Juvenile idiopathic arthritis-associated uveitis

Abstract

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.

Uveitis Associated with Juvenile Idiopathic Arthritis, our Observations

“…The prevalence of uveitis in children with JIA widely ranges 10-38%, due to different classifications and differences in schemes for monitoring affected children (1, 4, 14). Heiligenhaus et al (15) reported on the frequency of uveitis 12% in all children with JIA, and Clarke et al (16) observed uveitis in 13.1% of children with JIA. Similarly, we found uveitis in 14.4% of children with JIA; the incidence was significantly higher in girls (64.3%) then in boys (35.7%).…”

Prevalence, Risk Factors, and Expression of Human Leukocyte Antigen-DRB1 in Juvenile Idiopathic Arthritis-associated Uveitis

“…Previously reported frequencies of uveitis have varied from 10%∼20% in Western studies [2][3][4][5][6][7]. These diversity in frequency seem to be due to patient selection, especially inherent differences in the development of uveitis.…”

“…Among these, uveitis is the most critical complication, because it can cause severe vision loss even if it is asymptomatic when diagnosed [1]. The frequency of JIA-associated uveitis (JIA-U) in JIA is about 10%∼20% in each country [2][3][4][5][6][7]. Uveitis occurs most frequently in children with oligoarticular-type JIA, about 20%∼30% in Western data [3,8].…”

The Efficiency of Adalimumab in Cases of Chronic Methotrexate-Resistant Juvenile Idiopathic Arthritis-Associated Anterior Uveitis: Retrospective Case Series Study

“…Блокада TNF ␣ приводит к подавлению активности моноцитар-ных клеток (макрофагов и моноцитов), уменьшению степени воспалительной реакции и, как следствие, пре-дотвращению тканевого повреждения [9]. Применение с целью блокирования активности TNF ␣ моноклональ-ных антител (чаще адалимумаба и инфликсимаба, реже голимумаба и цертолизумаба) -наиболее перспектив-ный вид терапии у пациентов, резистентных к терапии небиологическими болезньмодифицирующими противо-ревматическими препаратами, такими как метотрексат и циклоспорин А [10].…”