In a patient with active spondylarthritis and uveitis who cannot take TNF inhibitors, what is your next agent of choice?

Uveitis and typically acute anterior uveitis is commonly associated with Axial spondyloarthritides (SpA) but also other spondyloarthritides and is usually recurrent with exacerbation and resolution. The approach to the management of uveitis in my opinion is similar to patients without an underlying SpA. In idiopathic uveitis, the treatment varies between local steroids, systemic steroids and long-acting depot steroids. In refractory cases, conventional immunosuppressive such as methotrexate and others are recommended. Those not responding to the above typically require treatment with a TNFi.

In a patient with active uveitis and SpA who can not take a TNFi, I would follow the paradigm outlined above for uveitis if not already tried. In patie...