Ophthalmic involvement in VEXAS syndrome and its influence on mortality: insights from the international AIDA network registry.

Jurgen Sota, Andrea Hinojosa-Azaola, Eduardo Martín-Nares, Paolo Sfriso, Sara Bindoli, Pravin Hissaria, Mark Beecher, José Hernández-Rodríguez, Verónica Gómez-Caverzaschi, Micol Frassi, Francesca Crisafulli, Lorenzo Dagna, Corrado Campochiaro, Serena Bugatti, Alessandra Milanesi, Guillermo Ruiz-Irastorza, Adriana Soto-Peleteiro, Matteo Piga, Ombretta Viapiana, Abdurrahman Tufan, Ertugrul Cagri Bolek, Paola Triggianese, Marcella Prete, Jessica Sblachiero, Valeria Caggiano, Antonio Vitale, Henrique Ayres Mayrink Giardini, Giuseppe Lopalco, Fabrizio Conti, Paolo Moscato, Chiara Cardamone, Ewa Wiesik-Szewczy, Andrés González-García, Amato De Paulis, Rosetta Vitetta, Perla Ayumi Kawakami-Campos, Alessandra Brancaleoni, Andrea Mercanti, Alessandra Renieri, Monica Bocchia, Gaafar Ragab, Vishali Gupta, Alejandra de-la-Torre, Bruno Frediani, Carmelo Gurnari, Luca Cantarini, Claudia Fabiani

Journal: Frontiers in immunology 2026;17():1709085

PMID: 42404884

Abstract

Orbital inflammation is the most common presentation of VEXAS, with any orbital structure potentially affected. Non-sight-threatening and uncomplicated anterior non-granulomatous uveitis and anterior diffuse scleritis follow in frequency, along with episcleritis. Ophthalmic involvement was significantly associated with relapsing polychondritis (p = 0.014), with an increased chance of a fatal outcome (RR 5.87, p = 0.016) and independently predicts a higher mortality rate (OR 3.72, p = 0.026). Treatment of ophthalmic involvement showed full or partial response to glucocorticosteroids alone in 66.7% of cases. Ophthalmic involvement is common in VEXAS syndrome and signals a poorer prognosis in terms of mortality, highlighting the need for close monitoring.

Copyright © 2026 Sota, Hinojosa-Azaola, Martín-Nares, Sfriso, Bindoli, Hissaria, Beecher, Hernández-Rodríguez, Gómez-Caverzaschi, Frassi, Crisafulli, Dagna, Campochiaro, Bugatti, Milanesi, Ruiz-Irastorza, Soto-Peleteiro, Piga, Viapiana, Tufan, Bolek, Triggianese, Prete, Sblachiero, Caggiano, Vitale, Giardini, Lopalco, Conti, Moscato, Cardamone, Wiesik-Szewczy, González-García, De Paulis, Vitetta, Kawakami-Campos, Brancaleoni, Mercanti, Renieri, Bocchia, Ragab, Gupta, de-la-Torre, Frediani, Gurnari, Cantarini and Fabiani.

Address: Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy.; Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy.; Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA, Australia.; Department of Immunopathology, SA Pathology, Adelaide, SA, Australia.; Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA, Australia.; Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Barcelona, Spain.; Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center, University of Brescia, Brescia, Italy.; Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, Milan, Italy.; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center, Milan, Italy.; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center, Milan, Italy.; Rheumatology Department, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy.; Faculty of Medicine and Nursery, University of the Basque Country, UPV/EHU, Leioa, Biscay, Spain.; Autoimmune Diseases Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Biscay, Spain.; Rheumatology Unit, Department of Medical Sciences and Public Health, University and Azienda Opsedaliero-Universitaria (AOU) of Cagliari, Cagliari, Italy.; Rheumatology Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.; Division of Rheumatology, Department of Internal Medicine, Gazi University Hospital, Ankara, Türkiye.; Unità Operativa Complessa (UOC) Medicina Interna - Unità Operativa Semplice Dipartimentale (UOSD) Geriatria, Università di Roma Tor Vergata, Rome, Italy.; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.; Internal Medicine Unit, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy.; Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas (HCFMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil.; Department of Precision and Rigenerative Medicine and Ionian Area (DiMePRe-J), Polyclinic Hospital, University of Bari, Bari, Italy.; Rheumatology Unit, Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.; Department of Medicine, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.; Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, National Research Institute, Warsaw, Poland.; Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.; Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy.; Center for Basic and Clinical Immunology Research (CISI), World Allergy Organization (WAO) Center of Excellence, University of Naples Federico II, Naples, Italy.; Unit of Rheumatology, Azienda Sanitaria Locale Vercelli (ASL VC) Sant' Andrea Hospital, Vercelli, Italy.; Department of Ophthalmology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Department of Ophthalmology, Azienda Unità Sanitaria Locale (AUSL) Romagna - Ospedale di Rimini, Rimini, Italy.; Medical Genetics, Department of Medical Biotechnologies, University of Siena, Siena, Italy.; Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy.; Genetica Medica, Azienda Ospedaliero-Universitaria Senese, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy.; Hematology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy.; Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt.; Faculty of Medicine, Newgiza University, 6th of October City, Egypt.; Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.; Neuroscience Research Group (NEUROS), NeuroVitae Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.; Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States.; Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory, and Autoimmune Diseases (RITA) Center], Siena, Italy.
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