Risk factors associated with the relapse of uveitis in patients with juvenile idiopathic arthritis: a preliminary report

Uveitis Reactivation in Children Treated With Tumor Necrosis Factor Alpha Inhibitors

“…Evaluating age as potentially such a factor, Kalinina reported that the relapse rates were lower in children who were older than 8 years at methotrexate discontinuation (18). Conversely, our study and that of Saboo found that relapse rates were lower in children who were younger at diagnosis (19). The two populations may not be comparable, as anti-TNFα typically is implemented after failure of methotrexate to adequately control uveitis thus, based on the limited available information, younger age tends to be associated with a better prognosis for sustained remission off of anti-TNFα therapy.…”

“…In support of this hypothesis, Kalinina reported that the risk of relapse of JIA-associated uveitis after MTX withdrawal was lower in children with a longer duration of inactivity on MTX (>2 years) (18). However, this hypothesis was not supported either by this study or by that of Saboo; in neither of these studies was the duration of treatment with immunomodulatory agents nor the duration of suppression significantly associated with the risk of relapse, at least if the duration of suppression was more than 1.5 years (19). While it is possible that the affect of maintaining a longer suppression, while on medication, varies by agent, Foell, et al, also observed that the risk of relapse in JIA was not associated with the duration of MTX treatment once suppression was achieved, but rather with levels of the pro-inflammatory myeloid related proteins (MRP8/14) during suppression (17).…”

“…Kalinina reported that uveitis relapses in 46% of JIA-associated uveitis within one year of stopping methotrexate (18). Saboo also examined the likelihood of relapse in children with JIA-associated uveitis, who had maintained a year of inactive disease off immunomodulatory therapy (either conventional and/or anti-TNF α ); 43% of children relapsed with an estimated median survival time of 84 months (median follow up of 72 months) (19). This analysis was restricted to children who successfully maintained 1 year of remission off anti-TNFα, suggesting that more than 43% of children would have relapsed after initial anti-TNFα discontinuation.…”

“…Similarly, many physicians who care for pediatric uveitis believe that the risk of reactivation is lowered by a more prolonged period of suppression while on medication (suppression). There are scant, conflicting, data on whether a longer duration of suppression results in decreased risk of disease reactivation after withdrawal for either JIA-arthritis or JIA-associated uveitis (16-19). All but one of these studies focused on reactivation following conventional immunomodulator withdrawal (17-19).…”

“…There are scant, conflicting, data on whether a longer duration of suppression results in decreased risk of disease reactivation after withdrawal for either JIA-arthritis or JIA-associated uveitis (16-19). All but one of these studies focused on reactivation following conventional immunomodulator withdrawal (17-19). Whether this is the case in uveitis controlled under anti-TNFα has not been directly examined.…”