Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis

Abstract

Pediatric uveitis may be a serious health problem because of the lifetime burden of vision loss due to severe complications if the problem is not adequately treated. Juvenile idiopathic arthritis (JIA)-associated uveitis is characterized by insidious onset and potentially blinding chronic anterior uveitis. Periodic ophthalmologic screening is of utmost importance for early diagnosis of uveitis. Early diagnosis and proper immunomodulatory treatment are essential for good visual prognosis. The goal of treatment is to achieve enduring drug-free remission. The choice of therapeutic regimen needs to be tailored to each individual case. One must keep in mind that patients under immunomodulatory treatment should be monitored closely due to possible side effects. Local and systemic corticosteroids have long been the mainstay of therapy; however, long-term corticosteroid therapy should be avoided due to serious side effects. Steroid-sparing agents in the treatment of JIA-associated uveitis include antimetabolites and biologic agents in refractory cases. Among the various immunomodulatory agents, methotrexate is generally the first choice, as it has a well-established safety and efficacy profile in pediatric cases and does not appear to increase the risk of cancer. Other classic immunomodulators that may also be used in combination with methotrexate include azathioprine, mycophenolate mofetil, and cyclosporin A. Biologic agents, primarily tumor necrosis factor alpha inhibitors including infliximab or adalimumab, should be considered in cases of treatment failure with classic immunomodulatory agents.

Juvenile Idiopathic Arthritis

“…Biological agents are used in patients with resistant disease (infliximab, adalimumab, tocilizumab). Surgical interventions are reserved for patients with disease complications ( 37 ).…”

“…The dose in usage is 3-6 mg/kg/4-8 weeks (maximum dose 200 mg). Spondyloarthropathies, inflammatory bowel disease, psoriatic arthritis and uveitis show a particularly excellent response to infliximab treatment ( 37 , 45 , 54 ). Combined use of infliximab with methotrexate markedly increases drug efficiency.…”

Uveitis associated with juvenile idiopathic arthritis

“…У 4 пациентов (2 с ювенильным идиопатическим артритом, 1 -с идиопатическим увеитом, 1 -с болезнью Бехчета) на 10-36-й неделе появилась рефрактерность к терапии. У 2 больных развилось осложнение в виде герпесвирусной инфекции [39]. В исследовании В. Нероева и соавт.…”

“…Ретроспективное когортное исследование с участием 50 детей с неинфекционным увеитом показало, что реактивация болезни возникла после прекращения приема инфликсимаба (n=45) или адалимумаба (n=5), при этом вероятность рецидива увеита была выше в группе пациентов, принимавших адалимумаб (ОШ 13,4; 95% ДИ 2,2-82,5) [54]. Кроме того, в литературе имеются немногочисленные сведения об испытании других классов генно-инженерных препаратов: СD20-антигенспецифичных монокло-нальных антител -ритуксимаба, блокаторов рецепторов интерлейкина-1 и интерлейкина-2 -анакинры и даклизумаба [55][56][57].…”

Juvenile Idiopathic Arthritis

“…The advance in biologic therapeutics over the past 15 years has led to marked improvement in JIA treatment. In the biological era, the rate of joint damage decreased, and achieved disease remission increased with an increased number of patients (37,45,54). Combined use of infliximab with methotrexate markedly increases drug efficiency.…”