Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Heiligenhaus, Arnd; Michels, H.; Schumacher, Claudia; Kopp, I.; Neudorf, Ulrich; Niehues, Tim; Baus, H; Becker, Matthias; Bertram, Bernd; Dannecker, Guenther E.; Deuter, Christoph; Foeldvari, Ivan; Frosch, Michael; Ganser, Gerd; Gaubitz, M.; Gerdes, G.; Horneff, Gerd; Illhardt, Arnold; Mackensen, Friederike; Minden, Kirsten; Pleyer, Uwe; Schneider, Matthias; Wagner, Norbert; Zierhut, Manfred

doi:10.1007/s00296-011-2126-1

Cited by 133 publications

(104 citation statements)

References 86 publications

(109 reference statements)

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“…Practical management protocols have recently been published both by our group in Bristol, UK [40] and an interdisciplinary panel from Spain [39]. A modified algorithm based on consensus guidelines [39][40][41] is provided in Fig. 1.…”

Section: Treatmentmentioning

confidence: 99%

“…Heiligenhaus et al identify these factors as poor initial vision, cataract, macular oedema, dense vitreous body opacification, ocular hypotony and glaucoma. Cataract, glaucoma, synechiae and band keratopathy alone, in the absence of active uveitis, do not require antiinflammatory treatment [41].…”

Section: Treatmentmentioning

confidence: 99%

“…The first line treatment for both acute and chronic anterior uveitis is topical glucocorticoids [41][42][43]. The greatest efficacy is seen with high potency steroids such as prednisolone acetate 1 % or dexamethasone phosphate 0.1 % used once daily to hourly depending on the degree of inflammation [44].…”

Section: Topical Glucocorticoidsmentioning

confidence: 99%

“…It is indicated after 12 weeks of topical treatment if there is no improvement to AC cell grade ≤ 0.5+, or sooner if > 2 drops daily are required, if there is worsening inflammation or if ocular complications develop [39,41]. A systematic review and meta-analysis identified 9 eligible studies of methotrexate in non-infectious uveitis including 135 patients of [38]].…”

Section: Synthetic Dmardsmentioning

confidence: 99%

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Juvenile idiopathic arthritis-associated uveitis

Sen

Ramanan

2017

Best Practice & Research Clinical Rheumatology

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Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, with JIA-associated uveitis its most common extra-articular manifestation. JIA-associated uveitis is a potentially sight-threatening condition and thus carries a considerable risk of morbidity. The aetiology of the condition is autoimmune in nature with the predominant involvement of CD4 + T cells. However, the underlying pathogenic mechanisms remain unclear, particularly regarding interplay between genetic and environmental factors. JIA-associated uveitis comes in several forms, but the most common presentation is of the chronic anterior uveitis type. This condition is usually asymptomatic and thus screening for JIA-associated uveitis in at-risk patients is paramount. Early detection and treatment aims to stop inflammation and prevent the development of complications leading to visual loss, which can occur due to both active disease and burden of disease treatment. Visually disabling complications of JIA-associated uveitis include cataracts, glaucoma, band keratopathy and macular oedema. There is a growing body of evidence for the early introduction of systemic immunosuppressive therapies in order to reduce topical and systemic glucocorticoid use. This includes more traditional treatments, such as methotrexate, as well as newer biological therapies. This review highlights the epidemiology of JIA-associated uveitis, the underlying pathogenesis and how affected patients may present. The current guidelines and criteria for screening, diagnosis and monitoring are discussed along with approaches to management.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Topical Glucocorticoidsmentioning

confidence: 99%

Section: Synthetic Dmardsmentioning

confidence: 99%

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Juvenile idiopathic arthritis-associated uveitis

Sen

Ramanan

2017

Best Practice & Research Clinical Rheumatology

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“…There is a suggested guideline (14) for the treatment of JIA-associated uveitis, but prospectively controlled data regarding treatment are sparse.…”

Section: Introductionmentioning

confidence: 99%

Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry

Foeldvari

Becker

Horneff

2015

Arthritis Care & Research

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ObjectiveUveitis is a major extraarticular quality of life–restricting manifestation of juvenile idiopathic arthritis (JIA). The aim of the study is to describe the occurrence of uveitis in JIA patients receiving tumor necrosis factor inhibitors or methotrexate (MTX).MethodsPatients’ characteristics, treatment, and the reported first occurrence of uveitis as an adverse event were searched in the Biologics in Pediatric Rheumatology Registry. The rates per exposed patients, exposure time, and time until event were calculated.ResultsUveitis was reported as an adverse event in 75 of 3,467 patients; 51 of 2,844 patients were receiving MTX, 37 of 1,700 patients were receiving etanercept, and 13 of 364 patients were receiving adalimumab. Patients with uveitis were younger (mean ± SD age 4.6 ± 4.2 versus 7.4 ± 4.5 years; P < 0.0001), more likely to be antinuclear antibody positive (69% versus 43%; odds ratio [OR] 2.7, P < 0.0001), and had extended oligoarticular JIA (OR 2.2, P = 0.0005). Patients with a uveitis diagnosis before starting treatment more often had a uveitis event (n = 28, 8.4%; OR 8.5, P < 0.0001), and more often received adalimumab (OR 2.15 [95% confidence interval 1.58–2.94], P < 0.0001). In 16 patients, a new uveitis event occurred: 11 while taking MTX (3.2 per 1,000 patient‐years), 2 while taking etanercept monotherapy (1.9 per 1,000 patient‐years), and 3 while taking etanercept and MTX combination (0.9 per 1,000 patient‐years). A new uveitis event occurred early in the disease course after a median disease duration of 1.5 years (interquartile range [IQR] 1.3–3.8) while taking etanercept and 1.8 years (IQR 1.8–2.1) for the MTX cohort. A recurrent uveitis event was reported after a disease duration of 7.6 years (IQR 4.3–10.0) in the etanercept cohort and 4.8 years (IQR 1.0–5.8) in the MTX cohort. Univariate analysis showed that MTX, but not etanercept or adalimumab, led to a lower rate of uveitis.ConclusionPatients with a history of uveitis had higher risks for uveitis events while taking both etanercept and adalimumab. Methotrexate turned out to be protective. Few patients developed a first uveitis event while taking etanercept, while the rate is comparable to that with MTX. Uveitis may not be attributed to be an adverse drug reaction to etanercept.

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Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis–Related Uveitic Glaucoma

et al. 2015

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IMPORTANCEThe majority of patients with juvenile idiopathic arthritis-related uveitic glaucoma require surgery to control intraocular pressure. Trabeculectomy with mitomycin C (MMC) is a major treatment option, although both chronic inflammation and young age increase risk of filtration failure. Factors that potentially protect from filtration failure are important to identify.OBJECTIVE To evaluate the potential effect of treatment with tumor necrosis factor (TNF) inhibitor on the success of an MMC-augmented trabeculectomy for patients with juvenile idiopathic arthritis-related uveitic glaucoma.

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Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Cited by 133 publications

References 86 publications

Juvenile idiopathic arthritis-associated uveitis

Juvenile idiopathic arthritis-associated uveitis

Uveitis Events During Adalimumab, Etanercept, and Methotrexate Therapy in Juvenile Idiopathic Arthritis: Data From the Biologics in Pediatric Rheumatology Registry

Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis–Related Uveitic Glaucoma

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