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Background:Cystoid Macular Edema (CME) is the most important cause of blindness in non-infectious uveitis (NIU) (1). Corticosteroids and conventional and/or biological immunosuppressant may be required (1-6). High-dose intravenous methylprednisolone (IVMP) pulse therapy may induce a rapid improvement.Objectives:To evaluate the efficacy and safety of IVMP pulse therapy in CME of different immune mediated inflammatory diseases (IMID).Methods:Multicentre study of 66 patients with severe ocular inflammation who received IVMP. The underlying diseases were: Vogt Koyanagy Harada disease (VKHD)(n=24), Behçet’s disease (BD) (19) and idiopathic NIU (23). The main outcome variable was macular thickness and macular edema (Optical coherence tomography [OCT] >300 μm); that was assessed at 0 (basal), 2-5, 7, 15 and 30 days after IVMP.The results are expressed as mean ±SD for normally distributed variables, or as median [IQR] when are not. Comparison of continuous variables was performed using the Wilcoxon test.Results:We studied 43♀/ 23♂ patients. The main features are shown in TABLE 1. IVMP dose ranged from 250 to 1000 mg/day administered for 3-5 consecutive days, the dose was established according to the presence or not of other systemic manifestations apart from uveitis. All of them had active intraocular inflammation at the moment of the study.Table 1.Main features of 66 patients with cystoid macular edema.VKHD(n=24)Idiophatic(n=23)Behcet’s disease(n=19)Overall(n=66)Men/Women, n5/199/149/1066Mean age (years)42 ± 1147 ± 1533 ± 10-Unilateral/Bilateral, n (%)2 (8.3) /22 (91.7)10 (43.5) /13 (56.5)4 (21) /15 (79)16/50Inflammatory ocular patterns, n (%) Posterior uveitis6 (25)9 (39.1)3 (15.8)18 Panuveitis18 (75)14 (60.9)16 (84.2)48Laboratory data, n (%) ANA2 (8.34)2 (8.7)0 (0)4 HLA B270 (0)4 (17.4)0 (0)4 HLA B290 (0)1 (4.3)0 (0)1 HLA B510 (0)5 (21.7)8 (42)13A rapid and maintained statistically improvement was observed in OCT values in all underlying diseases (FIGURE 1). No major side effects were observed.Conclusion:High-dose IVMP pulse therapy is useful and safe in the prompt control of CME, regardless of the underlying IMID.References:[1]Vegas-Revenga N, et al. Am J Ophthalmol. 2019; 200:85-94. doi: 10.1016/j.ajo.2018.12.019.[2]Calvo-Río V, et al. Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7. PMID: 25005576.[3]Santos-Gómez M, et al. Clin Exp Rheumatol. 2016;34(6 Suppl 102): S34-S40. PMID:27054359.[4]Atienza-Mateo B, et al. Rheumatology (Oxford) 2018;57(5):856-864. doi: 10.1093/rheumatology/kex480.[5]Atienza-Mateo B, et al. Arthritis Rheumatol. 2019; 71(12):2081-2089. doi: 10.1002/art.41026.[6]Martín-Varillas JL, et al. Ophthalmology. 2018;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020.Figure 1.Improvement of OCT in 66 patients with cystoid macular edema.Disclosure of Interests:None declared

Background Intense ocular inflammation can cause an early and irreversible structural and functional damage. Objectives Treatment with high-dose intravenous methylprednisolone (IVMP) can induce a rapid improvement in multiple inflammatory conditions including uveitis. Methods A multicenter study of 104 patients (169 eyes) with severe ocular inflammation treated with IVMP attended in uveitis units of 11 hospitals. The most frequent underlying syndromes were: idiopathic uveitis (n=21), Vogt-Koyanagi-Harada (n=26), Behcet (n=19), spondyloarthritis (n=4), Sjogren syndrome (n=2), psoriatic arthritis (n=2) and multiple Sclerosis (n=2). The patients were evaluated at baseline and on days 2-5, 7, 15 and 30 after treatment with IVMP. Results 104 patients (59 women/45 men) were studied with a mean age of 42.27±14.42 years (range 8-76 years) receiving doses of IVMP, which ranged from 0.25 to 1 gram per day for 2-5 consecutive days. They all had active and severe intraocular inflammation at baseline. The inflammatory ocular patterns were: panuveitis (n=61), posterior uveitis (n=35), anterior uveitis (n=3), scleritis (n=3) and intermediate uveitis (n=2). Bilateral ocular involvement was observed in 65 patients (62.5%). After IVMP treatment, the inflammation of the anterior chamber, the vitritis and visual acuity experienced rapid and statistically significant improvement from the second day. However, the improvement of retinal vasculitis, choroiditis/chorio-retinitis and macular edema was more slowly achieved, gaining statistical significance from the first week. Optical coherence tomography (OCT) showed a macular thickening (>250μ) in 90 eyes at baseline, with normalization in 30% of affected eyes at day 15 and in 50% of affected eyes at day 30 (p Conclusions Our study suggests that IVMP is an effective and safe remission induction therapy in severe ocular inflammation. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4735

