The Efficiency of Adalimumab in Cases of Chronic Methotrexate-Resistant Juvenile Idiopathic Arthritis-Associated Anterior Uveitis: Retrospective Case Series Study

Abstract

Background: Juvenile idiopathic arthritis (JIA) associated uveitis may be the cause of not only visual acuity decrement, but also blindness. At the same time, in some patients therapy with methotrexate can not prevent the development of these complications.Objective: Our aim was to investigate the efficiency and safety of using a tumor necrosis factor inhibitor (adalimumab) in patients with JIA-associated uveitis.Methods: We conducted a retrospective single-arm study of a series of cases. The results of using adalimumab were evaluated in patients with JIA-associated chronic anterior uveitis, who have been under observation for no less than 1 year before and after starting using adalimumab. The latter was prescribed due to progressing and/or recidivous methotrexate-resistant uveitis.Results: We have analyzed clinical case records of 36 children with JIA-associated uveitis. At the start of therapy with adalimumab, actual uveitis was diagnosed in 30 (83%) patients. Remission was achieved in 29 of 30 cases in 2 (2; 12) weeks in patients with actual uveitis. 11 (31%) patients had a uveitis exacerbation 28 (13; 69) weeks after adalimumab therapy started. Adalimumab reduced the exacerbation frequency from 4 (1; 9) to 0 (0; 1) exacerbations per year for one patient (p < 0,001), and reduced the proportion of patients who were treated with topical glucocorticosteroids (from 83 to 8%). There were no differences (in achieving remission and reducing exacerbation frequency) with regard to patients’ sex, involvement of one or both eyes in the disease onset, antinuclear factor seropositiveness, uveitis type and character of joints affection.Conclusion: Adalimumab promotes fast and long-lasting remission of JIA-associated methotrexate-resistant uveitis.

Research Progress in Fecal Microbiota Transplantation as Treatment for Irritable Bowel Syndrome

“…Moreover, Mazzawi et al [91] explored the effects of FMT on symptoms and duodenal enteroendocrine cells in IBS patients and reported the effectiveness of FMT in treating IBS-D patients, revealing that IBS symptom scores for abdominal pain ( P = 0.005), diarrhea ( P = 0.004), and anorexia ( P = 0.096); IBS severity scores ( P = 0.0002); and Bristol Stool Scale scores ( P = 0.02) were significantly decreased after FMT treatment for 3 weeks. Gaidar et al [92] investigated the effectiveness of colonoscopy-assisted FMT in treating refractory IBS-D, IBS-C, and IBS-M patients. They reported that 75% of patients experienced relief from abdominal pain ( P < 0.01) and that stool frequency and consistency in all IBS-M and IBS-D patients returned to normal.…”

Uveitis associated with juvenile idiopathic arthritis

“…РОССИЙСКИЙ ВЕСТНИК ПЕРИНАТОЛОГИИ И ПЕДИАТРИИ, 2019; 64: (2) ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII, 2019; 64: (2) купировать лишь в 2 (из 22) глазах [34]. Ретроспективный анализ историй болезни 36 пациентов продемонстрировал снижение частоты обострений с 4 до 0 на одного больного в год [35]. В проспективном открытом нерандомизированном исследовании при применении комбинированной терапии метотрексатом и адалимумабом у 27 детей с увеитом, ассоциированным с ювенильным идиопатическим артритом, отмечался выраженное положительное влияние как на суставной синдром, так и на орган зрения [9].…”