manifestation (uveitis or iridocyclitis) at admission or a history of at least one ocular manifestation. Data was collected from patients charts and statistical analysis was conducted using SPSS software and Microsoft Excel.

Results: A total of 57 patients were included in the study, 33 (57.9%) of which were male, with an age median (min-max) of 47 (24-77) years old. The frequency of rheumatic diseases associated with uveitis in our patients were as follows: Spondylarthritis- 35 (61.4%), Behcet’s Disease – 5 (8.77%), Psoriatic Arthritis – 4 (7.02%), Rheumatoid Arthritis – 3 (5.26%), Systemic Lupus Erythematosus– 3 (5.26%), ANCA-associated vasculitis – 1 (1.75%), Primary Sjogren’s disease – 1(1.75%) and 5 (8.77%) HLA-B27 uveitis cases (without systemic disease). Concerning the number of uveitis episodes per patient the median was 1(0-4), standard deviation of 0.84, in the year prior to admission. Typically, uveitis was unilateral (94.74%), manifesting mostly as anterior uveitis (82.46%) while posterior and panuveitis made up 14.04% and 3.5% of cases respectively. Thirty-one (54.38%) of the patients were undergoing biological therapy at the moment of acute uveitis. None of the biologic naïve patients necessitated initiation of biological therapy due to uveitis. Distribution of biological therapies were as follows: Adalimumab (ADA) – 16 (51.61%), Etanercept (ETA) - 5 (16.13%), Infliximab (INF) - 4 (12.9%), Certolizumab (CZP) – 2(6.45%), Secukinumab (SEK) – 1 (3.23%), Golimumab (GOL) – 1(3.23%), Guselkumab (GUS) – 1(3.23%) and Upadacitinib (UPA) – 1(3.23%). Fifty percent of the patients treated with ADA exhibited uveitis episodes, with a median of 1 (1-3) episodes per patient, while 40% of the patients treated with ETA and 25% with INF experienced only one uveitis relapse. The patient treated with GOL experienced 3 episodes of acute uveitis. The patients under treatment with CZP, SEK, GUS, UPA all experienced 1 episode of uveitis. It is worth noting that 3 (9.68%) out of 31 patients required a switch to a different biologic due to uveitis – one switch from ETA to ADA, one from GUS to UPA and another from UPA to INF. Pertaining to conventional immunosupressives, 40.35% of the patients included in the study were taking csDMARDs, with the following distribtuion: Methotrexate – 12 (21,05%), Sulfasalazine – 5 (8.77%), Leflunomide – 2 (3.51%), Azathioprine – 2 (3.51%), Mycophenolate mofetil – 1(1.75%) and 2 (3.51%) patients with a combination of Azathioprine and Hydroxychloroquine. It is worth noting that only 19.30% of patients underwent combination therapy with both bDMARDs and csDMARDS. Regarding the frequency of uveitis in relation to the presence of biological therapy, 54.84% of patients with biologics experienced a median of 1 (1-4) uveitis episodes while 65.38% of biologic naïve patients experienced a median of 1 (0-2) uveitis episodes in the year prior to hospital admission. Uveitis seemed to be more frequent in patients without biologics with an OR (CI95%) of 1.55 (0.531 to 4.552) and a P-value of 0.42, which is not statistically significant. In our cohort females were more likely to have at least 1 episode of uveitis when compared to males, with an OR (CI95%) of 4.56 (1.373-15.140) and a P-value of 0.013, which is statistically significant.

Conclusion: Our study revealed that spondyloarthritis was the most common rheumatic disease associated with uveitis, with the majority of cases being unilateral and anterior. Women were significantly more likely than men to experience uveitis episodes. Additionally, some patients required changes in biological therapy due to uveitis, highlighting its impact on treatment strategies.

REFERENCES: [1] Hysa E, Cutolo CA, Gotelli E, Pacini G, Schenone C, Kreps EO, Smith V, Cutolo M. Immunopathophysiology and clinical impact of uveitis in inflammatory rheumatic diseases: An update. Eur J Clin Invest. 2021 Aug;51(8):e13572. doi: 10.1111/eci.13572.

[2] Chauhan, K., & Tyagi, M. (2024). Update on non-infectious uveitis treatment: anti-TNF-alpha and beyond. Frontiers in Ophthalmology , 4 , 1412930. https://doi.org/10.3389/FOPHT.2024.1412930/BIBTEX .

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.