Onset of spondyloarthritis in a patient treated with adalimumab for relapsing anterior uveitis – efficacy of secukinumab on the joint domain and on ocular inflammatory relapses: A case report

Adalimumab, an inhibitor of tumor necrosis factor-alpha, is a systemic non-corticosteroid agent approved for the treatment of noninfectious uveitis. Secukinumab, a human monoclonal antibody inhibiting interleukin 17A, is also being investigated as a potential treatment for noninfectious uveitis. PATIENT CONCERNS: A 32-year-old Italian woman receiving adalimumab for relapsed anterior uveitis developed axial and peripheral clinical manifestations of spondyloarthritis during treatment. DIAGNOSIS: Physical, laboratory and instrumental examination confirmed axial and peripheral spondyloarthritis associated with uveitis. INTERVENTION: We decided to administer secukinumab 150 mg/month and interrupted the treatment with adalimumab 40 mg/2 weeks. OUTCOMES: The patient reported an evident remission of symptoms and improvement in clinical conditions. LESSONS: Here we show the therapeutic efficacy of the switch from adalimumab to secukinumab, with remission of joint symptoms and reduction of inflammation indices, in the absence of new relapses of uveitis. This case suggests that secukinumab is primarily effective and safe on joints pain of an inflammatory nature in patients with anterior uveitis who develop spondyloarthritis as an extra-ocular symptom, while also seeming to be effective in preventing ocular symptoms recurrence.