Female Sex and Oligoarthritis Category Are Not Risk Factors for Uveitis in Italian Children with Juvenile Idiopathic Arthritis

Calandra, Serena; Gallo, Maria Chiara; Consolaro, Alessandro; Pistorio, Angela; Lattanzi, Bianca; Bovis, Francesca; Muratore, Valentina; Marco, Riccardo De; Martini, Alberto; Ravelli, Angelo

doi:10.3899/jrheum.131494

Cited by 27 publications

(15 citation statements)

References 26 publications

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“…This finding is important as ocular inflammation has been postulated to be related to ETN [35, 36]. It should be taken into account, however, that our sample included a high proportion of children with early-onset and ANA-positive disease, who have a high background risk of uveitis [37]. It has been hypothesized that ETN may not directly cause the development of uveitis, but the discontinuation of MTX upon successful arthritis control may pose the patient at risk [38].…”

Section: Discussionmentioning

confidence: 99%

Disease status, reasons for discontinuation and adverse events in 1038 Italian children with juvenile idiopathic arthritis treated with etanercept

et al. 2016

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BackgroundData from routine clinical practice are needed to further define the efficacy and safety of biologic medications in children with juvenile idiopathic arthritis (JIA). The aim of this analysis was to investigate the disease status, reasons for discontinuation and adverse events in Italian JIA patients treated with etanercept (ETN).MethodsIn 2013, all centers of the Italian Pediatric Rheumatology Study Group were asked to make a census of patients given ETN after January 2000. Patients were classified in three groups: group 1 = patients still taking ETN; group 2 = patients discontinued from ETN for any reasons; group 3 = patients lost to follow-up while receiving ETN. All three groups received a retrospective assessment; patients in group 1 also underwent a cross-sectional assessment.Results1038 patients were enrolled by 23 centers: 422 (40.7%) were in group 1, 462 (44.5%) in group 2, and 154 (14.8%) in group 3. Median duration of ETN therapy was 2.5 years. At cross-sectional assessment, 41.8% to 48.6% of patients in group 1 met formal criteria for inactive disease, whereas 52.4% of patients in group 2 and 55.8% of patients in group 3 were judged in clinical remission by their caring physician at last visit. A relatively greater proportion of patients with systemic arthritis were discontinued or lost to follow-up. Parent evaluations at cross-sectional visit in group 1 showed that 52.4% of patients had normal physical function, very few had impairment in quality of life, 51.2% had no pain, 76% had no morning stiffness, and 82.7% of parents were satisfied with their child’s illness outcome. Clinically significant adverse events were reported for 27.8% of patients and ETN was discontinued for side effects in 9.5%. The most common adverse events were new onset or recurrent uveitis (10.2%), infections (6.6%), injection site reactions (4.4%), and neuropsychiatric (3.1%), gastrointestinal (2.4%), and hematological disorders (2.1%). Ten patients developed an inflammatory bowel disease and 2 had a malignancy. One patient died of a fulminant streptococcal sepsis.ConclusionsAround half of the patients achieved complete disease quiescence under treatment with ETN. The medication was overall well tolerated, as only one quarter of patients experienced clinically significant adverse events and less than 10% had treatment discontinued for toxicity.

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Section: Discussionmentioning

confidence: 99%

Disease status, reasons for discontinuation and adverse events in 1038 Italian children with juvenile idiopathic arthritis treated with etanercept

et al. 2016

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“…These factors are reflected in the American Academy of Pediatrics screening guidelines in which ANA-status, JIA subtype, and age of onset drive the recommended frequency of uveitis screening in children with JIA (24). More recent work suggests that interactions between features may be most important, in that development of uveitis under three years at JIA-onset in females (but not in males) and ANA-positivity (rather than subtype) were risk factors for uveitis (19), while newer work supports the notion that only younger age of onset and ANA status are risk factors, but not subtype or sex (18,25). …”

Section: Risk Factors For Uveitis In Jiamentioning

confidence: 91%

The Future Is Now: Biologics for Non-Infectious Pediatric Anterior Uveitis

Lerman

Rabinovich

2015

Pediatr Drugs

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Anterior uveitis (AU), inflammation of the iris, choroid, or ciliary body, can cause significant eye morbidity, including visual loss. In the pediatric age group, the most common underlying diagnosis for AU is juvenile idiopathic associated uveitis and idiopathic AU, which are the focus of this paper. AU is often resistant to medications such as topical corticosteroids and methotrexate. In the past 15 years, biologic agents (biologics) have transformed treatment. In this review, we discuss those in widespread use and those with more theoretical applications for anterior uveitis. Tumor Necrosis Factor alpha inhibitors (anti-TNFα) have been available the longest and are used widely to treat pediatric uveitis. The effects of anti-TNFα in children are described mostly in small retrospective case series. Together, the literature suggests that the majority of children treated with anti-TNFα achieve decreased uveitis activity and reduce corticosteroid burden. However, many will have disease flares even on treatment. Only a few small studies directly compare outcomes between alternate anti-TNFα (infliximab and adalimumab). The use of different uveitis grading systems, inclusion criteria, and outcome measures, makes cross-study comparisons difficult. Whether the achievement and maintenance of inactive disease occurs more frequently with certain anti-TNFα remains controversial. Newer biologics that modulate the immune system differently (e.g., interfere with TH17 activation through IL-17a and IL-6 blockade, limit T lymphocyte costimulation, and deplete B lymphocytes), have shown promise for uveitis. Studies of these agents are small and include mostly adults. Additional biologics are also being explored to treat uveitis. With their advent, we are hopeful that outcomes will ultimately be improved for children with AU. With many biologics available, much work remains to identify the optimal inflammatory pathway to target in AU.

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“…102, 110, 112 Development of asymptomatic anterior uveitis is associated with ANA positivity and younger age of disease onset. 113 Also similar to adult psoriasis, juvenile psoriasis is associated with an increased prevalence of obesity and comorbidities (including hyperlipidemia, diabetes, hypertension and Crohn's disease). 101 This relationship has not been examined specifically in JPsA.…”

Section: Methodsmentioning

confidence: 99%