Juvenile idiopathic arthritis-associated uveitis in the era of biological therapy: how the disease changed in more than 20 years of observation in a tertiary referral center in Rome (Italy)

Giudice, Emanuela Del; Simio, Claudia; Scala, Arianna; Coste, Annalisa di; Torre, Giuseppe La; Spadea, Leopoldo; Lubrano, Riccardo; Duse, Marzia; Paroli, Maria Pia

doi:10.1007/s10792-021-02043-1

Cited by 7 publications

(4 citation statements)

References 36 publications

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“…The prognosis of JIA-CAU has been greatly improved during the last decade, and current therapies can reduce uveitis recurrences and the need for cataract and glaucoma surgery. 59 …”

Section: Discussionmentioning

confidence: 99%

Management Strategies of Juvenile Idiopathic Arthritis-Associated Chronic Anterior Uveitis: Current Perspectives

Paroli¹,

Giudice²,

Giovannetti³

et al. 2022

OPTH

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Juvenile idiopathic arthritis (JIA) is the most common extraocular disease associated with pediatric uveitis. Despite the growing knowledge about the pathogenetic and clinical characteristics of the disease, it still remains a challenge for both the pediatric rheumatologist and ophthalmologist. Since uveitis is asymptomatic in most cases, it is generally detected by parents in a late phase of the disease when complications have occurred with consequent severe vision loss. Improvement in attentive screening and early treatment initiation to suppress inflammation has considerably reduced the sight-threatening outcomes of JIA-associated chronic anterior uveitis (JIA-CAU). Initial treatment with topical steroids is effective in most cases. However, more severe cases require the use of periocular or systemic corticosteroids, possibly leading to long-term complications. These include growth retardation, cataract and glaucoma. Systemic immunosuppressive agents are then employed in patients resistant to first-line therapy or to reduce steroid-associated complications. In this review, we will discuss the immunosuppressant agents currently employed for the treatment of the disease, including anti-tumor necrosis factor (TNF)α biologics approved or not by the regulatory agencies. We will also highlight how new therapeutic options like biologic targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4) co-stimulatory molecule, interleukin-6 receptor (IL-6R) or B lymphocytes might represent exciting new options for patients resistant to conventional therapy. Finally, the potential use of janus kinase (JAK) inhibitors recently approved for the treatment of several inflammatory rheumatic diseases in adults will be also discussed.

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“…The prognosis of JIA-CAU has been greatly improved during the last decade, and current therapies can reduce uveitis recurrences and the need for cataract and glaucoma surgery. 59 …”

Section: Discussionmentioning

confidence: 99%

Management Strategies of Juvenile Idiopathic Arthritis-Associated Chronic Anterior Uveitis: Current Perspectives

Paroli¹,

Giudice²,

Giovannetti³

et al. 2022

OPTH

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“…Noninfectious uveitis represents a rare condition in the pediatric population, mostly associated with JIA (59). Compared to adult uveitis, the pediatric form is more commonly asymptomatic while having the tendency to become chronic; indeed, up to 90% of pediatric uveitis cases present as chronic anterior uveitis and are associated with a significant rate and spectrum of sight-threatening complications (20, [60][61][62][63].…”

Section: Uveitismentioning

confidence: 99%

Off-label use of canakinumab in pediatric rheumatology and rare diseases

Giudice

Sota²,

Orlando³

et al. 2022

Front. Med.

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Since the first success of interleukin-1 blockade in cryopyrin-associated periodic syndrome, the use of interleukin-1 inhibitors has expanded to other disorders, including off-label indications. In particular, canakinumab has been employed in an off-label fashion in several diseases such as rare monogenic autoinflammatory diseases and multifactorial autoinflammatory diseases, disclosing an excellent efficacy and good safety profile in pediatric patients unresponsive to standards of care. In addition, hyperferritinemic syndromes and complex disorders, as well as Kawasaki disease, uveitis, and other pediatric rare disorders, represent additional areas where canakinumab efficacy is worth exploring. Altogether, the results summarized below are of paramount importance in pediatric patients where a considerable proportion of treatments are prescribed off-label. This review focuses on the off-label use of canakinumab in pediatric patients affected by systemic immune-mediated diseases.

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“…Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood ( 1 , 2 ) and according to the International League of Associations for Rheumatology (ILAR) classification seven JIA categories can be identified, with distinct clinical symptoms and disease outcomes ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Proteinuria and hematuria as early signs of renal involvement in juvenile idiopathic arthritis

Del Giudice,

Marcellino,

Hoxha

et al. 2024

Front. Pediatr.

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ObjectivesTo evaluate glomerular and tubular renal functions and analyze blood pressure in a cohort of pediatric patients with juvenile idiopathic arthritis (JIA).MethodsA total of 40 pediatric patients, 20 (50%) with JIA and 20 (50%) healthy control subjects, were studied, and performed the renal function on 24-h collection and the 24-h ambulatory blood pressure monitoring (ABPM). Moreover, we compared renal function and blood pressure trends between the groups of JIA patients with different disease activities.ResultsNo statistically significant differences were observed between patients with JIA and healthy children in terms of glomerular filtration rate (GFR), fractional excretion of sodium (FENa), tubular reabsorption of phosphate (TRP), and calcium-creatinine urine ratio (CaU/CrU). In contrast, we observed significantly higher values in JIA patients than in controls for the presence of hematuria (p < 0.0001) and proteinuria (p < 0.0001). Compared to the control group there were significantly higher values of hematuria and proteinuria/day in both groups of JIA patients with low disease activity (respectively, p = 0.0001 and p = 0.0002) and moderate disease activity (respectively p = 0.0001 and p = 0.0012). Systolic and diastolic dipping were significantly reduced in patients with JIA compared with healthy controls (p < 0.0001 and p < 0.0001, respectively).ConclusionsOur study showed that children with JIA, already in the early stages of the disease, have higher values of hematuria and proteinuria, which are early warning signs of nephropathy. Therefore, detailed screening of renal function and pressure monitoring in patients are necessary to monitor their evolution over time.

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Juvenile idiopathic arthritis-associated uveitis in the era of biological therapy: how the disease changed in more than 20 years of observation in a tertiary referral center in Rome (Italy)

Cited by 7 publications

References 36 publications

Management Strategies of Juvenile Idiopathic Arthritis-Associated Chronic Anterior Uveitis: Current Perspectives

Management Strategies of Juvenile Idiopathic Arthritis-Associated Chronic Anterior Uveitis: Current Perspectives

Off-label use of canakinumab in pediatric rheumatology and rare diseases

Proteinuria and hematuria as early signs of renal involvement in juvenile idiopathic arthritis

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