Managing juvenile idiopathic arthritis-associated uveitis

Madeleine J Hawkins, Andrew David Dick, Richard W J Lee, Athimalaipet V Ramanan, Ester Carreño, Catherine Guly, Adam H Ross

Research output: Contribution to journalArticle (Academic Journal)peer-review

31 Citations (Scopus)
387 Downloads (Pure)

Abstract

Bilateral chronic anterior uveitis is an extra-articular feature of juvenile idiopathic arthritis. Although figures vary, uveitis occurs in approximately 11%-13% of patients with this disease and is most commonly associated with the female gender, oligoarthritis, and presence of antinuclear antibodies. The disease has an insidious onset and is often asymptomatic. Managing patients with juvenile idiopathic arthritis-associated uveitis remains challenging as the disease may prove to be refractory to traditional treatment regimens. Stepwise immunomodulatory therapy is indicated, with new biologic drugs being used last in cases of refractory uveitis. Small scale studies and practice have provided the evidence to undertake randomized control trials to evaluate the efficacy, safety, and cost-effectiveness of anti-tumor necrosis factor-α therapies, such as infliximab and adalimumab. These have demonstrated promising results, with further data awaited from ongoing trials for adalimumab (as SYCAMORE and ADJUVITE trials). Lower grade evidence is supporting the use of newer biologics such as rituximab, daclizumab, tocilizumab, and abatacept in those cases refractory to anti-tumor necrosis factor-α therapy.

Original languageEnglish
Pages (from-to)197-210
Number of pages14
JournalSurvey of Ophthalmology
Volume61
Issue number2
Early online date24 Oct 2015
DOIs
Publication statusPublished - Apr 2016

Keywords

  • juvenile idiopathic arthritis
  • uveitis
  • management
  • biologics
  • childhood

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