The effect of methotrexate and sulfasalazine on the course of HLA-B27-positive anterior uveitis: results from a retrospective cohort study

To investigate the effect of methotrexate (MTX) or sulfasalazine (SSZ) on the course of HLA-B27-positive, remitting acute anterior uveitis (AAU). Forty-six patients with HLA-B27-positive AAU with or without associated systemic rheumatic disease either receiving MTX (n = 20), SSZ (n = 13), or no systemic immunomodulating treatment (Ctrl; n = 13) were studied retrospectively. Best-corrected visual acuity (BCVA), AAU relapse rate, and occurrence of uveitis-related ocular complications were analyzed at baseline (BL) and at 12-month follow-up (FU). Groups did not differ regarding age, gender, and presence of associated systemic diseases. BCVA at baseline was significantly worse in patients receiving MTX (logMAR 0.39 +/- 0.4) than in those treated with SSZ (0.17 +/- 0.2; P = 0.05) or in controls (Ctrl; 0.14 +/- 0.2; P = 0.009). At the 12-month endpoint, MTX treatment was associated with significantly improved BCVA (0.18 +/- 0.4 logMAR; P = 0.004). In contrast, BCVA did not significantly change in patients treated with SSZ (0.17 +/- 0.3 logMAR) or in the controls (0.11 +/- 0.2 logMAR). The annual uveitis relapse rate significantly decreased with MTX (BL 3.6 +/- 2.4 relapses to FU 0.7 +/- 0.8; P = 0.0001) and SSZ (BL 3.6 +/- 1.9 to FU 1.8 +/- 2.4, P < 0.01), but not in the controls (BL 1.9 +/- 1.4 vs 1.9 +/- 1.7 FU). The complication rate was slightly reduced with MTX (BL 1.75 +/- 1.2 complications present versus FU 1.3 +/- 1.2, P = 0.09) but not with SSZ (BL 0.9 +/- 0.8 to FU 1.3 +/- 1.4; P = 0.4) or in the controls (BL and FU 1.0 +/- 0.95; P = 0.7). MTX and SSZ reduced the uveitis relapse rate in HLA-B27-positive AAU patients, with MTX showing a beneficial effect on AAU-related macular edema.