A Review of Pediatric Uveitis: Part II. Autoimmune Diseases and Treatment Modalities

Madigan, William P.; Raymond, Wilfred W.; Wroblewski, Keith J.; Thebpatiphat, Nuthida; Birdsong, Richard; Jaafar, Mohamad Suhaimi

doi:10.3928/01913913-20080701-10

Cited by 9 publications

(5 citation statements)

References 123 publications

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“…), daclizumab (Zenepax, Hoffman-La Roche, Nutley, N.J.) and adalimumab (Humira, Abbott, North Chicago, Ill.). 3,4 There are also early reports within the literature on the use of rituximab in the treatment of Wegener’s granulomatosus and primary intraocular lymphoma. 5,6 Cytokines such as tumor necrosis factor α (TNFα) and interleukin-2 (IL-2) are important factors in the development of intraocular inflammation and the use of biologic agents to inhibit these factors may be considered when standard therapies are insufficient or intolerable to patients.…”

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confidence: 99%

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease

Wroblewski

Sen

Yeh

et al. 2011

Canadian Journal of Ophthalmology

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Objective Safety and efficacy of daclizumab during an 11-year period. Design Structured, retrospective chart review. Participants Thirty-nine patients. Methods Patients with chronic, noninfectious intermediate and/or posterior uveitis. Results Thirty-nine patients (78 eyes) were treated for a mean of 40.3 months. Visual acuity improved by ≥2 lines in the better eye in 7 patients (18.4%) and worsened by 2 lines in 6 patients (15.8%) with a mean of 2.8 Snellen lines of vision lost per eye. Six eyes with vitreous cell less than grade 2 lost 2 lines of vision and 7 eyes with less than grade 2 vitreous cell improved 2 lines. Mean number of immunosuppressive medications per patient decreased from 1.89 medications/patient to 1.17 medications/patient. The average number of periocular injections per patient was 1.46 (range, 0–9). The mean number of flares was 2.05/patient (range, 0–12), with the rate being 0.62 flares per patient-year. Four patients developed cancer during the course of this study. Mean time to onset of malignancy was 26 months and the mean age in this group was 49 years. Conclusions Daclizumab demonstrated efficacy in the reduction of concomitant immunosuppressive medication, stabilization of visual acuity, and the prevention of uveitic flares in most cases. Dermatologic complications were the most frequently observed adverse event in our series. Four patients developed solid tumor malignancies during this 11-year period.

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confidence: 99%

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease

Wroblewski

Sen

Yeh

et al. 2011

Canadian Journal of Ophthalmology

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“…Mean age at onset of JIA in the patients with uveitis was 3.2 years (range 0-14) ( Table 2). The mean age for developing uveitis was 5.2 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14], and the mean time interval between the onset of JIA and development of uveitis was 21.9 months (range À4 to 48), with one case developing uveitis 4 months before the onset of JIA. Oligoarticular onset, rheumatoid factor negativity (o14 IU ml À1 ) and low anti-cyclic citrullinated peptide (o4.5 U ml À1 ), as well as younger age at onset of JIA were all significantly associated with JIA accompanied by uveitis (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…In the clinical setting, the frequency of occurrence (1) Test (2) Test (3) Test (4) Test (5) Test (6) Test (7) Test (8) HLA-A HLA-A*02:06/HLA-DRB1*04:05 and subtypes of JIA M Yanagimachi et al of uveitis is one of the main differences between polyarticular and oligoarticular JIA (Table 2). 4 Uveitis is one of the most devastating complications of JIA, because it causes posterior synechia, band keratopathy and cataract, which can result in a poor visual prognosis. 22,23 Clinical risk factors for JIA-associated uveitis were also found to be associated with JIA-associated uveitis in Japanese (Table 2).…”

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confidence: 99%

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Association of HLA-A02:06 and HLA-DRB104:05 with clinical subtypes of juvenile idiopathic arthritis

et al. 2010

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Juvenile idiopathic arthritis (JIA) is one of the most common forms of pediatric chronic arthritis. JIA is a clinically heterogeneous disease. Therefore, the genetic background of JIA may also be heterogeneous. The aim of this study was to investigate associations between human leukocyte antigen (HLA) and susceptibility to JIA and/or uveitis, which is one of the most devastating complications of JIA. A total of 106 Japanese articular JIA patients (67 with polyarthritis and 39 with oligoarthritis) and 678 healthy controls were genotyped for HLA-A, -B and -DRB1 by PCR-sequence-specific oligonucleotide probe methodology. HLA-A*02:06 was the risk factor for JIA accompanied by uveitis after adjustment for clinical factors (corrected P-value o0.001, odds ratio (OR) 11.7, 95% confidence interval (CI) 3.2-43.0). On the other hand, HLA-DRB1*04:05 was associated with polyarticular JIA (corrected P-value o0.001, OR 2.9, 95% CI 1.7-4.8). We found an association of HLA-A*02:06 with susceptibility to JIA accompanied by uveitis, which might be considered a separate clinical JIA entity. We also found an association between HLA-

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“…As a result, serious sight-threatening complications such as band keratopathy, cataract, glaucoma or hypotony may be observed at presentation. 1,18,19,20 …”

Section: Introductionmentioning

confidence: 99%

Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis

Oray¹,

Tuğal-Tutkun²

2016

tjo

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Pediatric uveitis may be a serious health problem because of the lifetime burden of vision loss due to severe complications if the problem is not adequately treated. Juvenile idiopathic arthritis (JIA)-associated uveitis is characterized by insidious onset and potentially blinding chronic anterior uveitis. Periodic ophthalmologic screening is of utmost importance for early diagnosis of uveitis. Early diagnosis and proper immunomodulatory treatment are essential for good visual prognosis. The goal of treatment is to achieve enduring drug-free remission. The choice of therapeutic regimen needs to be tailored to each individual case. One must keep in mind that patients under immunomodulatory treatment should be monitored closely due to possible side effects. Local and systemic corticosteroids have long been the mainstay of therapy; however, long-term corticosteroid therapy should be avoided due to serious side effects. Steroid-sparing agents in the treatment of JIA-associated uveitis include antimetabolites and biologic agents in refractory cases. Among the various immunomodulatory agents, methotrexate is generally the first choice, as it has a well-established safety and efficacy profile in pediatric cases and does not appear to increase the risk of cancer. Other classic immunomodulators that may also be used in combination with methotrexate include azathioprine, mycophenolate mofetil, and cyclosporin A. Biologic agents, primarily tumor necrosis factor alpha inhibitors including infliximab or adalimumab, should be considered in cases of treatment failure with classic immunomodulatory agents.

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A Review of Pediatric Uveitis: Part II. Autoimmune Diseases and Treatment Modalities

Cited by 9 publications

References 123 publications

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease

Association of HLA-A02:06 and HLA-DRB104:05 with clinical subtypes of juvenile idiopathic arthritis

Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis

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A Review of Pediatric Uveitis: Part II. Autoimmune Diseases and Treatment Modalities

Cited by 9 publications

References 123 publications

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease

Long-term daclizumab therapy for the treatment of noninfectious ocular inflammatory disease

Association of HLA-A*02:06 and HLA-DRB1*04:05 with clinical subtypes of juvenile idiopathic arthritis

Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis

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Association of HLA-A02:06 and HLA-DRB104:05 with clinical subtypes of juvenile idiopathic arthritis