Objective The objective of this study was to evaluate the short-term ocular safety, feasibility, and exploratory functional signals associated with intravitreal adalimumab (ADA) in patients with retinitis pigmentosa (RP). Methods This prospective, single-arm pilot study included 21 patients with RP who received intravitreal adalimumab (2 mg/0.05 mL) at baseline, month 2, and month 4, with follow-up to month 6. The primary objective was to assess ocular safety and treatment feasibility. Exploratory functional outcomes included best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution (LogMAR)) and automated perimetry parameters (mean deviation (MD), pattern standard deviation (PSD), and Field Preservation Deviation Index (FPDI)). Structural assessment was performed using optical coherence tomography (OCT). Analyses compared baseline and month 6 outcomes using paired statistical methods. BCVA values were analyzed at the patient level as the mean of both eyes. Results All scheduled intravitreal injections were successfully completed, and no serious ocular adverse events were observed during follow-up. Mean BCVA showed no statistically significant change from baseline to month 6 (0.76 to 0.70 LogMAR; p = 0.115). Visual field parameters (MD, PSD, and FPDI) remained stable, with no statistically significant differences over time. OCT findings demonstrated advanced baseline structural alterations consistent with RP, without evidence of treatment-related anatomical deterioration or cystoid macular edema during follow-up. Flicker electroretinography (ERG) responses were measurable in a limited subset of patients and were analyzed descriptively, showing no consistent evidence of decline. Conclusions In this prospective pilot study, intravitreal adalimumab demonstrated a favorable short-term ocular safety profile and was feasible to administer in patients with retinitis pigmentosa. No significant functional or structural changes were observed over six months. These findings are hypothesis-generating and support the need for controlled studies to further evaluate the safety and potential role of tumor necrosis factor alpha (TNF-α) inhibition in inherited retinal degeneration.

The co-occurrence of axial spondyloarthritis (SpA) and rheumatoid arthritis (RA) is rarely reported and poses significant diagnostic and therapeutic challenges due to their distinct pathophysiological mechanisms. While tumor necrosis factor (TNF) inhibitors are effective for both conditions, optimal strategies for patients with inadequate response remain unclear. We report a 65-year-old male with a long-standing history of HLA-B27-positive ankylosing spondylitis (AS) with radiographic bamboo spine who subsequently developed seropositive RA. After 15 years of successful treatment with adalimumab, the patient developed peroneal tendonitis suggestive of active enthesitis, prompting a switch to bimekizumab, an IL-17 A/F inhibitor. Although the tendonitis improved, the patient experienced a severe flare of peripheral polyarthritis within one year. Switching to a Janus kinase (JAK) inhibitor led to rapid improvement of both RA-related arthritis and AS manifestations. Our literature review identified a limited number of reported SpA-RA overlap cases treated with biologics or JAK inhibitors (n = 6). Together with our case, all patients had a history of treatment with TNF inhibitors. Among them, three achieved successful therapeutic responses, whereas the remaining four experienced primary or secondary treatment failure, respectively. Our case, together with one prior report, suggests that IL-17 inhibitors may be effective for SpA-related manifestations but insufficient for controlling RA-associated synovitis, even in cases of SpA-RA overlap. Although the number of reported cases remains limited, this case-based review suggests the different patterns of therapeutic response consistent with known differences in inflammatory pathways in SpA-RA overlap and underscores the importance of individualized therapeutic strategies integrating clinical phenotype and treatment response.

Behçet syndrome (BS) is a multisystem variable-vessel vasculitis characterized by recurrent mucocutaneous manifestations and severe organ involvement affecting the eyes, blood vessels, nervous system, and gastrointestinal tract. Although therapeutic advances over the past two decades have significantly improved outcomes, important clinical questions remain regarding optimal treatment selection, sequencing, durability, and long-term safety.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the sacroiliac joints, spine, and peripheral joints. The widespread application of biological agents has led to significant clinical improvements in the management of AS. However, some patients may develop paradoxical immune deviation following treatment with biologics, such as eczematous drug-induced rash, drug-related vasculitis, and inflammatory bowel disease (IBD).In this study, we present a case of a 25-year-old female patient diagnosed with AS who developed secondary loss of response following 6 months of adalimumab (ADA) therapy. After completing ADA washout, she was started on secukinumab (SEC) treatment. Subsequent to the fourth dose of SEC, the patient developed worsening low back pain accompanied by a severe eczematous rash. Treatment was then switched to upadacitinib (UPA). After 6 months of UPA administration, both her AS and drug-induced atopic dermatitis (AD) achieved significant clinical remission.

Disseminated histoplasmosis is primarily a disease of the immunosuppressed, with clinically significant symptoms most commonly observed in the lungs, intra-abdominal organs, or central nervous system. We present a case of native joint septic arthritis due to Histoplasma capsulatum in an 88-year-old male on adalimumab for psoriasis with no other etiologies for immunosuppression. The patient presented with four weeks of right knee pain without inciting trauma. Synovial fungal cultures grew Histoplasma capsulatum. He underwent incision and drainage with anterior compartment synovectomy along with six months of oral itraconazole. Ultimately, the patient's infection resolved. Repeat cultures were negative, and he returned to his baseline physical activity. While recombinant monoclonal antibodies such as adalimumab have been revolutionary in the treatment of autoimmune diseases, this case highlights how infections may have atypical presentations and the importance of close infection surveillance for those on these medications.

Spondyloarthritis (SpA) is a complex inflammatory disease involving multiple cytokine pathways, including tumor necrosis factor-α (TNF-α) and Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling. Despite advances in biologic and targeted synthetic therapies, up to 40% of patients with SpA remain refractory to monotherapy. This case series from a tertiary care center in India evaluated the efficacy and safety of dual-targeted therapy (DTT) combining tofacitinib, a JAK inhibitor, with TNF inhibitors in four patients with refractory SpA and psoriatic arthritis (PsA). All four patients had longstanding disease (mean duration 11.5 years) and had failed at least one prior biologic. Case 1 (PsA): Long-standing disease (24 years) failed optimized adalimumab; following DTT, disease activity in psoriatic arthritis (DAPSA) score improved from high disease activity (36) to low disease activity (8). Case 2 (SpA): Refractory to two TNF inhibitors; after adding tofacitinib, the Ankylosing Spondylitis Disease Activity Score incorporating C-reactive protein (ASDAS-CRP) score improved from very high activity (3.7) to low disease activity (1.7). Case 3 (SpA): Presented with very high ASDAS-CRP (3.8); rapid clinical response and laboratory remission (ASDAS-CRP, 1.6) were achieved within months of starting DTT. Case 4 (SpA): Failed adalimumab monotherapy; the addition of tofacitinib led to an improvement in ASDAS-CRP from 3.5 to 1.7. No serious adverse events or significant laboratory abnormalities were observed over 5-18 months. DTT combines extracellular TNF-α blockade with intracellular JAK-STAT inhibition. This addresses the pathway redundancy and compensatory mechanisms in refractory SpA. Our findings add to the emerging real-world evidence supporting DTT therapy as a promising option for patients with refractory SpA. Our real-world findings demonstrate improved disease control and safety when monotherapy fails. Future prospective studies are essential to optimize the selection, dosing, and long-term safety of DTT.