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Ophthalmology: A 2020 Retrospective of Landmark Contributions. Ophthalmology 2020; 127:S1-S2. [DOI: 10.1016/j.ophtha.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 11/19/2022] Open
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Rodriguez-Smith J, Yeh S, Angeles-Han S. Improving quick and accurate diagnosis of childhood JIA-uveitis from a pediatric rheumatology perspective. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 15:101-109. [PMID: 32313548 PMCID: PMC7170263 DOI: 10.1080/17469899.2020.1739521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease associated with uveitis. JIA-associated uveitis (JIA-U) is typically asymptomatic, chronic, and can lead to sight-threatening complications. This review will provide approaches to improve the diagnosis and outcomes of children with JIA-U. AREAS COVERED We will provide updates on risk factors for uveitis onset and ocular complications, improvements in the ophthalmic screening schedule for uveitis detection, and potential strategies to advance the diagnosis and monitoring of JIA-U using advanced ophthalmic imaging and diagnostic equipment and laboratory biomarkers. EXPERT OPINION There is a lack of high-quality research in JIA-U and few randomized controlled trials, underscoring the urgent need for further studies in this population. Early uveitis diagnosis combined with timely and appropriate treatment can improve visual outcomes. Improved knowledge of uveitis pathogenesis, risk factors for uveitis onset, measurement of uveitis outcomes, and optimal treatment are crucial.
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Affiliation(s)
- Jackeline Rodriguez-Smith
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, 3333 Burnett Avenue, Cincinnati, Ohio 45229-3026, United States
| | - Steven Yeh
- Emory Eye Center, Department of Ophthalmology, Atlanta, Georgia 30322-1013, United States
| | - Sheila Angeles-Han
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, 3333 Burnett Avenue, Cincinnati, Ohio 45229-3026, United States
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Heiligenhaus A, Klotsche J, Tappeiner C, Sengler C, Niewerth M, Liedmann I, Hoeft S, Walscheid K, Lavric M, Foell D, Minden K. Predictive factors and biomarkers for the 2-year outcome of uveitis in juvenile idiopathic arthritis: data from the Inception Cohort of Newly diagnosed patients with Juvenile Idiopathic Arthritis (ICON-JIA) study. Rheumatology (Oxford) 2020; 58:975-986. [PMID: 30590748 PMCID: PMC6532445 DOI: 10.1093/rheumatology/key406] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/01/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To define predictors for the 2-year outcome in terms of achieving inactivity, subsequent uveitis reactivation and occurrence of uveitis-related complications of JIA-associated uveitis. Methods Demographic and clinical parameters and serum samples of JIA-associated uveitis patients enrolled in ICON at ⩽1 year of JIA diagnosis were collected at study enrolment, every 3 months during the first year and subsequently every 6 months. Predictors for the 2-year outcome were evaluated by linear mixed models. Results Of 954 JIA patients included, uveitis occurred in 106 up to the first 2-year follow-up, with 98 of them having complete ophthalmological documentation. In 81.8% and 80.0% of patients, uveitis inactivity was achieved at the 1- and 2-year follow-up after uveitis onset, respectively. JIA onset after the age of 5 years, no use of topical corticosteroids, and adalimumab treatment were significantly associated with an inactive uveitis for at least 6 months (n = 57). Correlates for subsequent uveitis reactivation (n = 16, 30.2%) were age at uveitis onset ⩽5 years and active disease (clinical Juvenile Arthritis Disease Activity Score >4.5). Uveitis-related complications were present in 29.8% of patients at first uveitis documentation and in 30.7% and 32.8% at 1- and 2-year follow-up, respectively. Older age at JIA onset, short duration between JIA and uveitis onset, high anterior chamber (AC) cell grades, poor visual acuity, and topical steroid use at first uveitis documentation correlated with uveitis-related complications. Conclusion In addition to demographic risk factors, JIA disease and uveitis activity scores and adalimumab are significant predictors for the 2-year outcome of JIA-associated uveitis patients.
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Affiliation(s)
- Arnd Heiligenhaus
- Department of Ophthalmology at St Franziskus Hospital, University of Duisburg-Essen, Münster
| | - Jens Klotsche
- German Rheumatism Research Center, a Leibniz Institute, Berlin.,Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medicine Berlin, Berlin, Germany
| | - Christoph Tappeiner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudia Sengler
- German Rheumatism Research Center, a Leibniz Institute, Berlin
| | | | - Ina Liedmann
- German Rheumatism Research Center, a Leibniz Institute, Berlin
| | | | - Karoline Walscheid
- Department of Ophthalmology at St Franziskus Hospital, University of Duisburg-Essen, Münster
| | - Miha Lavric
- Department of Paediatric Rheumatology and Immunology, University of Muenster, Münster
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University of Muenster, Münster
| | - Kirsten Minden
- German Rheumatism Research Center, a Leibniz Institute, Berlin.,Department of Rheumatology and Clinical Immunology Charité - University Medicine Berlin, Berlin, Germany
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Factors Predictive of Remission of Chronic Anterior Uveitis. Ophthalmology 2020; 127:826-834. [PMID: 31932091 DOI: 10.1016/j.ophtha.2019.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To estimate the incidence of medication-free remission of chronic anterior uveitis and identify predictors thereof. DESIGN Retrospective cohort study. PARTICIPANTS Patients diagnosed with anterior uveitis of longer than 3 months' duration followed up at United States tertiary uveitis care facilities. METHODS Estimation of remission incidence and identification of associated predictors used survival analysis. MAIN OUTCOME MEASURES Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis while off treatment at all visits spanning an interval of at least 90 days or-for patients who did not return for follow-up after 90 days-remaining inactive without receiving suppressive medications at all of the last visits. Association of factors potentially predictive of medication-free remission was also studied. RESULTS Two thousand seven hundred ninety-five eyes of 1634 patients with chronic anterior uveitis were followed up over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7% (95% confidence interval [CI], 30.4%-35.2%). Baseline clinical factors predictive of reduced remission incidence included longer duration of uveitis at presentation (for 2 to 5 years vs. less than 6 months: adjusted hazard ratio [aHR], 0.61; 95% CI, 0.44-0.83), bilateral uveitis (aHR, 0.75; 95% CI, 0.59-0.96), prior cataract surgery (aHR, 0.70; 95% CI 0.56-0.88), and glaucoma surgery (aHR, 0.63; 95% CI, 0.45-0.90). Two time-updated characteristics were also predictive of reduced remission incidence: keratic precipitates (aHR, 0.36; 95% CI, 0.21-0.60) and synechiae (aHR, 0.62; 95% CI, 0.41-0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy were also associated with reduced remission incidence. Older age at presentation was associated with higher incidence of remission (for age ≥40 years vs. <40 years: aHR, 1.29; 95% CI, 1.02-1.63). CONCLUSIONS Approximately one third of patients with chronic anterior uveitis remit within 5 years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict reduced remission incidence; patients with these factors should be managed taking into account the higher probability of a longer disease course.
