Outcomes of Treatment with Immunomodulatory Therapy in Patients with Corticosteroid-Resistant Juvenile Idiopathic Arthritis-Associated Chronic Iridocyclitis

En, YU; Meniconi, M.; Tufail, F; Baltatzis, Stefanos; Foster, C. Stephen

doi:10.1080/09273940590951061

Cited by 49 publications

(34 citation statements)

References 22 publications

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“…Nevertheless, avoidance of moderate vision loss provides an adequate indication to advocate use of immunosuppressive therapy in patients with chronic uveitis related to JIA. Given evidence supporting the relative safety and effectiveness of immunosuppressive drug therapy in the treatment of a variety of ocular inflammatory diseases, 23–33 the threshold for starting immunosuppression in cases that are not easily and stably controlled by simpler means should be low. Our ability to conduct sub-analyses investigating various types of IMT was limited by indication for treatment bias, as drugs typically employed for more severe cases would tend to have worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Loss of Visual Acuity among Patients with Uveitis Associated with Juvenile Idiopathic Arthritis: The Systemic Immunosuppressive Therapy for Eye Diseases Study

et al. 2013

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Purpose To describe the incidence of and risk factors for visual acuity (VA) loss and ocular complications in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. Design Multicenter retrospective cohort study. Participants 327 patients (596 affected eyes) with JIA-associated uveitis managed at five tertiary uveitis clinics in the United States. Methods Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. Demographic and clinical characteristics were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures Loss of VA to 20/50 or to 20/200 or worse thresholds and the development of ocular complications. Results At presentation, 240 (40.3%) eyes had a VA of 20/50 or worse; 144 (24.2%) had a VA of 20/200 or worse; 359 (60.2%) had at least one ocular complication. The incidences of VA loss to the 20/50 or worse and 20/200 or worse thresholds were 0.18 and 0.09 per eye-year (EY), respectively; the incidence of developing at least one new ocular complication over follow-up was 0.15/EY (95% confidence interval [CI]: 0.13/EY, 0.17/EY). However, among eyes with uveitis that had no complications at presentation, the rate of developing at least one ocular complication during follow up was lower (0.04/EY, 95% CI: 0.02, 0.06). Posterior synechiae, active uveitis, and prior intraocular surgery were statistically significantly associated with VA to the 20/50 or worse and 20/200 or worse thresholds, both at presentation and during follow-up. Increasing (time-updated) anterior chamber cell grade was associated with increased rates of visual loss in a dose-dependent fashion. Use of immunosuppressive drugs was associated with a reduced the risk of visual loss, particularly for the 20/50 or worse outcome (hazard ratio = 0.40, 95% CI: 0.21, 0.75, P<0.01). Conclusions Ocular complications and vision loss were common in our cohort. Increasing uveitis activity was associated with increased risk of vision loss and use of immunosuppressive drugs was associated with reduced risk of vision loss suggesting that control of inflammation and use of immunosuppression may be critical aspects in improving the outcomes of patients with JIA-related uveitis.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Loss of Visual Acuity among Patients with Uveitis Associated with Juvenile Idiopathic Arthritis: The Systemic Immunosuppressive Therapy for Eye Diseases Study

et al. 2013

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“…JIA-associated uveitis frequently has been reported to result in visual impairment as a result of structural ocular complications such as cataract 1,6,7,9,19. We reviewed our experience with JIA-associated uveitis over 21 years in order to estimate in the effect of treatment with topical corticosteroids on the development of cataract over time.…”

Section: Discussionmentioning

confidence: 99%

Risk of Cataract Development among Children with Juvenile Idiopathic Arthritis-Related Uveitis Treated with Topical Corticosteroids

et al. 2010

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Purpose-To investigate the risk of cataract development among patients with juvenile idiopathic arthritis (JIA)-associated uveitis treated with topical corticosteroids. Design-Retrospective cohort studyParticipants-75 patients with JIA-associated uveitis observed from July 1984 through August 2005 at a single academic center.Methods-Clinical data on these patients were collected by chart review and were analyzed.Main outcome measures-Incidence of new-onset cataract. Risk factors for cataract development were assessed with attention paid to the use of topical corticosteroids.Results-Over a median follow-up of 4 years, the incidence of new-onset cataract was 0.04/eyeyear (EY, 95% confidence interval [CI]: 0.02/EY, 0.09/EY). Of the 60 eyes in 40 patients who received topical corticosteroid therapy, there was a dose-dependent increase in the rate of cataract development among eyes receiving topical corticosteroids. The incidence of cataract was 0.01/EY for eyes treated with ≤ 3 drops daily and 0.16/EY (P = 0.0006 for log rank test) for eyes treated with >3 drops daily. Among eyes receiving ≤ 2 drops daily, the incidence of cataract was 0/EY (95% CI, one-sided: 0.03/EY). Presence of posterior synechiae, active uveitis, and use of topical corticosteroids at presentation were statistically significantly associated with cataract development after controlling for confounding variables. Use of topical corticosteroids was associated with cataract formation independent of uveitis activity. Using longitudinal data analysis and controlling for duration of uveitis, presence and degree of active uveitis, and concomitant use of other forms of corticosteroids in a time-updated fashion, treatment with ≤ 3 drops daily of topical corticosteroid was associated with an 87% lower risk of cataract formation compared to eyes treated with >3 drops daily (relative risk = 0.13, 95% CI: 0.02, 0.69, P = 0.02).Corresponding Author: Jennifer E. Thorne, MD, PhD; Department of Ophthalmology, The Wilmer Eye Institute; 550 North Broadway; Suite 700; Baltimore, MD 21205, Phone: (410) 955-1966; Fax: (410) 955-0629; jthorne@jhmi.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2011 July 1. Published in final edited form as:Ophthalmology. Conclusions-In our cohort, topical corticosteroid use was associated with an increased risk of cataract formation independent of active uveitis or presence of posterior synechiae. However, chronic use of topical corticosteroids dosed at ≤ 3 drops daily appeared to be associated wi...

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“…Another study reported that patients who received immunomodulatory therapy early in the course of steroid resistant JIA uveitis, had better visual acuity than patients who received it later. 13 Increased treatment of JIA in childhood with methotrexate and tumor necrosis factor-alpha blocking agents may decrease adult uveitis, but this has yet to be established. 12 , 14 This series suggests that active uveitis in adults who have had JIA as children, is often associated with ongoing complications at a rate that is higher than other series of chronic uveitis in adults.…”

Section: Discussionmentioning

confidence: 99%

Juvenile Idiopathic Arthritis Associated Uveitis in Adults: A Case Series

Camuglia

Whitford²,

Hall

2009

Ocular Immunology and Inflammation

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Outcomes of Treatment with Immunomodulatory Therapy in Patients with Corticosteroid-Resistant Juvenile Idiopathic Arthritis-Associated Chronic Iridocyclitis

Cited by 49 publications

References 22 publications

Risk Factors for Loss of Visual Acuity among Patients with Uveitis Associated with Juvenile Idiopathic Arthritis: The Systemic Immunosuppressive Therapy for Eye Diseases Study

Risk Factors for Loss of Visual Acuity among Patients with Uveitis Associated with Juvenile Idiopathic Arthritis: The Systemic Immunosuppressive Therapy for Eye Diseases Study

Risk of Cataract Development among Children with Juvenile Idiopathic Arthritis-Related Uveitis Treated with Topical Corticosteroids

Juvenile Idiopathic Arthritis Associated Uveitis in Adults: A Case Series

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