Managing juvenile idiopathic arthritis–associated uveitis

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

doi:10.1016/j.survophthal.2015.10.005

Cited by 39 publications

(23 citation statements)

References 106 publications

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“…Second-line IMT agents such as CsA and mycophenolate are known to be more effective when used in combination with other drugs 23. In our study, 66.7% of children with JIA had their inflammation controlled with the use of MTX plus CsA, higher than the 50% uveitis control rate previously reported with this combination therapy 25. Children with JIA and refractory uveitis who did not respond well to first-line treatment or those who were intolerant to standard IMT agents received biologic therapy.…”

Section: Discussioncontrasting

confidence: 50%

Clinical features of paediatric uveitis at a tertiary referral centre in São Paulo, SP, Brazil

et al. 2018

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Section: Discussioncontrasting

confidence: 50%

Clinical features of paediatric uveitis at a tertiary referral centre in São Paulo, SP, Brazil

et al. 2018

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“…The aim of treatment is to achieve 0 cells in the anterior chamber (SUN AC cell grade 0) in both eyes [39]. Practical management protocols have recently been published both by our group in Bristol, UK [40] and an interdisciplinary panel from Spain [39]. A modified algorithm based on consensus guidelines [39][40][41] is provided in Fig.…”

Section: Treatmentmentioning

confidence: 99%

“…Aggressive Case series (n = 3) and case report showing efficacy. Phase II trial in progress Legend: CTLA-4 cytotoxic T-lymphocyte-associated antigen 4, IL interleukin, IV intravenous, JIA-U juvenile idiopathic arthritis-associated uveitis, mAb monoclonal antibody, od once daily, ow once per week, q2w every 2 weeks, q4w every 4 weeks, RCT randomised controlled trial, sc subcutaneous, TNF tumour necrosis factor courses of pre-and post-operative topical and systemic glucocorticoids may be required to optimise surgical results [40]. Surgical treatment may also be required for glaucoma associated with JIA-U unresponsive to pharmacological management.…”

Section: Surgical Treatmentsmentioning

confidence: 99%

Juvenile idiopathic arthritis-associated uveitis

Sen

Ramanan

2017

Best Practice & Research Clinical Rheumatology

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Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, with JIA-associated uveitis its most common extra-articular manifestation. JIA-associated uveitis is a potentially sight-threatening condition and thus carries a considerable risk of morbidity. The aetiology of the condition is autoimmune in nature with the predominant involvement of CD4 + T cells. However, the underlying pathogenic mechanisms remain unclear, particularly regarding interplay between genetic and environmental factors. JIA-associated uveitis comes in several forms, but the most common presentation is of the chronic anterior uveitis type. This condition is usually asymptomatic and thus screening for JIA-associated uveitis in at-risk patients is paramount. Early detection and treatment aims to stop inflammation and prevent the development of complications leading to visual loss, which can occur due to both active disease and burden of disease treatment. Visually disabling complications of JIA-associated uveitis include cataracts, glaucoma, band keratopathy and macular oedema. There is a growing body of evidence for the early introduction of systemic immunosuppressive therapies in order to reduce topical and systemic glucocorticoid use. This includes more traditional treatments, such as methotrexate, as well as newer biological therapies. This review highlights the epidemiology of JIA-associated uveitis, the underlying pathogenesis and how affected patients may present. The current guidelines and criteria for screening, diagnosis and monitoring are discussed along with approaches to management.

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“…1,2 In a step-by-step approach, topical and/or systemic corticosteroids and synthetic and/or biological disease-modifying antirheumatic drugs (DMARDs) are indicated. 1,2 In a step-by-step approach, topical and/or systemic corticosteroids and synthetic and/or biological disease-modifying antirheumatic drugs (DMARDs) are indicated.…”

Section: What Is K Nown and S Tudy Objec Tivementioning

confidence: 99%

Tocilizumab for refractory uveitis associated with juvenile idiopathic arthritis: A report of two cases

et al. 2019

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Summary What is known and the objective Low‐grade evidence supports the use of newer biologics for otherwise refractory juvenile idiopathic arthritis (JIA)‐associated uveitis, such as tocilizumab. Case summary This report details the cases of two adolescents whose severe JIA‐associated uveitis was unresponsive to the first‐line therapeutic approach. Tocilizumab therapy led to the remission of uveitis after a mean time of 3 weeks, and methotrexate was safely discontinued 1.5 years later. What is new and conclusion To our knowledge, these are the first reports of successful methotrexate withdrawal during tocilizumab treatment of JIA‐associated uveitis. The administration of tocilizumab without methotrexate could be considered in patients with JIA‐associated uveitis unresponsive to conventional therapy.

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Managing juvenile idiopathic arthritis–associated uveitis

Abstract: General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Tocilizumab and Abatacept, in those cases refractory to anti-TNF-α therapy.3

Cited by 39 publications

References 106 publications

Clinical features of paediatric uveitis at a tertiary referral centre in São Paulo, SP, Brazil

Clinical features of paediatric uveitis at a tertiary referral centre in São Paulo, SP, Brazil

Juvenile idiopathic arthritis-associated uveitis

Tocilizumab for refractory uveitis associated with juvenile idiopathic arthritis: A report of two cases

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