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Malcová H, Dallos T, Bouchalova K, Brejchová I, Brichová M, Bušányová B, Fabianová J, Fráňová J, Furdová A, Jarošová K, Kobrová K, Kostolná B, Košková E, Lokaj M, Macků M, Melocíková J, Michaličková M, Minxová L, Moravčíková D, Němcová D, Pískovský T, Říhová E, Schüller M, Skalická E, Svozílková P, Tomčíková D, Vargová V, Vrtíková E, Doležalová P, Heissigerová J. Recommendations for the Management of Uveitis Associated With Juvenile Idiopathic Arthritis: The Czech and Slovak adaptation of SHARE Initiative. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2020; 76:1-15. [PMID: 33086847 DOI: 10.31348/2020/7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is its most important extra-articular manifestation. Evidence-based recommendations are available only to a limited extent and therefore JIA associated uveitis management is mostly based on physicians experience. Consequently, treatment practices differ widely, both nationally and internationally. Therefore, an effort to optimize and publish recommendations for the care of children and young adults with rheumatic diseases was launched in 2012 as part of the international project SHARE (Single Hub and Access Point for Pediatric Rheumatology in Europe) to facilitate clinical practice for paediatricians and (paediatric) rheumatologists. The aim of this work was to translate published international SHARE recommendations for the diagnosis and treatment of JIA associated uveitis and to adapt them for use in the Czech and Slovak Republics. International recommendations were developed according to the standard methodology of the European League against Rheumatism (EULAR) by a group of nine experienced paediatric rheumatologists and three experts in ophthalmology. It was based on a systematic literature review and evaluated in the form of an online survey and subsequently discussed using a nominal group technique. Recommendations were accepted if > 80% agreement was reached (including all three ophthalmologists). A total of 22 SHARE recommendations were accepted: 3 on diagnosis, 5 on disease activity assessment, 12 on treatment and 2 on future recommendations. Translation of the original text was updated and modified with data specific to the czech and slovak health care systems and supplemented with a proposal for a protocol of ophthalmological dispensarization of paediatric JIA patients and a treatment algorithm for JIA associated uveitis. Conclusion: The aim of the SHARE initiative is to improve and standardize care for paediatric patients with rheumatic diseases across Europe. Therefore, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated based on the evidence and agreement of leading European experts in this field.
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Schnabel A, Unger E, Brück N, Berner R, Range U, Holl-Wieden A, Morbach H, Leszczynska A, Bau V, Hedrich CM. High-dose intravenous methylprednisolone in juvenile non-infectious uveitis: A retrospective analysis. Clin Immunol 2019; 211:108327. [PMID: 31863906 DOI: 10.1016/j.clim.2019.108327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
Abstract
Non-infectious uveitis is associated with visual impairment and blindness. Non-biologic treatment for non-infectious uveitis is not based on strong evidence. A retrospective chart review was conducted to investigate treatment response to high-dose intravenous methylprednisolone (IVMP) in children with non-infectious uveitis. Fifty-six patients (93 eyes affected) were included. In 29% uveitis was associated with juvenile idiopathic arthritis. Uveitis predominately affected the anterior segment, was bilateral and recurrent. Complications were common and included visual loss, synechiae, cataract and/or retinal lesions. Patients received up to 5 IVMP at monthly intervals. Visual acuity improved at 3 and 6 months. Anterior chamber cells, synechiae, keratic precipitates, papillary and/or macular edema improved at 3 months. Children treated with ≥3 IVMP (vs 1 IVMP) experienced trends towards fewer relapses, fewer cataracts and less frequently required treatment with biologic agents. High-dose IVMP induce rapid improvement in children with non-infectious uveitis. Prospective randomized trials are required to confirm results.
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Affiliation(s)
- Anja Schnabel
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany.
| | - Elisabeth Unger
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Normi Brück
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Reinhard Berner
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Annette Holl-Wieden
- Pediatric Rheumatology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Henner Morbach
- Pediatric Rheumatology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Anna Leszczynska
- Department of Ophthalmology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Viktoria Bau
- Department of Ophthalmology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Christian M Hedrich
- Pediatric Rheumatology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Germany; Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom.
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Juvenile idiopathic arthritis-associated uveitis. Clin Immunol 2019; 211:108322. [PMID: 31830532 DOI: 10.1016/j.clim.2019.108322] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/05/2019] [Indexed: 12/25/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the commonest rheumatic disease in children and JIA-associated uveitis its most frequent extra-articular manifestation. The uveitis is potentially sight-threatening and so carries a considerable risk of morbidity. The commonest form of uveitis seen in JIA is chronic anterior uveitis which is almost always asymptomatic in the initial stages. Therefore, screening for JIA-associated uveitis in at-risk patients is essential. The aim of early detection and treatment is to minimise intra-ocular inflammation and avoid complications leading to visual loss, resulting from both disease activity and medications. There is increasing evidence for the early introduction of systemic immunosuppressive therapies in order to reduce topical and systemic glucocorticoid use. Two randomised controlled trials of adalimumab in JIA-associated uveitis provide convincing evidence for the use of this biologic in patients who fail to respond adequately to methotrexate. Tocilizumab and baricitinib are being investigated as alternatives to anti-tumour necrosis factor drugs.
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Beck KM, Seitzman GD, Yang EJ, Sanchez IM, Liao W. Ocular Co-Morbidities of Atopic Dermatitis. Part II: Ocular Disease Secondary to Treatments. Am J Clin Dermatol 2019; 20:807-815. [PMID: 31352589 DOI: 10.1007/s40257-019-00465-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Treatments used for managing atopic dermatitis (AD) may have adverse ocular effects that permanently affect vision. The objective of this review is to raise awareness among dermatologists regarding the potential ocular adverse effects of various AD therapies, including corticosteroids, calcineurin inhibitors, an interleukin-4 receptor α (IL-4Rα) antagonist, and phototherapy. Pertinent potential short- and long-term risks of these therapies include elevations in intraocular pressure from use of topical corticosteroids and conjunctivitis from use of dupilumab. Since some of these adverse effects may not exhibit symptomatology until permanent vision impairment occurs, it is important for dermatologists to understand these risks and proactively ensure their patients are receiving appropriate measures to prevent them.
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Affiliation(s)
- Kristen M Beck
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA.
