Sensorineural hearing loss in ankylosing spondylitis treated with TNF blockers

Objectives: Sensorineural hearing loss (SNHL) in the uncommon disease ankylosing spondylitis (AS) has been previously reported. We analysed the relationships between AS, anti-TNF drug treatment, and SNHL. Methodology: We determined pure tone thresholds in 28 consecutive patients with AS who were treated with the TNFα inhibitors etanercept or infliximab, or with a TNFα inhibitor plus methotrexate (MTX). Results: SNHL was diagnosed in 16 patients (57.1%): 7/7 (100%) of those treated with anti-TNFα plus MTX, and 9/21 (43%) of those treated with anti-TNFα alone. We found a significant association between SNHL and treatment modality (p = 0.011) or treatment time in months (p = 0.020). Conclusions: The SNHL rate was significantly higher in patients treated with anti-TNFα plus MTX than those treated with anti-TNFα alone. The culpability of anti-TNF therapy was supported by the association between SNHL and treatment time, which was longer for anti-TNFα plus MTX than for anti-TNFα alone. SNHL may be due not only to AS, but also to drug-induced vasculitis of the labyrinthine artery or its cochlear branch.