Ocular threat in juvenile idiopathic arthritis

Marvillet, Isabelle; Terrada, C.; Quartier, Pierre; Quoc, E. Bui; Bodaghi, Bahram; Prieur, Anne‐Marie

doi:10.1016/j.jbspin.2008.10.015

Cited by 32 publications

(16 citation statements)

References 21 publications

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“…Tynjälä et al reported that 7 of 20 children with JIA had improved uveitis while receiving ADA, but 19 children had previously received other anti-TNF␣ treatments, and the remaining child was 19 years old (40). A French case series of 69 children with JIA reported significant improvement in uveitis activity in only 1 child treated with INF of 15 children who received anti-TNF␣ treatments (41). Even if some uveitis outcomes were mentioned, large registries, such as the British Society of Paediatric and Adolescent Rheumatology Biologics and New Drug Register (42) and the German ETA registry for JIA treatment (43), did not report the required information for inclusion in the current review.…”

Section: Discussionmentioning

confidence: 99%

Current Evidence of Anti–Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta‐Analysis Approach of Individual Drugs

Simonini

Druce

Cimaz

et al. 2014

Arthritis Care & Research

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Objective. To summarize evidence regarding the effectiveness of anti-tumor necrosis factor ␣ (anti-TNF␣) treatments in childhood autoimmune chronic uveitis (ACU), refractory to previous disease-modifying antirheumatic drugs (DMARDs). Methods. A systematic search between January 2000 and October 2012 was conducted using EMBase, Ovid Medline, Evidence-Based Medicine (EBM) Reviews: American College of Physicians Journal Club, Cochrane libraries, and EBM Reviews. Studies investigating the efficacy of anti-TNF␣ therapy, in children ages <16 years, as the first treatment with a biologic agent for ACU, refractory to topical and/or systemic steroid therapy and at least 1 DMARD, were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation, as defined by the Standardization of Uveitis Nomenclature Working Group criteria. We determined a combined estimate of the proportion of children responding to anti-TNF␣ treatment, including etanercept (ETA), infliximab (INF), or adalimumab (ADA). Results. We initially identified 989 articles, of which 148 were potentially eligible. In total, 22 retrospective chart reviews and 1 randomized clinical trial were deemed eligible, thus including 229 children (ADA: n ‫؍‬ 31, ETA: n ‫؍‬ 54, and INF: n ‫؍‬ 144). On pooled analysis of observational studies, the proportion of responding children was 87% (95% confidence interval [95% CI] 75-98%) for ADA, 72% (95% CI 64 -79%) for INF, and 33% (95% CI 19 -47%) for ETA. There was no difference in the proportion of responders between ADA and INF ( 2 ‫؍‬ 3.06, P ‫؍‬ 0.08), although both showed superior efficacy compared with ETA (ADA versus ETA: 2 ‫؍‬ 20.9, P < 0.001 and INF versus ETA: 2 ‫؍‬ 20.9, P < 0.001). Conclusion. Although randomized controlled trials are needed, the available evidence suggests that INF and ADA provide proven similar benefits in the treatment of childhood ACU, and they are both superior to ETA.

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Section: Discussionmentioning

confidence: 99%

Current Evidence of Anti–Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta‐Analysis Approach of Individual Drugs

Simonini

Druce

Cimaz

et al. 2014

Arthritis Care & Research

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“…TNF-α has also been reported to play a role in the pathogenesis of ocular inflammation, with high levels detected in the serum and aqueous humor of patients with uveitis [12-14]. Chronic anterior uveitis is insidious, highly refractory, bilateral in 80% of patients, often corticosteroid-dependent, and associated with high rates of medium- and long-term complications such as posterior synechiae, band keratopathy, cataract and glaucoma [15,16]. Overall, 20% to 25% of all pediatric uveitis is associated with JIA [17].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of adalimumab in young children with juvenile idiopathic arthritis and chronic uveitis: a case series

et al. 2014

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BackgroundJuvenile idiopathic arthritis is a relatively common chronic disease of childhood, and is associated with persistent morbidity and extra-articular complications, one of the most common being uveitis. The introduction of biologic therapies, particularly those blocking the inflammatory mediator tumor necrosis factor-α, provided a new treatment option for juvenile idiopathic arthritis patients who were refractory to standard therapy such as non-steroidal anti-inflammatory drugs, corticosteroids and/or methotrexate.Case presentationsThe first case was a 2-year-old girl with juvenile idiopathic arthritis and uveitis who failed to respond to treatment with anti-inflammatories, low-dose corticosteroids and methotrexate, and had growth retardation. Adalimumab 24 mg/m2 every 2 weeks and prednisone 0.5 mg/kg/day were added to methotrexate therapy; steroid tapering and withdrawal started after 1 month. After 2 months the patient showed good control of articular and ocular manifestations, and she remained in remission for 1 year, receiving adalimumab and methotrexate with no side effects, and showing significant improvement in growth. Case 2 was a 9-year-old boy with an 8-year history of juvenile idiopathic arthritis and uveitis that initially responded to infliximab, but relapse occurred after 2 years off therapy. After switching to adalimumab, and adjusting doses of both adalimumab and methotrexate based on body surface area, the patient showed good response and corticosteroids were tapered and withdrawn after 6 months; the patient remained in remission taking adalimumab and methotrexate. The final case was a 5-year-old girl with juvenile idiopathic arthritis for whom adalimumab was added to methotrexate therapy after three flares of uveitis. The patient had two subsequent episodes of uveitis that responded well to local therapy, but was then free of both juvenile idiopathic arthritis and uveitis symptoms, allowing methotrexate and then adalimumab to be stopped; the patient remained in drug-free remission.ConclusionThis report includes the first published case of the use of adalimumab in a child aged <3 years. Our clinical experience further supports the use of biologic therapy for the management of juvenile idiopathic arthritis and uveitis in children as young as two years of age.

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“…Para destacar y preocupar es el hecho de que, en el momento de su primera visita oftalmológica, casi la mitad de los pacientes con AIJ en alto riesgo para desarrollar uveítis presenten ceguera legal en al menos un ojo como consecuencia de las complicaciones oculares secundarias a la inflamación intraocular 36 . Además, la aparición de complicaciones y secuelas oculares derivadas del curso clínico prolongado de la enfermedad durante el seguimiento a largo plazo de estos pacientes no siempre recibe la consideración necesaria por el grupo de especialistas que atienden la enfermedad, como lo demuestran diversas publicaciones al respecto 37,38,40 .…”

Section: Monitorización Oftalmológica En Pacientes Con Artritis Idiopunclassified

Importancia de la evaluación oftalmológica en pacientes con artritis idiopática juvenil

Rodríguez-García

2015

Reumatología Clínica

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Ocular threat in juvenile idiopathic arthritis

Cited by 32 publications

References 21 publications

Current Evidence of Anti–Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta‐Analysis Approach of Individual Drugs

Current Evidence of Anti–Tumor Necrosis Factor α Treatment Efficacy in Childhood Chronic Uveitis: A Systematic Review and Meta‐Analysis Approach of Individual Drugs

Efficacy of adalimumab in young children with juvenile idiopathic arthritis and chronic uveitis: a case series

Importancia de la evaluación oftalmológica en pacientes con artritis idiopática juvenil

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