| | - Gerami D Seitzman
- Department of Ophthalmology, Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Eric J Yang
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Isabelle M Sanchez
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, 515 Spruce Street, San Francisco, CA, 94118, USA
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Miraldi Utz V, Bulas S, Lopper S, Fenchel M, Sa T, Mehta M, Ash D, Lovell DJ, Kaufman AH. Effectiveness of long-term infliximab use and impact of treatment adherence on disease control in refractory, non-infectious pediatric uveitis. Pediatr Rheumatol Online J 2019; 17:79. [PMID: 31783768 PMCID: PMC6884783 DOI: 10.1186/s12969-019-0383-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/14/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Refractory non-infectious uveitis is a serious condition that leads to ocular complications and vision loss and requires effective systemic treatment to control disease. The effectiveness of long-term infliximab [IFX] in refractory non-infectious childhood uveitis and the impact of treatment adherence on disease control were evaluated. METHODS Retrospective, single-center study between December 2002 and April 2016 of 27 children with refractory non-infectious uveitis [17 with juvenile idiopathic arthritis, JIA] treated with long-term IFX [9+ months]. Disease activity was assessed prior to and while on IFX using the Standardization of Uveitis Nomenclature [SUN]. Number of visits per year with active uveitis was analyzed by repeated measures logistic regression analysis from 2 years prior to IFX initiation or from onset of uveitis until most recent visit on IFX. Incomplete treatment adherence was assessed for each visit and defined as any deviance in corticosteroid use, prescribed infusion frequency, and/or follow-up examination frequency. RESULTS Primary outcomes were sustained uveitic and systemic disease control prior to and during IFX treatment and the impact of incomplete adherence on uveitic disease control while on IFX. Secondary outcomes included corticosteroid and glaucoma medication requirement, ocular complications and need for surgical intervention. Mean age at IFX initiation was 10.4 ± 4.5 years; initial mean dose was 6.6 ± 2.2 mg/kg [and given at weeks 0, 2, 4 and q4 weeks thereafter for 93%]. Median duration on IFX was 35 [range 9-128] months. Prior to IFX, 14/27 patients had failed adalimumab ± methotrexate [MTX]; 21/27 failed MTX. IFX led to uveitis control in 89% and arthritis control in 76% (13/17). The odds ratio of having controlled disease after IFX was 4.1 (2.6, 6.4) compared to pre-treatment visits. Topical corticosteroids and glaucoma medications were statistically decreased (p = 0.007 right eye [OD], 0.003 left eye [OS] and p = 0.001 OD, p = 0.028 OS respectively). Incomplete adherence to treatment showed 10.3 times greater odds (7.1, 15.0) of having disease activity than full adherence. CONCLUSIONS This study adds significantly to the IFX literature by documenting outstanding uveitis control with long-term IFX treatment in non-infectious pediatric uveitis patients. Higher dosage and shorter interval were utilized without adverse effects. Importantly, this is the first study, to our knowledge, to document the significant impact of treatment adherence on uveitis control.
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Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.
| | - Sabrina Bulas
- 0000 0000 9025 8099grid.239573.9Abrahamson Pediatric Eye Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,0000 0001 2179 9593grid.24827.3bDepartment of Ophthalmology, University of Cincinnati, Cincinnati, OH USA
| | - Sarah Lopper
- 0000 0000 9025 8099grid.239573.9Abrahamson Pediatric Eye Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,0000 0001 2179 9593grid.24827.3bDepartment of Ophthalmology, University of Cincinnati, Cincinnati, OH USA
| | - Matthew Fenchel
- 0000 0000 9025 8099grid.239573.9Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Ting Sa
- 0000 0000 9025 8099grid.239573.9Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Mitul Mehta
- 0000 0001 0668 7243grid.266093.8Gavin Herbert Eye Institute, University of California, Irvine, CA USA
| | - Daniel Ash
- 0000 0004 1936 7822grid.170205.1Department of Medicine, University of Chicago, Chicago, IL USA
| | - Daniel J. Lovell
- 0000 0000 9025 8099grid.239573.9Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Adam H. Kaufman
- 0000 0000 9025 8099grid.239573.9Abrahamson Pediatric Eye Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,0000 0001 2179 9593grid.24827.3bDepartment of Ophthalmology, University of Cincinnati, Cincinnati, OH USA ,grid.418609.2Cincinnati Eye Institute, Cincinnati, OH USA
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Cheung CSY, Mireskandari K, Ali A, Silverman E, Tehrani N. Earlier use of systemic immunosuppression is associated with fewer ophthalmic surgeries in paediatric non-infectious uveitis. Br J Ophthalmol 2019; 104:938-942. [DOI: 10.1136/bjophthalmol-2019-314875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/04/2019] [Accepted: 09/27/2019] [Indexed: 11/03/2022]
Abstract
Background/aimsThere is a paucity of large trials investigating the effect of management strategies for paediatric non-infectious uveitis on complications requiring surgery. The purpose of our study is to investigate whether earlier initiation of systemic immunosuppression in paediatric non-infectious uveitis is associated with fewer ophthalmic surgeries.MethodsA retrospective review was conducted on 48 children with non-infectious uveitis assessed in 1998–2013. Patients were divided into uveitis diagnosed before December 2008 (group 1) and after January 2009 (group 2). Duration from uveitis onset to methotrexate initiation (U-MTX) and biological addition (U-Biologic) were reviewed. Follow-up visits with topical corticosteroids >3 times daily and active uveitis (≥1+ cells) during 3.5 years were documented. The main outcome measure was the need for ≥1 ophthalmic surgery at 3.5 years.ResultsIn group 1, 69.5% of patients required ≥1 ophthalmic surgery at 3.5 years versus 26.9% in group 2 (p=0.005). U-MTX was 28.9±11.8 weeks and 14.2±10.0 weeks for groups 1 and 2 (p=0.028). U-Biologic was 134.6±46.0 weeks and 82.3±43.3 weeks for groups 1 and 2 (p=0.0016). Corticosteroid use >3 times daily was 85.9±52.7 weeks and 14.6±11.1 weeks for groups 1 and 2. Multivariate regression showed methotrexate initiation within 6 months of uveitis onset lowered the likelihood of needing ophthalmic surgery at 3.5 years (OR=6.2, 95% CI 1.2 to 33.4; p=0.033). Univariate regression demonstrated biological addition within 18 months of uveitis onset reduced the likelihood of requiring ophthalmic surgery (OR 12.57, 95% CI 1.28 to 123.48; p=0.030).ConclusionEarlier control of uveitis by addition of immunosuppressive therapy reduced the need for ophthalmic surgery.
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Effect of topical steroids on recently developed incomplete nasolacrimal duct obstruction: optical coherence tomography study. Graefes Arch Clin Exp Ophthalmol 2019; 257:2315-2322. [DOI: 10.1007/s00417-019-04392-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/29/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022] Open
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Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Holland GN, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Sen HN, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken) 2019; 71:703-716. [PMID: 31021540 DOI: 10.1002/acr.23871] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.
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Affiliation(s)
- Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gary N Holland
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Rayfel Schneider
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Holland GN, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Sen HN, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Rheumatol 2019; 71:864-877. [PMID: 31021511 DOI: 10.1002/art.40885] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.
