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Case Reports in Medicine
Volume 2014, Article ID 471319, 4 pages
Case Report

Inefficacy or Paradoxical Effect? Uveitis in Ankylosing Spondylitis Treated with Etanercept

1Rheumatology Unit, Department of Medicine, General Hospital of Bolzano, Lorenz Boehler Street No. 5, 39100 Bolzano, Italy
2Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy

Received 10 March 2014; Accepted 27 May 2014; Published 4 June 2014

Academic Editor: Edgar M. Carvalho

Copyright © 2014 Bernd Raffeiner et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Ankylosing spondylitis (AS) is presented with axial and peripheral articular involvement. Uveitis is a severe and rather specific manifestation of AS. Biologics targeting tumor necrosis factor (TNF) α are effective on both articular and ocular manifestations of disease. The occurrence of uveitis in patients that never had eye involvement or the relapse of uveitis is described during anti-TNFα treatment. The frequency of these events is slightly higher during therapy with etanercept. The available TNFα blockers show different pharmacokinetics and pharmacodynamics yielding different biological effects. There is an ongoing debate whether uveitis during anti-TNFα has to be considered as paradoxical effect or an inadequate response to therapy. Here, we present a case report and review what the evidences for the two hypotheses are.