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Surv Ophthalmol. 2016 Mar-Apr;61(2):197-210. doi: 10.1016/j.survophthal.2015.10.005. Epub 2015 Oct 24.

Managing juvenile idiopathic arthritis-associated uveitis.

Author information

1
Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK.
2
Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK; Department of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Ocular Immunology, National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
3
Department of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Pediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK.
4
Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK. Electronic address: Adam.Ross@bristol.ac.uk.

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.

KEYWORDS:

biologics; childhood; juvenile idiopathic arthritis; management; uveitis

[Indexed for MEDLINE]

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