Recurrent uveitis in a patient with juvenile spondyloarthropathy associated with tumour necrosis factor α inhibitors

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Abstract
A 31 year old female patient has had juvenile rheumatic disease since the age of 10. She has had a polyarticular disease in her peripheral joints with inflammatory manifestations both in the cervical spine and sacroiliac joints. She is HLA-B27 positive. At the time of diagnosis she was treated with aurothiomalate and hydroxychloroquine, but they were withdrawn because of side effects. During treatment with d-penicillamine remission was achieved. This drug was discontinued after treatment of 2.5 years. Between 1984 and 1989 she was in remission. Thereafter she was treated with d-penicillamine, azathioprine, podophyllotoxin, auranofin, chlorambucil, cyclosporin, and methotrexate, either each drug alone or in the 1990s with a combination of two drugs. Most often the combinations included methotrexate, which she has used continuously since May 1995. Many of the aforementioned drugs were withdrawn because of side effects, but some of them owing to lack of efficacy. Her joint disease was continuously active.