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Affiliation(s)
- Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gary N Holland
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Rayfel Schneider
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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Costet C, Andrèbe C, Paya C, Pillet P, Richer O, Rougier MB, Korobelnik JF, Coste V. [Cataract surgery in children with non-infectious uveitis: Review of current practices in France]. J Fr Ophtalmol 2019; 42:441-450. [PMID: 30975438 DOI: 10.1016/j.jfo.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the medical-surgical management of cataract surgery in children with chronic uveitis in various French pediatric ophthalmology centers. MATERIALS AND METHODS Two-part study: first, a descriptive observational segment on the evaluation of French practices. A questionnaire was sent to the various pediatric ophthalmologists in France. A second retrospective chart review, including children with non-infectious chronic uveitis who had cataract surgery in the pediatric ophthalmology department of Bordeaux University Hospital from 2008 to 2017. RESULTS Twenty-one ophthalmologists responded to the questionnaire. Only 23.8% systematically initiated immunosuppressive drugs (aside from corticosteroids) before surgery. A total of 88.2% prescribed oral corticosteroid treatment preoperatively. Eleven surgeons administered intravenous corticosteroid boluses during the surgery, and primary lens implantation is the most common method used in 95.2%. A total of 76.2% initiated oral steroid therapy after surgery. Postoperatively, all surgeons started local therapy with high-dose corticosteroids. At one year, 100% achieved improvement of visual acuity greater than or equal to 2 lines. On our service, 10 eyes (7 children) underwent cataract surgery. Seven were treated with systemic immunosuppressive drugs (aside from corticosteroids) and 80% of cases received oral corticosteroid therapy a few days before surgery. An intravenous corticosteroid bolus was administered preoperatively in 8 cases, and primary lens implantation was performed in 100% of cases. Postoperatively, 5 children received oral corticosteroid treatment. All were treated with local high dose steroids. At one year, the mean best-corrected visual acuity was 0.18 LogMar (0-0.7, SD: 0.25). CONCLUSION When performed with an aggressive anti-inflammatory protocol, cataract surgery leads to a good visual outcome in selected children with chronic uveitis.
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Affiliation(s)
- C Costet
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - C Andrèbe
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - C Paya
- Centre d'ophtalmologie Palais Gallien, 33000 Bordeaux, France
| | - P Pillet
- Pole de pédiatrie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - O Richer
- Pole de pédiatrie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - M B Rougier
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J F Korobelnik
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, ISPED, place Amélie-Raba-Léon, 33000 Bordeaux, France; Inserm, U1219, Bordeaux Population Health Research Center, 33000 Bordeaux, France
| | - V Coste
- Service d'ophtalmologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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66
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Yasumura J, Yashiro M, Okamoto N, Shabana K, Umebayashi H, Iwata N, Okura Y, Kubota T, Shimizu M, Tomiita M, Nakagishi Y, Nishimura K, Hara R, Mizuta M, Yasumi T, Yamaide F, Wakiguchi H, Kobayashi M, Mori M. Clinical features and characteristics of uveitis associated with juvenile idiopathic arthritis in Japan: first report of the pediatric rheumatology association of Japan (PRAJ). Pediatr Rheumatol Online J 2019; 17:15. [PMID: 30975163 PMCID: PMC6460824 DOI: 10.1186/s12969-019-0318-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/01/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although there are many reports on Juvenile Idiopathic arthritis-associated uveitis (JIA-U) from various countries, especially from Europe and North America, there are few reports from Asia. Our aim was to investigate the epidemiology, characteristics and predictors of JIA-U in Japan. METHODS Data were retrospectively collected on 726 patients with JIA from medical records as of April 2016 at 15 medical centers specialized in pediatric rheumatic diseases. Of these, patients with uveitis were further investigated for the specific characteristics of this manifestation. RESULTS The prevalence of uveitis was 6.1% in the 726 JIA patients examined. Incidence of uveitis was significantly higher in patients with an earlier arthritis onset (2.6-vs.-5.8 years, P < 0.0001), oligoarthritis (16.1%-vs.-1.6%, P < 0.001), or anti-nuclear antibodies. On the contrary, it was significantly less common in patients with rheumatoid factor or anti-cyclic citrullinated peptide antibodies. A history of using methotrexate (MTX), infliximab or adalimumab was also associated with uveitis occurrence. The median age at uveitis diagnosis was 5 years, and the median time from arthritis onset to uveitis diagnosis was 2 years. The occurrence of anterior and bilateral uveitis was 79.3 and 53.7%, respectively. There were no symptoms at uveitis diagnosis in 58.5% of cases. Complications arising between the time of uveitis diagnosis and the last observation increased from 31.7 to 56.1%; in particular, cataract was increased 3-fold. While no patients lost their vision, 61.9% did not recover normal vision (≥ 1.0), and in many cases active uveitis persisted, especially in males. In addition to steroid eye drops (97.6%) and MTX (15.4%), biological agents were used for treating the uveitis in 41.5% of patients. CONCLUSIONS The epidemiology, characteristics and predictors of JIA-U in Japan are described here for the first time. Although the prevalence of JIA-U in Japan is lower than in predominantly Caucasian cohorts, as reported from North America and Europe, the epidemiology, characteristics and predictors were found to be similar.
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Affiliation(s)
- Junko Yasumura
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Masato Yashiro
- 0000 0004 0631 9477grid.412342.2Department of Pediatrics, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Nami Okamoto
- 0000 0001 2109 9431grid.444883.7Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686 Japan
| | - Kosuke Shabana
- 0000 0001 2109 9431grid.444883.7Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686 Japan
| | - Hiroaki Umebayashi
- 0000 0004 0471 4457grid.415988.9Department of General Pediatrics, Miyagi Children’s Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, 989-3126 Japan
| | - Naomi Iwata
- Department of Immunology and Infectious Diseases, Aichi Children’s Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710 Japan
| | - Yuka Okura
- Department of Pediatrics, KKR Sapporo Medical Center, 6-3-40 Hiragishi 1-jo, Toyohira-ku, Sapporo, 062-0931 Japan
| | - Tomohiro Kubota
- 0000 0004 0377 8088grid.474800.fDepartment of Pediatrics, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-0075 Japan
| | - Masaki Shimizu
- 0000 0001 2308 3329grid.9707.9Department of Pediatrics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Minako Tomiita
- 0000 0004 0632 2959grid.411321.4Department of Allergy and Rheumatology, Chiba Children’s Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0007 Japan
| | - Yasuo Nakagishi
- grid.415413.6Department of Pediatric Rheumatology, Hyogo Prefectural Kobe Children’s Hospital, 1-6-7 Minatojimaminami-machi, Chuo-ku, Kobe, 650-0047 Japan
| | - Kenichi Nishimura
- 0000 0001 1033 6139grid.268441.dDepartment of Pediatrics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Ryoki Hara
- 0000 0001 1033 6139grid.268441.dDepartment of Pediatrics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Japan
| | - Mao Mizuta
- 0000 0001 2308 3329grid.9707.9Department of Pediatrics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Takahiro Yasumi
- 0000 0004 0372 2033grid.258799.8Department of Pediatrics, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - Fumiya Yamaide
- 0000 0004 0370 1101grid.136304.3Department of Pediatrics, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Hiroyuki Wakiguchi
- 0000 0001 0660 7960grid.268397.1Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, 755-8505 Japan
| | - Masao Kobayashi
- 0000 0000 8711 3200grid.257022.0Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 Japan
| | - Masaaki Mori
- 0000 0001 1014 9130grid.265073.5Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
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67
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Angeles-Han ST, Lo MS, Henderson LA, Lerman MA, Abramson L, Cooper AM, Parsa MF, Zemel LS, Ronis T, Beukelman T, Cox E, Sen HN, Holland GN, Brunner HI, Lasky A, Rabinovich CE. Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans for Juvenile Idiopathic Arthritis-Associated and Idiopathic Chronic Anterior Uveitis. Arthritis Care Res (Hoboken) 2019; 71:482-491. [PMID: 29806733 PMCID: PMC6261704 DOI: 10.1002/acr.23610] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/22/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Systemic immunosuppressive treatment of pediatric chronic anterior uveitis (CAU), both juvenile idiopathic arthritis-associated and idiopathic anterior uveitis, varies, making it difficult to identify best treatments. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) for CAU for the purpose of reducing practice variability and allowing future comparison of treatments using comparative effectiveness analysis techniques. METHODS A core group of pediatric rheumatologists, ophthalmologists with uveitis expertise, and a lay advisor comprised the CARRA uveitis workgroup that performed a literature review on pharmacologic treatments, held teleconferences, and developed a case-based survey administered to the CARRA membership to delineate treatment practices. We held 3 face-to-face consensus meetings using nominal group technique to develop CTPs. RESULTS The survey identified areas of treatment practice variability. We developed 2 CTPs for the treatment of CAU, case definitions, and monitoring parameters. The first CTP is directed at children who are naive to steroid-sparing medication, and the second at children initiating biologic therapy, with options for methotrexate, adalimumab, and infliximab. We defined a core data set and outcome measures, with data collection at 3 and 6 months after therapy initiation. The CARRA membership voted to accept the CTPs with a >95% approval (n = 233). CONCLUSION Using consensus methodology, 2 standardized CTPs were developed for systemic immunosuppressive treatment of CAU. These CTPs are not meant as treatment guidelines, but are designed for further pragmatic research within the CARRA research network. Use of these CTPs in a prospective comparison effectiveness study should improve outcomes by identifying best practice options.