Objectives To assess the efficacy and safety of Golimumab in patients with refractory uveitis to other anti-TNFα drugs. Methods Study of patients from a single center with refractory uveitis to previous standard synthetic immunosuppressive drugs and at least 1 anti-TNFα drug. Golimumab was given at the standard dose of 50 mg/sc/month. Results A total of 25 patients (39 affected eyes) (19 men/6 women); mean age, 32.5±8.9 years (range 11-47); fulfilled the above-mentioned criteria. In 14 cases uveitis was bilateral and in 11 cases it was unilateral. The underlying diseases were spondylarthritis (n=7), psoriatic arthropathy (n=4), juvenile idiopathic arthritis (n=4), sarcoidosis (n=3), Behcet disease (n=2), uveitis associated with HLA-B27 and ulcerative colitis (n=1), pars planitis (n=1) and Vogt-Koyanagi-Harada (n=1). Besides oral steroids and before Golimumab onset they had received: intraocular corticosteroids (n=10), methylprednisolone i.v. boluses (n=6), methotrexate (n=20), cyclosporine A (n=6), azathioprine (n=6), adalimumab (n=17), infliximab (n=14), abatacept (n=2) and certolizumab (n=1). Golimumab was started because inefficacy (n=23) and/or toxicity (n=2) to other biologics. Golimumab was used as monotherapy (n=9) or in combination with methotrexate (n=9), azathioprine (n=3), leflunomide (n=2) and mycophenolate (n=2). There was a rapid (from 1st week) and maintained (1st year) improvement of visual acuity, anterior chamber inflammation, vitritis and OCT. The mean OCT improved from 319.9±77.9 μm (baseline) to 270.2±54.8 μm (1st month) (p Conclusions Golimumab seems an effective and safe treatment for those patients with uveitis even refractory to other anti-TNFα drugs. Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4758

Objectives To assess the efficacy and safety of anti-TNFα drugs in refractory uveitis to conventional synthetic immunosuppressive drugs (CSISDs). Methods Study of refractory uveitis from a single Universitary hospital who had failed to at least one CSISD. The degree of ocular inflammation was established according to SUN-2005. Macular thickness was evaluated by OCT. We compared data between baseline 1st month, and 1st, 2nd, 3rd and 4th year (Wilcoxon test). Results We studied 40 adult patients/62 affected eyes (16 men/24 women); mean age, 39.3±11.5 years. The underlying pathologies were Spondyloarthritis-HLA-B27+ (n=7), Behcet disease (n=6), sarcoidosis (n=6), VKH (n=2), Birdshot (n=1), serpinginous (n=1), sympathic opthalmopathy (n=1), Juvenile Idiopathic Arthritis (n=1) and idiopathic uveitis (n=15). Besides oral corticosteroids and before anti-TNFα, patients had received methylprednisolone i.v. (n=9), methotrexate (n=16), cyclosporine A (n=13) and azathioprine (n=10). The first anti-TNFα was: adalimumab (n=18; 45%) (40 mg/sc/2 weeks) and infliximab (n=22; 55%) (5 mg/kg/i.v./every 4-8 weeks. Anti-TNFα drugs were used as monotherapy (n=8), or combined with methotrexate (n=18), azathioprine (n=10), Cyclosporine A (n=3) and salazopyrine (n=1). Adalimumab was switched to golimumab (50 mg/sc/week) (n=2) and to tocilizumab (n=2). Infliximab was switched to adalimumab (n=8) and to golimumab (n=2). Visual acuity (VA), Tyndall, vitritis and OCT experienced significant improvement at the 1st month, and 1st, 2nd and 3rd year. The mean OCT in cases of cystoid macular edema (OCT>300 μ) (n=11 eyes) improved from 382.2±98.4 (baseline) to 195.5±38.9 microns (1st year). After a mean follow-up of 40.7±25 months anti-TNFα drugs was well tolerated in most cases. The most important side effects were pulmonary TBC (n=1), herpes zoster (n=2), urinary tract infection (n=3) and elevation of liver enzymes during treatment (n=2). Conclusions Anti-TNFα therapy seems effective and relatively safe in refractory uveitis. Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3369

