Incidence of toxoplasma retinochoroiditis in patients with ankylosing spondylitis after using TNF-α blockers

• Published in: Parasitology international Vol. 62; no. 3; pp. 272 - 275
• Main Authors: de Paula Rodrigues, Kelly Fernandes, Faria e Arantes, Tiago Eugênio, Muccioli, Cristina, de Andrade Neto, João Lins, Pinheiro, Marcelo M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 01.06.2013
• Subjects: Adalimumab; Adult; Animals; Ankylosing spondylitis; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Antirheumatic Agents - therapeutic use; Chorioretinitis - drug therapy; Chorioretinitis - immunology; Chorioretinitis - parasitology; Etanercept; eyes; Female; Follow-Up Studies; Gastroenterology and Hepatology; HLA-B27; Humans; Immunoglobulin G - therapeutic use; immunologic techniques; Incidence; Infectious Disease; inflammation; Infliximab; Male; Middle Aged; parasitology; patients; Prevalence; Prospective Studies; Prospective study with control group; Receptors, Tumor Necrosis Factor - therapeutic use; Retinochoroiditis; risk; Spondylitis, Ankylosing - complications; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - immunology; therapeutics; TNF-α blockers; Toxoplasma; Toxoplasma - physiology; Toxoplasma gondii; toxoplasmosis; Toxoplasmosis, Ocular - complications; Toxoplasmosis, Ocular - drug therapy; Toxoplasmosis, Ocular - immunology; tumor necrosis factor-alpha; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Toxoplasma; TNF-α blockers; HLA-B27; Ankylosing spondylitis; Retinochoroiditis; Prospective study with control group
• ISSN: 1383-5769; 1873-0329
• DOI: 10.1016/j.parint.2013.02.003

Abstract TNF-α blockers are associated with reactivation of latent granulomatous infections and almost 6% of the world population has some chorioretinitis (CR) caused by Toxoplasma gondii . Thus, the blockade of TNF-α could reactivate a latent toxoplasmosis infection (LTxI). This study was conducted to evaluate the prevalence and incidence of chronic and active CR related to T. gondii in patients with ankylosing spondylitis (AS). A total of 74 eyes from 37 active AS outpatients starting TNFα blockers were compared with 35 AS patients, matched to age and sex, under conventional therapy in a prospective and controlled trial. All patients underwent serological tests for T. gondii , as well as periodic ophthalmologic examination during 12 months. Active CR was defined if a white, focal retinochoroidal lesion with overlying vitreous inflammation had been found. Retinochoroidal lesions with sharp edges, hyperpigmented borders and atrophic center were defined as CR scars. At baseline, no patient had active CR. From the 144 eyes examined, almost 6% had CR scars and only 2.1% had a typical toxoplasmic CR scar and all of them were negative for HLA-B27. During 12 months of follow-up, no recurrence or new CR were observed. AS patients using TNF-α blockers do not have a higher risk of acute or chronic CR caused by T. gondii.