Uveitis in Juvenile Idiopathic Arthritis: Recent Therapeutic Advances

ObjectivesUveitis and juvenile idiopathic arthritis (JIA) relatively often coexist. Inflammatory changes in the anterior segment of the eye are the most common extra-articular symptom in children with JIA, and JIA is, in turn, the main systemic cause of anterior uveitis in children. The aim of our study was to compare the course of anterior uveitis accompanying JIA and isolated uveitis.Material and methodsWe analyzed 25 children with JIA and uveitis (group I) and 28 children with isolated uveitis (group II). The study population was retrospectively selected from the patients treated in our center in the years 1998–2016 through a search of the hospital database. All data were presented as descriptive statistics.ResultsIn group I there was a higher percentage of girls than in group II (64% vs. 50%) and uveitis occurred at a significantly younger age (8.7 years vs. 11.6). Patients from group I more often presented with immunological abnormalities (positive antinuclear antibodies or HLA-B27 antigen). The majority of children from group I developed uveitis prior to (44%) or simultaneously with (20%) arthritis. In patients who first presented with uveitis, arthritis appeared on average after 28 months (median 12 months). In children in whom arthritis developed first, uveitis appeared on average after 51 months (median 36 months). In some patients the time interval between the involvement of these two organs was as long as 9–10 years. Four children from group I and three from group II were qualified for biological treatment.ConclusionsThe results of our analysis indicate the need for constant cooperation between the pediatric rheumatologist and the ophthalmologist. Although the risk of uveitis in JIA decreases with the disease duration, in some cases this complication can develop after many years. Children with present antinuclear antibodies, at younger age and of female gender should be subject to particularly close observation.

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“…Such treatment resulted in the relief of symptoms from the joints and/or the eye. Similar experiences are described by other authors [ 17 , 18 ].…”

Section: Discussionsupporting

confidence: 91%

Comparison of uveitis in the course of juvenile idiopathic arthritis with isolated uveitis in children – own experiences

et al. 2018

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“…Uveitis is an important eye disease that may cause blindness. It has been extensively investigated, however, its exact pathogenesis remains to be determined ( 10 ), resulting in a lack of specifically efficient drugs for its treatment ( 11 , 12 ). Arsenic trioxide has been shown to be effective in the treatment of acute promyelocytic leukemia and other tumors, and more recently investigators tested it against EAU, via intraperitoneal injection, with promising results, albeit a high incidence of adverse effects ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Treatment of experimental autoimmune uveoretinitis with different natural compounds

Chen

Liu³

et al. 2016

Molecular Medicine Reports

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Uveitis is an important eye disease that potentially causes loss of sight. Although extensive studies have been conducted on uveitis, the exact pathogenesis remains to be determined. The effects of treatment with natural compounds on an experimental autoimmune uveoretinitis (EAU) rat model were examined in the present study. A total of 25 rats were divided into 5 groups: Alkaloids (n=5), saponins (n=5), flavonoids (n=5), phenols (n=5), and the normal saline group (n=5). The rats in each group were treated with an intraperitoneal injection of proper alkaloids (berberine hydrochloride), saponins (steroidal saponins), flavonoids (baicalein), or phenols (chlorogenic acid) or physiological saline, respectively. The rats' aqueous humour and crystalline lens was then observed under the slit lamp periodically, looking for signs of inflammation. After 2 weeks, the rats were sacrificed and the degree of pathological changes on their eyeballs under different treatment methods were determined using an optical microscope. The expression of the interleukin (IL)-17 gene in the ocular tissues of the rats was assessed via RT-PCR and western blot analysis. Apoptosis on the rats' retinal tissues was detected using flow cytometry. The results showed that rats injected with phenols (chlorogenic acid) had serious ocular vascular dilatation, iris hemorrhage and purulent exudation; those injected with alkaloids (berberine hydrochloride) and flavonoids (baicalein) had a more mild form of inflammation; and those administered saponins (steroidal saponins) had only mild inflammation signs. Following detection of IL-17 mRNA and protein expression levels in the ocular tissues of rats of the five groups, it was found that their expression was lowest in the saponin-treated group and the other differences in expression were all statistically significant (P<0.05). A comparison with other groups revealed that cell apoptosis in the eyes of rats in the saponin group was the most prominent, reflecting a beneficial decrease in the amount of inflammatory cells on the lesion. Based on these findings, natural compounds such as saponins (steroidal saponins), alkaloids (berberine hydrochloride), and flavonoids (baicalein), but not phenols (chlorogenic acid), can inhibit the clinical symptoms of EAU in rats to a certain extent and reduce cell apoptosis. The most promising results in the present study were obtained using steroidal saponins.