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Affiliation(s)
- Sheila T. Angeles-Han
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Mindy S. Lo
- Division of Immunology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lauren A. Henderson
- Division of Immunology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Leslie Abramson
- Vermont Children’s Hospital at University of Vermont Medical Center, Burlington, VT
| | | | | | | | - Tova Ronis
- Children’s National Health System, Washington, DC
| | | | | | - H. Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Gary N. Holland
- UCLA Stein Eye Institute and David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Hermine I. Brunner
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Andrew Lasky
- Randall Children’s Hospital at Legacy Emmanuel, Portland, OR
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68
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Haasnoot AMJ, Kuiper JJ, de Boer JH. Predicting uveitis in juvenile idiopathic arthritis: from biomarkers to clinical practice. Expert Rev Clin Immunol 2019; 15:657-666. [DOI: 10.1080/1744666x.2019.1593139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Anne-Mieke J.W. Haasnoot
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jonas J.W. Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joke H. de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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69
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Oh LJ, Nguyen CL, Phan K, Wong E, Zagora S, Singh-Grewal D, Chaitow J, Grigg JR, McCluskey P. Changing biological disease modifying treatment for paediatric uveitis in the real world. Clin Exp Ophthalmol 2019; 47:741-748. [PMID: 30834650 DOI: 10.1111/ceo.13494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/07/2019] [Accepted: 02/24/2019] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Paediatric uveitis is a severe sight-threatening uveitis due to disease progression and treatment failure. Biological agents are a promising new treatment. This study provides real-world data on their use from Sydney, Australia. BACKGROUND Traditionally corticosteroids and non-biological immunosuppressive agents were used to treat paediatric uveitis, often with poor outcomes. DESIGN Retrospective, chart review over an 8-year period at a tertiary referral eye hospital. PARTICIPANTS A total of 27 paediatric uveitis patients treated with biological agents. METHODS Chart review of demographic data and treatment outcomes. MAIN OUTCOME MEASURES Treatment efficacy (corticosteroid-sparing effect, topical steroid cessation/reduction, reduction in systemic-steroid sparing agents, change in intraocular inflammation, visual acuity and central macular thickness); treatment failure; and adverse events. Data were collected at biological initiation, 6 weeks, 6 months and 12 months. RESULTS Biological therapy over 1 year was effective with prednisolone dose reduced to <5 mg/day in five of six patients (83%), number of systemic steroid-sparing agents was reduced to ≤1 in two of four patients (50%) and cessation of topical steroid achieved in 12/41 of eyes (29%). Improvement of anterior chamber cells by two grades occurred in 20/25 eyes (80%), improvement of logMAR to ≤0.3 occurred in 12/18 eyes (67%) and macular oedema decreased in 4/5 eyes (80%). Treatment failure occurred in six eyes (13.01%) and five patients (18.5%) developed an adverse reaction. CONCLUSIONS AND RELEVANCE Biological therapy was effective in paediatric patients with uveitis. Intraocular inflammation improved with maintained visual acuity, systemic corticosteroid dose decreased and there was a low frequency of adverse events.
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Affiliation(s)
- Lawrence J Oh
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Chu L Nguyen
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Kevin Phan
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Eugene Wong
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Sophia Zagora
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Davinder Singh-Grewal
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia.,Department of Ophthalmology, Department of Rheumatology, The Sydney Children's Hospital, Sydney, Australia.,Department of Ophthalmology, Department of Rheumatology, The Children's Hospital at Westmead, Sydney, Australia
| | - Jeffrey Chaitow
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia.,Department of Ophthalmology, Department of Rheumatology, The Sydney Children's Hospital, Sydney, Australia
| | - John R Grigg
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia.,Department of Ophthalmology, Department of Rheumatology, The Children's Hospital at Westmead, Sydney, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
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70
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Heiligenhaus A, Minden K, Tappeiner C, Baus H, Bertram B, Deuter C, Foeldvari I, Föll D, Frosch M, Ganser G, Gaubitz M, Günther A, Heinz C, Horneff G, Huemer C, Kopp I, Lommatzsch C, Lutz T, Michels H, Neß T, Neudorf U, Pleyer U, Schneider M, Schulze-Koops H, Thurau S, Zierhut M, Lehmann HW. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin Arthritis Rheum 2018; 49:43-55. [PMID: 30595409 DOI: 10.1016/j.semarthrit.2018.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized. METHODS Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure). RESULTS Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of ≥ 2 years of uveitis inactivity. CONCLUSIONS An interdisciplinary, evidence-based treatment guideline for JIAU is presented.
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Affiliation(s)
- A Heiligenhaus
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany.
