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

Abstract

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.

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

“…Treatment of noninfectious uveitis is currently based on GCs that are mainly used in the acute phase during a disease flare or as a bridge therapy to GC-sparing agents. The advent of biotechnological agents has revolutionized the management of noninfectious uveitis (64). In particular, a robust experience has accrued over time with TNF-α inhibitors both in a randomized clinical trial and in a real-life setting (60,61,(65)(66)(67)(68).…”

Beyond Diagnosis: Preliminary Study of Impact on Children and Parents in Neurodevelopmental Disorders and Juvenile Idiopathic Arthritis-Associated Uveitis

“…JIA-U is categorized according to the specific ocular compartment that is affected (anterior, intermediate, posterior, or panuveitis) and the temporal pattern of inflammation (acute, subacute, chronic, or recurring). Among children with JIA-U, the most common form is the chronic anterior and bilateral kind [51]. Significantly, JIA-U often results in serious problems, such as irreversible visual loss, particularly when not addressed [52].…”

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

“…In addition to pathognomonic joint disease, JIA is also burdened by extra-articular involvement and comorbidities ( 4 – 6 ), the most frequent of which are uveitis and cardiovascular complications ( 7 – 9 ). However, the pathogenesis of renal involvement in JIA is poorly understood, it may develop because of subclinical endothelial damage due to the inflammatory systemic process itself, leading to kidney disease, cardiovascular disease up to hypertension in children with JIA.…”