Objective: To evaluate the efficacy of anti-tumour necrosis factor (anti-TNF) treatment in juvenile idiopathic arthritis (JIA)-associated uveitis. Methods: 24 patients with uveitis taking etanercept and 21 taking infliximab were studied. The endpoint ophthalmological evaluation was at 24 months or at the termination of the first biological agent. The ocular inflammatory activity was graded on the basis of the number of anterior chamber cells. Results: Of the 45 patients, uveitis improved in 14 (31%), no change was observed in 14 (31%) and the activity of uveitis increased in 17 (38%). Inflammatory activity improved more frequently (p = 0.047) in the patients taking infliximab than in those taking etanercept. The number of uveitis flares/year was higher (p = 0.015) in the patients taking etanercept (mean 1.4, range 0-3.2) than in those taking infliximab (mean 0.7, range 0-2). Uveitis developed for the first time while taking anti-TNF treatment in five patients-4 taking etanercept (2.2/100 patient-years) and 1 taking infliximab (1
Juvenile idiopathic arthritis (JIA) is the most common systemic disease associated with uveitis in childhood. The frequency of JIA-associated uveitis (JIAU) varies geographically, and between ethnicities. Uveitis risk is high in JIA associated with oligoarthritis, young age at arthritis onset and ANA positivity. Gender alters risk for the incidence of JIA and the severity of JIAU. Familial cases support the possible role of genetic influences in the pathogenesis. Arthritis typically precedes the uveitis, but uveitis may occur up to seven years following the arthritis onset. Although complications still occur, the frequency of bilateral blindness has dropped, probably by both improved screening of high-risk patients with JIA, and the increased use of early immunosuppression. However, there is still continuing persistence of JIAU into adulthood. For improvement of epidemiological knowledge of this complicated disease, large, well-defined, long-term population-based registries are needed with the application of universally agreed case definitions and outcome measures.
Objective. To develop a set of core outcome measures for use in randomized controlled trials (RCTs) and longitudinal observational studies in juvenile idiopathic arthritis (JIA)-associated uveitis. Methods. The literature relating to outcome measures used in studies of uveitis in childhood and adolescence was reviewed. A set of core outcomes and domains was established using the Delphi process. This was reviewed by a representative multinational interdisciplinary working group. Nominal group technique consensus was reached on face and content validity of the range and content of the domains. The outcomes and the appropriate instruments for uveitis trials were adapted to the age ranges of patients with JIA-associated uveitis. Results. Consensus was reached that data should be reported at defined time points in longitudinal studies with patients stratified by prognostic markers. Visual acuity testing should be age appropriate. The severity of uveitis (measured as anterior chamber cell grade) and duration of active inflammation should be documented. Visually significant structural complications should be recorded and quantified with standard measures. The responses to treatment and corticosteroidsparing effects of treatment should be documented. Patient-reported disease activity and age-specific uveitis-related quality of life should be reported using appropriate questionnaires. Conclusion. The proposed outcome measures in JIA-associated uveitis should aid in the standardization and comparison of future RCTs of the treatment regimens for this disease. The proposed outcome measures will be verified in a prospective validation study.
Objective: To evaluate the development of cataract and the results of cataract surgery with intraocular lens (IOL) implantation in patients with chronic uveitis associated with juvenile idiopathic arthritis (JIA). Patients and Methods: A hospital-based retrospective case series consisted of 25 patients with JIA-associated uveitis. The mean age of the patients was 5.8 years at the onset of arthritis and 6.8 years at the onset of uveitis. During the 15-year study period cataract surgery with implantation of an IOL was performed in 36 eyes. In 17 eyes phacoemulsification and initial posterior capsulectomy with anterior core vitrectomy were performed. The treatment of JIA and uveitis was carefully adjusted with systemic immunosuppressive drugs and topical corticosteroids perioperatively. The mean postoperative follow-up period was 3.3 years. Results: The first signs of cataract were observed 2.3 years (mean) after the diagnosis of uveitis and the cataract operation of the first eye was performed 4.5 years (mean) after the diagnosis of uveitis. After IOL surgery the visual result was good (≧0.5) in 64%, moderate (0.3 to <0.5) in 11% and impaired (<0.3) in 25% of eyes. Secondary cataract developed in 16 eyes but in none of the eyes with initial posterior capsulectomy and core vitrectomy. Secondary glaucoma developed in 18 eyes, retinal detachment in 2, cystoid macular edema in 16 and band keratopathy in 12 eyes. Conclusion: Cataract is an early complication of JIA-associated uveitis. Under strict control of uveitis, IOL implantation is an important alternative in visual rehabilitation for this type of patient.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.