Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative

Abstract

BackgroundIn 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is possibly its most devastating extra-articular manifestation. Evidence-based guidelines are sparse and management is mostly based on physicians’ experience. Consequently, treatment practices differ widely, within and between nations.ObjectivesTo provide recommendations for the diagnosis and treatment of JIA-associated uveitis.MethodsRecommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of nine experienced paediatric rheumatologists and three experts in ophthalmology from Europe. Recommendations derived from a validated systematic literature review were evaluated by an Expert Committee and subsequently discussed at two consensus meetings using nominal group techniques. Recommendations were accepted if >80% agreement was reached (including all three ophthalmologists).ResultsIn total, 22 recommendations were accepted (with >80% agreement among experts): 3 on diagnosis, 5 on disease activity measurements, 12 on treatment and 2 on future recommendations.ConclusionsThe SHARE initiative aims to identify best practices for treatment of patients suffering from JIA-associated uveitis. Within this remit, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated by an evidence-informed consensus process to suggest a standard of care for JIA-associated uveitis patients throughout Europe.

Changing biological disease modifying treatment for paediatric uveitis in the real world

“…This study provides further evidence of the effectiveness of biological agents for the management of uveitis and reducing glucocorticoid therapy in children with uveitis. Biological therapy, including adalimumab, has been used successfully in the treatment of paediatric uveitis, including idiopathic paediatric uveitis, JIA‐U and Blau syndrome …”

“…Uveitis accounts for approximately 10% of blindness in developed countries, of which paediatric uveitis comprises a small proportion . Paediatric uveitis is most commonly idiopathic . This is followed closely by uveitis associated with juvenile idiopathic arthritis (JIA), with approximately 12% to 38% of children with JIA developing uveitis (JIA‐U) …”

“…Paediatric uveitis is most commonly idiopathic . This is followed closely by uveitis associated with juvenile idiopathic arthritis (JIA), with approximately 12% to 38% of children with JIA developing uveitis (JIA‐U) …”

“…A significant factor affecting management is the lack of international consensus regarding the treatment of JIA‐U with significant variation in practice worldwide . Urgent and aggressive treatment may be indicated if there are complications from uveitis at the time of diagnosis . Additionally, poor patient compliance with intensive topical treatment and medication side effects often limit the effectiveness of therapy .…”

Biologic therapy for uveitis: a new beginning

“…There are also many challenges for our Physician colleagues: managing co‐morbidities such as diabetes, cardiovascular disease and metabolic syndrome; drug interactions; diagnosing and managing opportunistic infection; and recognising and managing drug side‐effects and toxicity. The best model of care for these patients is the multi‐disciplinary clinic model . At our uveitis unit at Sydney Eye Hospital we have both an adult and paediatric multi‐disciplinary uveitis clinic with Rheumatology.…”