| | - K Minden
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Tappeiner
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H Baus
- The Participation of the Following Bodies: Parents' Group for Children with Uveitis and their Families, Germany
| | - B Bertram
- Professional Association of Ophthalmologists (BVA), Germany
| | - C Deuter
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - I Foeldvari
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - D Föll
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Frosch
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - G Ganser
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Gaubitz
- German Society of Rheumatology (DGRh), Germany
| | - A Günther
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Heinz
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - G Horneff
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Huemer
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - I Kopp
- Association of the Scientific Medical Societies in Germany (AWMF), Germany
| | - C Lommatzsch
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - T Lutz
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - H Michels
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - T Neß
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - U Neudorf
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - U Pleyer
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Schneider
- German Society of Rheumatology (DGRh), Germany
| | | | - S Thurau
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Zierhut
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H W Lehmann
- The Society for Paediatric Rheumatology (GKJR), Germany
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71
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Tappeiner C, Klotsche J, Sengler C, Niewerth M, Liedmann I, Walscheid K, Lavric M, Foell D, Minden K, Heiligenhaus A. Risk Factors and Biomarkers for the Occurrence of Uveitis in Juvenile Idiopathic Arthritis: Data From the Inception Cohort of Newly Diagnosed Patients With Juvenile Idiopathic Arthritis Study. Arthritis Rheumatol 2018; 70:1685-1694. [PMID: 29732713 DOI: 10.1002/art.40544/abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/26/2018] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To analyze the prognostic value of demographic, clinical, and therapeutic factors and laboratory biomarkers and to assess their role in predicting uveitis occurrence in patients with juvenile idiopathic arthritis (JIA). METHODS Patients with JIA were enrolled within the first year after JIA diagnosis. Demographic and clinical parameters were documented. Serum samples were collected at study enrollment, at 3-month follow-up visits within the first year, and then every 6 months. A multivariable Cox regression analysis was performed to evaluate the impact of demographic, clinical, laboratory, and therapeutic parameters on uveitis onset. RESULTS We included 954 JIA patients (67.2% female, 54.2% antinuclear antibody [ANA] positive, mean ± SD age at onset 7.1 ± 4.6 years). Uveitis occurred in 133 patients (observation period 44.5 months). Young age at JIA onset and ANA positivity were significantly associated with the onset of uveitis (both P < 0.001). Treatment of arthritis with methotrexate alone (hazard ratio [HR] 0.18 [95% confidence interval (95% CI) 0.12-0.29], P < 0.001) or combined with etanercept (HR 0.10 [95% CI 0.04-0.23], P < 0.001) or adalimumab (HR 0.09 [95% CI 0.01-0.61], P = 0.014) reduced the risk of uveitis onset and the occurrence of uveitis-related complications. Predictors of uveitis onset included elevated erythrocyte sedimentation rate at baseline (HR 2.36 [95% CI 1.38-4.02], P = 0.002) and continuing moderate or high disease activity during follow-up as measured by the 10-joint clinical Juvenile Arthritis Disease Activity Score (HR 4.30 [95% CI 2.51-7.37], P < 0.001). Additionally, S100A12 levels ≥250 ng/ml at baseline were significantly associated with the risk of uveitis (HR 2.10 [95% CI 1.15-3.85], P = 0.016). CONCLUSION Apart from demographic risk factors and treatment modalities, JIA disease activity scores and laboratory biomarkers could be used to better define the group of JIA patients at high risk of uveitis onset.
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Affiliation(s)
- Christoph Tappeiner
- Inselspital, University of Bern, Bern, Switzerland, German Rheumatism Research Center, Berlin, Germany, and St. Franziskus Hospital, Muenster, Germany
| | - Jens Klotsche
- German Rheumatism Research Center and Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ina Liedmann
- German Rheumatism Research Center, Berlin, Germany
| | | | | | - Dirk Foell
- University of Muenster, Muenster, Germany
| | - Kirsten Minden
- German Rheumatism Research Center and Charité Universitätsmedizin Berlin, Berlin, Germany
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72
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Batu ED. Glucocorticoid treatment in juvenile idiopathic arthritis. Rheumatol Int 2018; 39:13-27. [PMID: 30276425 DOI: 10.1007/s00296-018-4168-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/26/2018] [Indexed: 01/17/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of joints in childhood. Glucocorticoids are being used in JIA treatment effectively for decades. Although systemic glucocorticoid use decreased with the introduction of biologic drugs, intraarticular glucocorticoid injections (IAGI) with nonsteroidal anti-inflammatory drugs and non-biologic disease modifying anti-rheumatic drugs (DMARDs) still remain the primary treatment in JIA, especially in oligoarticular subcategory. Systemic glucocorticoids are used mainly for severe JIA-associated complications such as macrophage activation syndrome (MAS), myocarditis, pericarditis, pleuritis, peritonitis, and severe anemia; as bridging therapy while waiting for the full therapeutic effect of DMARDs; and in certain occasions for patients with severe refractory uveitis. Since glucocorticoid administration is associated with many adverse events, it is important to use glucocorticoids in an optimum way balancing the risks and benefits. The aim of this review is to summarize the current knowledge on glucocorticoid treatment in JIA. A comprehensive literature search was conducted utilizing the Cochrane Library and MEDLINE/PubMed databases. The main topics include mechanism of action, dose, duration, adverse events, vaccination during glucocorticoid treatment, the place of glucocorticoids in JIA treatment guidelines and consensus treatment plans, glucocorticoid use in JIA-associated uveitis, MAS, and IAGI. Data from the literature provide guidance on how to use glucocorticoids in JIA treatment especially for IAGI and systemic use in systemic JIA and MAS. However, there is lack of evidence and need for prospective randomized studies in most parts including the indications in different JIA subcategories, optimum dose/route of administration/duration of treatment, and tapering strategies.
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Affiliation(s)
- Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Ankara Training and Research Hospital, University of Health Sciences, Ankara, 06100, Turkey.
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74
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Sharief L, Lightman S, Baltinas J, Tomkins-Netzer O. Long-term effect of cataract phacoemulsification on the inflammation control and clinical outcome in uveitis patients .. Clin Exp Ophthalmol 2018; 46:1048-1054. [PMID: 30073744 DOI: 10.1111/ceo.13369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Cataract is one of the most common complications associated with uveitis, and is the leading cause of vision loss in these patients. BACKGROUND The study aimed to evaluate the effect of phacoemulsification on the long-term clinical outcome and inflammation control in uveitis patients. DESIGN Longitudinal study. PARTICIPANTS Of 1907 eyes with uveitis, 309 eyes underwent phacoemulsification were compared to a control group of 300 phakic eyes with uveitis. METHOD The risk of vision loss and macular oedema in pseudophakic eyes were compared to the phakic group. The rates of corticosteroids administration and uveitis relapse were also measured in pseudophakic eyes and compared to preoperative period. MAIN OUTCOME MEASURES Change in uveitis activity post phacoemulsification by measuring rate of uveitis relapse and use of topical and systemic steroids. Also, to measure the risk of vision loss and macular oedema post surgery. RESULTS Over a median follow-up time of 6.7 years or 2249 eye-years (EY), pseudophakic eyes had a greater risk of vision loss (hazard ratio [HR] 2.4, CI 1.4 to 4.0; P < 0.001) and macular oedema (HR 2.2, CI 1.4 to 3.4, P < 0.001) compared to the phakic uveitis group. Over 5 years post-surgery, the annual rate of uveitis relapses was less than the same period pre surgery (-1.2, 95% CI -2.0 to -0.2, P = 0.012) with no significant change in the annual rate of using topical and systemic prednisolone >7.5 mg/day. CONCLUSIONS AND RELEVANCE There was no significant increase in uveitis relapse rate post-phacoemulsification with the use of current prophylactic inflammation control measures.