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“… 26 Anterior uveitis occurs in 10%–20% of patients with JIA and can be managed with topical and oral steroids, immunosuppressive drugs such as methotrexate, and antimetabolites. 27 Despite the fact that no biologics are approved for the treatment of JIA-associated uveitis, the TNF antagonists have been employed to treat patients with refractory disease. 27 …”

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

“… 27 Despite the fact that no biologics are approved for the treatment of JIA-associated uveitis, the TNF antagonists have been employed to treat patients with refractory disease. 27 …”

Section: The Role Of Tnf Blockers In Other Chronic Childhood Diseasesmentioning

confidence: 99%

Efficacy and safety of ustekinumab in adolescents

Kellen¹,

Silverberg²,

Lebwohl³

2016

PHMT

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The biologic agent ustekinumab is a human monoclonal antibody that binds to the p40 subunit shared by interleukins (ILs) 12 and 23. The antibody is able to prevent binding of cytokines to the IL-12Rβ1 cell surface receptor and therefore may prevent IL-23 driven activation of the IL-23/Th 17 axis of inflammation. The anti-inflammatory activity has been beneficial in adult psoriasis. Ustekinumab has been approved in the United States for the treatment of adults with psoriasis and psoriatic arthritis. Approval in children and adolescents has not been granted by the US Food and Drug Administration. Subcutaneous injections of ustekinumab are administered at baseline, week 4 and every 12 weeks thereafter, a regimen that is particularly appealing to young patients who do not like more frequent injections at home. The product is attractive because, although it works through an immune system mechanism, the selective activity is such that the drug has not been associated with many of the side effects attributed to other immunosuppressive medications. Case reports of ustekinumab for pediatric psoriasis have shown promising results, and the recent Phase III CADMUS trial tested the agent in adolescents aged 12–17 years with psoriasis, using standard dose 0.75 mg/kg (≤60 kg), 45 mg (>60–≤100 kg), and 90 mg (>100 kg) or half-standard dosing 0.375 mg/kg (≤60 kg), 22.5 mg (>60–≤100 kg), and 45 mg (>100 kg) with a loading dosage at week 0 and week 4. Psoriasis area and severity index-75 was achieved in more than three-quarters of patients in full and half dosing by 12 weeks, and psoriasis area and severity index-90 in 54.1% and 61.1% of half and full dosage by 12 weeks, respectively. Ustekinumab was generally well tolerated in adolescents, with some patients developing antibodies, and nasopharyngitis being the major adverse event. Ustekinumab is a promising agent in adolescent psoriasis that appears to be well tolerated. The best monitoring plan and usage in younger patients still remain to be defined.

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Uveitis in Juvenile Idiopathic Arthritis: Recent Therapeutic Advances

Cited by 15 publications

References 26 publications

Comparison of uveitis in the course of juvenile idiopathic arthritis with isolated uveitis in children – own experiences

Comparison of uveitis in the course of juvenile idiopathic arthritis with isolated uveitis in children – own experiences

Treatment of experimental autoimmune uveoretinitis with different natural compounds

Efficacy and safety of ustekinumab in adolescents

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