Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans for Juvenile Idiopathic Arthritis–Associated and Idiopathic Chronic Anterior Uveitis

Angeles‐Han, Sheila T.; Lo, Mindy S.; Henderson, Lauren A.; Lerman, Melissa A.; Abramson, Leslie; Cooper, Ashley M.; Parsa, Miriam F.; Zemel, Lawrence; Ronis, Tova; Beukelman, Timothy; Cox, Erika; Sen, H. Nida; Holland, Gary N.; Brunner, Hermine I.; Lasky, Andrew; Rabinovich, C. Egla

doi:10.1002/acr.23610

Cited by 65 publications

(27 citation statements)

References 56 publications

(34 reference statements)

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“…Recommendations generated by the SHARE, 12 CARRA 13 and ACR 14 groups on the use of systemic immunomodulatory drugs in children with JIA‐type uveitis generally agreed with each other and those of the Australian and New Zealand Juvenile Idiopathic Arthritis‐Uveitis Working Group. All groups agreed that topical corticosteroid—specified as prednisolone acetate 1% or dexamethasone 0.1%— was appropriate initial treatment.…”

Section: Discussionmentioning

confidence: 73%

“…The goal of the Working Group was to generate recommendations for the management of childhood JIA‐type uveitis for implementing in Australia and New Zealand specifically. Consensus statements were recently published by similar consortia based in Europe (SHARE), 12 North America (CARRA) 13 and the United States (ACR), 14 with clear similarities between the three sets of statements, as well as areas of disagreement. All groups supported the use of the SUN criteria 7 when assessing the inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…In November 2019, the panel met in person at the Sydney Eye Hospital, Sydney, Australia, and used the Delphi technique 15 with the goal of achieving consensus on items that did not qualify on the practice pattern survey (ie, greater than 25%, but less than 75% consensus). In addition to considering the survey responses and their expert experience, they drew from a set of eight highly relevant current peer‐reviewed journal articles 4,8,9,12‐14,16,17 . As for the practice pattern survey, items that achieved 75% or greater agreement or disagreement at the panel meeting were considered to represent consensus recommendations.…”

Section: Methodsmentioning

confidence: 99%

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Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Smith

Matthews

Conrad

et al. 2021

Clinical Exper Ophthalmology

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Importance Australian‐ and New Zealand‐based, uveitis‐specialized ophthalmologists have produced recommendations for the management of juvenile idiopathic arthritis (JIA)‐type chronic anterior uveitis. Background Historically, the visual prognosis of JIA‐type chronic anterior uveitis has been poor. New medical advances are likely to improve outcomes, but recently published guidelines are tailored for ophthalmic care in Europe and the United States. Design This work involved a consensus survey and a panel meeting. Participants The Australian and New Zealand JIA‐Uveitis Working Group (29 ophthalmologists) participated in the work. Methods The Delphi technique was used to achieve consensus. Main Outcome Measures This work yielded consensus statements. Results The Working Group achieved consensus around 18 statements related to clinical evaluation, use of topical and regional corticosteroids, use of systemic corticosteroid and non‐corticosteroid immunomodulatory drugs, and management of secondary cataract and glaucoma in childhood JIA‐type uveitis. Conclusions and Relevance Recommendations of the Australian and New Zealand JIA‐Uveitis Working Group provide current and regionally applicable advice for managing chronic anterior uveitis in children with JIA.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Smith

Matthews

Conrad

et al. 2021

Clinical Exper Ophthalmology

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“…In children with severe active uveitis and sight‐threatening complications, combining methotrexate with a monoclonal antibody TNFi at the time of initiation of systemic immunosuppressive treatment was recommended over methotrexate as monotherapy. Severe uveitis could be considered as the presence of ocular structural complications due to uveitis or complications of topical steroid therapy . This recommendation was conditional based on the lack of direct evidence from studies, the risk of permanent vision loss, and anticipated differences in patient values and preferences.…”

Section: Results/recommendationsmentioning

confidence: 99%

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis

Angeles‐Han

Ringold

Beukelman

et al. 2019

Arthritis & Rheumatology

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Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to the recommendations within this guideline to be voluntary, with the ultimate determination regarding their application to be made by the health care provider in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed and endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. ACR recommendations are not intended to dictate payment or insurance decisions. These recommendations cannot adequately convey all uncertainties and nuances of patient care.The American College of Rheumatology is an independent, professional, medical and scientific society that does not guarantee, warrant, or endorse any commercial product or service.Objective. To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA).Methods. Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong.Results. Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because ACR/AF GUIDELINE FOR JIA-ASSOCIATED UVEITIS | 865 of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss.Conclusion. This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with ...

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“…10 Nominal group technique NGT is a qualitative research methodology, where every meeting is a structured small group exercise allowing judgements by individuals to be pooled to arrive at a decision in an uncertain situation. 17 19 NGT has been used frequently in ophthalmology and medicine [20][21][22][23][24][25][26][27][28] and is a highly adaptable method. 29 An information pack with the predictors list from the systematic review was sent to participating unit before the meeting 7 (online supplemental appendices A1−A4).…”

Section: Study Design and Methodsmentioning

confidence: 99%

Predictors for diabetic retinopathy progression—findings from nominal group technique and Evidence review

et al. 2020

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ObjectivesRisk stratification is needed for patients referred to hospital eye services by Diabetic Eye Screening Programme UK. This requires a set of candidate predictors. The literature contains a large number of predictors. The objective of this research was to arrive at a small set of clinically important predictors for the outcome of the progression of diabetic retinopathy (DR). They need to be evidence based and readily available during the clinical consultation.Methods and analysisInitial list of predictors was obtained from a systematic review of prediction models. We sought the clinical expert opinion using a formal qualitative study design. A series of nominal group technique meetings to shorten the list and to rank the predictors for importance by voting were held with National Health Service hospital-based clinicians involved in caring for patients with DR in the UK. We then evaluated the evidence base for the selected predictors by critically appraising the evidence.ResultsThe source list was presented at nominal group meetings (n=4), attended by 44 clinicians. Twenty-five predictors from the original list were ranked as important predictors and eight new predictors were proposed. Two additional predictors were retained after evidence check. Of these 35, 21 had robust supporting evidence in the literature condensed into a set of 19 predictors by categorising DR.ConclusionWe identified a set of 19 clinically meaningful predictors of DR progression that can help stratify higher-risk patients referred to hospital eye services and should be considered in the development of an individual risk stratification model.Study designA qualitative study and evidence review.SettingSecondary eye care centres in North East, Midlands and South of England.

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Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans for Juvenile Idiopathic Arthritis–Associated and Idiopathic Chronic Anterior Uveitis

Cited by 65 publications

References 56 publications

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis

Predictors for diabetic retinopathy progression—findings from nominal group technique and Evidence review

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