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Affiliation(s)
- Lazha Sharief
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,College of Medicine, Hawler Medical University, Erbil, Iraq
| | | | - Julijana Baltinas
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,Technion - Israel Institute of Technology, Haifa, Israel
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75
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Tappeiner C, Klotsche J, Sengler C, Niewerth M, Liedmann I, Walscheid K, Lavric M, Foell D, Minden K, Heiligenhaus A. Risk Factors and Biomarkers for the Occurrence of Uveitis in Juvenile Idiopathic Arthritis: Data From the Inception Cohort of Newly Diagnosed Patients With Juvenile Idiopathic Arthritis Study. Arthritis Rheumatol 2018; 70:1685-1694. [PMID: 29732713 PMCID: PMC6174956 DOI: 10.1002/art.40544] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/26/2018] [Indexed: 12/18/2022]
Abstract
Objective To analyze the prognostic value of demographic, clinical, and therapeutic factors and laboratory biomarkers and to assess their role in predicting uveitis occurrence in patients with juvenile idiopathic arthritis (JIA). Methods Patients with JIA were enrolled within the first year after JIA diagnosis. Demographic and clinical parameters were documented. Serum samples were collected at study enrollment, at 3‐month follow‐up visits within the first year, and then every 6 months. A multivariable Cox regression analysis was performed to evaluate the impact of demographic, clinical, laboratory, and therapeutic parameters on uveitis onset. Results We included 954 JIA patients (67.2% female, 54.2% antinuclear antibody [ANA] positive, mean ± SD age at onset 7.1 ± 4.6 years). Uveitis occurred in 133 patients (observation period 44.5 months). Young age at JIA onset and ANA positivity were significantly associated with the onset of uveitis (both P < 0.001). Treatment of arthritis with methotrexate alone (hazard ratio [HR] 0.18 [95% confidence interval (95% CI) 0.12–0.29], P < 0.001) or combined with etanercept (HR 0.10 [95% CI 0.04–0.23], P < 0.001) or adalimumab (HR 0.09 [95% CI 0.01–0.61], P = 0.014) reduced the risk of uveitis onset and the occurrence of uveitis‐related complications. Predictors of uveitis onset included elevated erythrocyte sedimentation rate at baseline (HR 2.36 [95% CI 1.38–4.02], P = 0.002) and continuing moderate or high disease activity during follow‐up as measured by the 10‐joint clinical Juvenile Arthritis Disease Activity Score (HR 4.30 [95% CI 2.51–7.37], P < 0.001). Additionally, S100A12 levels ≥250 ng/ml at baseline were significantly associated with the risk of uveitis (HR 2.10 [95% CI 1.15–3.85], P = 0.016). Conclusion Apart from demographic risk factors and treatment modalities, JIA disease activity scores and laboratory biomarkers could be used to better define the group of JIA patients at high risk of uveitis onset.
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Affiliation(s)
- Christoph Tappeiner
- Inselspital, University of Bern, Bern, Switzerland, German Rheumatism Research Center, Berlin, Germany, and St. Franziskus Hospital, Muenster, Germany
| | - Jens Klotsche
- German Rheumatism Research Center and Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ina Liedmann
- German Rheumatism Research Center, Berlin, Germany
| | | | | | - Dirk Foell
- University of Muenster, Muenster, Germany
| | - Kirsten Minden
- German Rheumatism Research Center and Charité Universitätsmedizin Berlin, Berlin, Germany
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76
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Cann M, Ramanan AV, Crawford A, Dick AD, Clarke SLN, Rashed F, Guly CM. Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy. Pediatr Rheumatol Online J 2018; 16:51. [PMID: 30081917 PMCID: PMC6080499 DOI: 10.1186/s12969-018-0266-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is a paucity of data on the ocular outcomes in paediatric non-infectious uveitis since the introduction of the biologic agents. The purpose of this study was to outline the clinical characteristics of children with non-infectious uveitis and determine the visual outcomes and ocular complication rates in the modern era. METHODS Children with non-infectious uveitis from January 2011 to December 2015 were identified. Data was collected at baseline, 1, 3, 5, and 10 years post diagnosis. The incidence rates of visual impairment, structural ocular complications and surgical intervention were calculated. Using logistic regression the association between various baseline characteristics and later visual impairment was investigated. RESULTS Of the 166 children, 60.2% (n = 100) had a systemic disease association. 72.9% (n = 121) children received methotrexate, 58 children progressed to a biologic. The incidence rates of visual acuity loss to > 0.3 LogMAR (6/12) and to ≥1.0 LogMAR (6/60) were 0.05/Eye Year (EY) and 0.01/EY, respectively. Visual outcomes in the Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) and Idiopathic Uveitis cohorts were not statistically significant. Of the 293 affected eyes, posterior synechiae was the predominant complication on presentation, while cataract had the highest incidence rate (0.05/EY). On direct comparison, children with JIA-U were statistically significantly more likely to develop glaucoma while children with Idiopathic Uveitis were statistically significantly more likely to develop macular oedema. CONCLUSION One third of children received a biological therapy, reflecting increasing utilisation and importance of biological agents in the management of inflammatory conditions. Rates of visual impairment and ocular complications are an improvement on previously published data.
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Affiliation(s)
- Megan Cann
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Athimalaipet V. Ramanan
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK
| | - Andrew Crawford
- 0000 0004 1936 7988grid.4305.2BHF Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK ,0000 0004 1936 7603grid.5337.2MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Andrew D. Dick
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfield Eye Hospital, London, UK ,0000000121901201grid.83440.3bUniversity College London Institute of Ophthalmology, London, UK
| | - Sarah L. N. Clarke
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,0000 0004 1936 7603grid.5337.2MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Fatima Rashed
- Translational Health Sciences, Bristol Medical School, Faculty of Health sciences, Bristol, UK
| | - Catherine M. Guly
- 0000 0004 0380 7336grid.410421.2University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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77
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Constantin T, Foeldvari I, Anton J, de Boer J, Czitrom-Guillaume S, Edelsten C, Gepstein R, Heiligenhaus A, Pilkington CA, Simonini G, Uziel Y, Vastert SJ, Wulffraat NM, Haasnoot AM, Walscheid K, Pálinkás A, Pattani R, Györgyi Z, Kozma R, Boom V, Ponyi A, Ravelli A, Ramanan AV. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann Rheum Dis 2018; 77:1107-1117. [PMID: 29592918 PMCID: PMC6059050 DOI: 10.1136/annrheumdis-2018-213131] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is possibly its most devastating extra-articular manifestation. Evidence-based guidelines are sparse and management is mostly based on physicians' experience. Consequently, treatment practices differ widely, within and between nations. OBJECTIVES To provide recommendations for the diagnosis and treatment of JIA-associated uveitis. METHODS Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of nine experienced paediatric rheumatologists and three experts in ophthalmology from Europe. Recommendations derived from a validated systematic literature review were evaluated by an Expert Committee and subsequently discussed at two consensus meetings using nominal group techniques. Recommendations were accepted if >80% agreement was reached (including all three ophthalmologists). RESULTS In total, 22 recommendations were accepted (with >80% agreement among experts): 3 on diagnosis, 5 on disease activity measurements, 12 on treatment and 2 on future recommendations. CONCLUSIONS The SHARE initiative aims to identify best practices for treatment of patients suffering from JIA-associated uveitis. Within this remit, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated by an evidence-informed consensus process to suggest a standard of care for JIA-associated uveitis patients throughout Europe.
