Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Abstract

Importance Australian‐ and New Zealand‐based, uveitis‐specialized ophthalmologists have produced recommendations for the management of juvenile idiopathic arthritis (JIA)‐type chronic anterior uveitis. Background Historically, the visual prognosis of JIA‐type chronic anterior uveitis has been poor. New medical advances are likely to improve outcomes, but recently published guidelines are tailored for ophthalmic care in Europe and the United States. Design This work involved a consensus survey and a panel meeting. Participants The Australian and New Zealand JIA‐Uveitis Working Group (29 ophthalmologists) participated in the work. Methods The Delphi technique was used to achieve consensus. Main Outcome Measures This work yielded consensus statements. Results The Working Group achieved consensus around 18 statements related to clinical evaluation, use of topical and regional corticosteroids, use of systemic corticosteroid and non‐corticosteroid immunomodulatory drugs, and management of secondary cataract and glaucoma in childhood JIA‐type uveitis. Conclusions and Relevance Recommendations of the Australian and New Zealand JIA‐Uveitis Working Group provide current and regionally applicable advice for managing chronic anterior uveitis in children with JIA.

Outcomes of cataract surgery in paediatric uveitis: A multisite study

“…Prior studies suggest perioperative control of inflammation is a key factor in surgical outcomes and most authors suggest uveitis should be inactive for 3 months preoperatively. 1,5 In this study, most patients in both groups had inactive uveitis immediately prior to surgery. While topical and systemic corticosteroids were used in the majority patients in both groups, not all patients in the pseudophakic group received preoperative steroids and this may have affected postoperative outcomes.…”

Canadian Rheumatology Association Recommendations for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-associated Uveitis

“…This recommendation is also in agreement with the Australia and New Zealand expert-consensus based JIA-uveitis Working Group recommendations which support the threshold of >2 drops per day. 19 The decision to escalate therapy should be individualized and done using a shared decision-making framework; in some cases where noncompliance or significant burden is associated with topical drops, escalation may be considered when 1-2 drops per day is required.…”

“…The ACR/AF guidelines did not have a specific recommendation for first line systemic therapy although it is implied in recommendation 10 which conditionally recommends subcutaneous over oral methotrexate in patients starting systemic therapy. Both the expert-consensus based Single Hub and Access Point for Paediatric Rheumatology in Europe (SHARE), 20 and Australia/New Zealand 19 groups have a specific recommendation for methotrexate as first line systemic therapy. Methotrexate has demonstrated safety and efficacy for the treatment of JIA-associated uveitis in several retrospective studies in doses of 15 mg/m 2 (alternatively up to 1mg/kg) to a maximum of 25 mg weekly [21][22][23][24][25][26][27] .…”

Research Progress on the Mechanism of Natural Product Ingredients in the Treatment of Uveitis

“…The main drugs currently available in China to treat uveitis include immunosuppressants and glucocorticoids. Immunosuppressants such as cyclophosphamide, cyclosporin, and azathioprine not only inhibit bone marrow function but also have nephrotoxicity or hepatotoxicity [ 19 ]. Subconjunctival injection, peribulbar injection, retrobulbar injection, and vitreous cavity injection of glucocorticoid can improve visual impairment, inhibit the formation of adhesion, and relieve eye pain but can lead to adverse reactions including ptosis, cataract, and increased intraocular pressure [ 20 ].…”