Background Increased incidence of syphilis has been observed in developed countries in the last decade. In some cases uveitis indistinguishable from that related to non-infectious autoimmune uveitis may be the presenting manifestation of syphilis. Objectives From a wide series of patients with syphilitic uveitis our aims were: 1) To describe the clinical features and visual outcomes. 2) To assess differences with syphilitic patients without uveitis in demographic features, HIV status, viral load and CD4 count and cerebrospinal fluid findings. Methods Retrospective and comparative case series study. Since year 2000, 50 patients (19 females/31 males) with 45±17 years were diagnosed as having syphilitic uveitis in 8 centers from Spain. Other 86 randomly selected syphilitic patients without uveitis diagnosed in the same centers during the same period were included. Clinical and laboratory data were collected from the clinical records. Continuous variables (normally and not normally distributed) were compared with the 2-tailed Student’ Results The most frequent anatomic uveitic pattern was posterior; 26 (52%) cases. Granulomatous inflammation of the anterior chamber was observed in 3 (6%) patients. Several types of posterior segment inflammation were observed: optic neuritis (40%), vitritis (35%), necrotizing retinopathy (35%), retinal vasculitis (20%), posterior placoid chorioretinitis (10%), multifocal chorioretinitis (10%), macular edema (7.5%), serous retinal detachment (5%), neuroretinitis (5%), multifocal choroiditis (2.5%). Mean ± SD initial visual acuity (VA) of right and left eyes (RE, LE) was 0.43±0.37 and 0.49±0.37 respectively. After a mean follow-up of 27.1±3 months final VA was statistically better in both eyes (RE: 0.72±0.34; p=0.012 and LE: 0.75±0.33; p=0.012). We did not find differences in syphilitic patients with and without uveitis in age and sex distribution. We observed more frequently homosexual and HIV+ patients in the group of uveitis (p=0.002 and p=0.032). HIV patients from both groups did not presented differences in CD4 count and viral load. Patients with uveitis had higher amount of cells in cerebrospinal fluid: 5 (0-10400) vs 1 (0-50) p=0.020. No differences were observed in the concentration of proteins and frequency of positive serology. Conclusions We observed an increased incidence of syphilis presenting as uveitis in our Uveitis Units. High level of suspicion for this infection is required to establish an early diagnosis and appropriate treatment. In this relatively large series of patients with syphilitic uveitis, posterior uveitis was the most frequent type of uveitis. Prognosis was favourable in terms of VA. Patients with syphilitic uveitis presented more frequently homosexual practices, HIV+ and presented a greater number of cells in the cerebrospinal fluid. Disclosure of Interest None Declared

Objectives To assess the efficacy of Infliximab (IFX) and adalimumab (ADA) in refractory uveitis of Behcet’s syndrome. Methods Study of 63 patients followed in the Uveitis Clinic of 24 hospitals. All of them were refractory to conventional therapy with systemic steroids and ≥1 immunosuppressive drug. Efficacy was evaluated according to SUN criteria, and macular thickness by optical coherence tomography (OCT). Outcomes and comparisons were made at week 1, week 2, month 1, month 6 and at 1 and 2 years. Statistical analyses were performed using the STATISTICA (Statsoft). Results were expressed: mean±1SD (normally distributed variables) or median [25th-75th interquartile range-IQR] (not normally). Continuous variables were compared with the Wilcoxon test. Results We studied 63 patients/110 affected eyes (36M, 27W), mean age 38.9±9.0 years. Prior to anti-TNF, patients had received ivMprednisolone (n=20), cyclosporine (CyA) (n=53), methotrexate (MTX) (n=31) and azathioprine (AZA) (n=30). IFX was the anti-TNF more commonly used (64%). The remaining patients (36%) were treated with ADA. 14 patients (22%) required switching (12 from IFX→ADA; 2 ADA→IFX). Dosage: IFX 5 mg/kg/iv every 4-8 weeks or ADA 40 mgsc/2weeks. The median[IQR] follow-up from the onset of anti-TNF was 36 [20-60] months. Significant improvement of Visual acuity (VA), Tyndall and vitritis was observed soon (week 1). At 2 years,VA improved from 0.5±0.3 at basal to 0.7±0.3 (p Conclusions Monoclonal anti-TNF therapy is effective and relatively safe in uveitis of Behcet’s syndrome refractory to conventional therapy. Disclosure of Interest None Declared