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Affiliation(s)
- Tamas Constantin
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Ivan Foeldvari
- Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Joke de Boer
- Department of Ophthalmology, University Hospital Utrecht, Utrecht, The Netherlands
| | | | - Clive Edelsten
- Department of Ophthalmology, Great Ormond Street Hospital, London, UK
| | - Raz Gepstein
- Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel
| | - Arnd Heiligenhaus
- Department of Ophthalmology, Uveitis-Center, and Ophtha Lab, at St. Franziskus Hospital, Muenster, Germany
- University of Duisburg-Essen, Duisburg, Germany
| | | | - Gabriele Simonini
- Department of Paediatrics, Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Yosef Uziel
- Department of Paediatrics, Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sebastian J Vastert
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Anne-Mieke Haasnoot
- Department of Ophthalmology, University Hospital Utrecht, Utrecht, The Netherlands
| | - Karoline Walscheid
- Department of Ophthalmology, Uveitis-Center, and Ophtha Lab, at St. Franziskus Hospital, Muenster, Germany
| | | | - Reshma Pattani
- Department of Ophthalmology, Great Ormond Street Hospital, London, UK
| | - Zoltán Györgyi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Richárd Kozma
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Victor Boom
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Andrea Ponyi
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
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78
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Gonzales JA, Lietman TM. Ocular Involvement in Sjögren’s Syndrome: Advances in Therapy. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0084-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Anterior uveitis is the most common form of uveitis. There are several known and many possible etiologies for anterior uveitis. After examining the posterior segment and ruling out masquerade syndromes, the main step of etiologic diagnosis is clinical characterization. It is essential to establish unilateral versus bilateral involvement and presence or absence of granulomatous features. Subsequently, a work-up may be obtained which then helps to confirm diagnostic hypotheses based on the detailed history and clinical examination. The priority is to rule out an infection, although less frequent, before starting steroid therapy, adapted to the severity of the clinical picture. Finally, biologics have greatly changed the management and prevention of some forms of anterior uveitis, in particular uveitis associated with HLA-B27 and juvenile idiopathic arthritis-associated anterior uveitis.
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Affiliation(s)
- J Gueudry
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen Cedex, France.
| | - M Muraine
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen Cedex, France
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80
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Gueudry J, Muraine M. Anterior uveitis. J Fr Ophtalmol 2017; 41:e11-e21. [PMID: 29290458 DOI: 10.1016/j.jfo.2017.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 09/07/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
Abstract
Anterior Uveitis is the most common form of uveitis. There are several known and many possible etiologies for anterior uveitis. After examining the posterior segment and ruling out masquerade syndromes, the main step of etiologic diagnosis is clinical characterization. It is essential to establish the presence or absence of unilateral versus bilateral and granulomatous features. Subsequently, a directed work-up may be obtained which then helps to confirm diagnostic hypotheses based on the detailed history and clinical examination. The priority is to rule out an infection. Treatments are adapted according to etiology and disease severity. Finally, biologics have greatly changed the management and prevention of some forms of anterior uveitis, in particular uveitis associated with HLA-B27 and juvenile idiopathic arthritis-associated anterior uveitis.
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Affiliation(s)
- J Gueudry
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - M Muraine
- Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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Abstract
The visual outcome of uveitic cataract surgery depends on the underlying uveitic diagnosis, the presence of vision-limiting pathology and perioperative optimization of disease control. A comprehensive preoperative ophthalmic assessment for the presence of concomitant ocular pathology, with particular emphasis on macula and optic nerve involvement, is essential to determine which patients will benefit from improved vision after cataract surgery. Meticulous examination in conjunction with adjunct investigations can help in preoperative surgical planning and in determining the need for combined or staged procedures. The eye should be quiescent for a minimum of 3 months before cataract surgery. Perioperative corticosteroid prophylaxis is important to reduce the risk of cystoid macular edema and recurrence of the uveitis. Antimicrobial prophylaxis may also reduce the risk of reactivation in eyes with infectious uveitis. Uveitic cataracts may be surgically demanding due to the presence of synechiae, membranes, and pupil abnormalities that limit access to the cataract. This can be overcome by manual stretching, multiple sphincterotomies or mechanical dilation with pupil dilation devices. In patients <2 years of age and in eyes where the inflammation is poorly controlled, intraocular lens implantation should be deferred. Intensive local and/or oral steroid prophylaxis should be given postoperatively if indicated. Patients must be monitored closely for disease recurrence, excessive inflammation, raised intraocular pressure, hypotony, and other complications. Complications must be treated aggressively to improve visual rehabilitation. With proper patient selection, improved surgical techniques and optimization of peri- and post-operative care, patients with uveitic cataracts can achieve good visual outcomes.
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Affiliation(s)
| | - Seng-Ei Ti
- Singapore National Eye Centre, Singapore 168751, Singapore
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82
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Uveitis in the Spondyloarthopathies. Best Pract Res Clin Rheumatol 2017; 31:846-862. [DOI: 10.1016/j.berh.2018.08.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/01/2018] [Indexed: 02/07/2023]
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83
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Blum-Hareuveni T, Seguin-Greenstein S, Kramer M, Hareuveni G, Sharon Y, Friling R, Sharief L, Lightman S, Tomkins-Netzer O. Risk Factors for the Development of Cataract in Children with Uveitis. Am J Ophthalmol 2017; 177:139-143. [PMID: 28257832 DOI: 10.1016/j.ajo.2017.02.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the risk factors for the development of cataract in children with uveitis of any etiology. DESIGN Cohort study. METHODS Two hundred forty-seven eyes of 140 children with uveitis were evaluated for the development of vision-affecting cataract. Demographic, clinical, and treatment data were collected between the time of presentation and the first instance cataract was recorded or findings at final follow-up. Main outcome measures included the prevalence of cataract and distribution by type of uveitis, incidence of new onset cataract time to cataract development, and risk factors for the development of cataract. RESULTS The prevalence of cataract in our cohort was 44.2% and was highest among eyes with panuveitis (77.1%), chronic anterior uveitis (48.3%), and intermediate uveitis (48.0%). The overall incidence of newly diagnosed cataract was 0.09 per eye-year, with an estimated 69% to develop uveitis-related cataract with time. The main factors related with cataract development were the number of uveitis flares per year (hazard ratio [HR] = 3.06 [95% confidence interval {CI}, 2.15-4.35], P < .001), cystoid macular edema (HR = 2.87 [95% CI, 1.41-5.82], P = .004), posterior synechia at presentation (HR = 2.85 [95% CI, 1.53-5.30], P = .001), and use of local injections of corticosteroids (HR = 2.37 [95% CI, 1.18-4.75], P = .02). Treatments with systemic and topical corticosteroids were not significant risk factors. CONCLUSIONS In this study, we found that development of cataract is common among pediatric eyes with uveitis and is most strongly related to the extent of inflammation recurrences and ocular complications. We suggest that controlling the inflammation, even using higher doses of systemic and topical corticosteroids, is of importance in preventing ocular complications, such as cataract.
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Affiliation(s)
- Tamar Blum-Hareuveni
- Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, Galilee Medical Center, Naharia, Israel
| | | | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Hareuveni
- Department of Ophthalmology, Galilee Medical Center, Naharia, Israel
| | - Yael Sharon
- Department of Ophthalmology, Rabin Medical Center, Petah-Tikva, Israel
| | - Ronit Friling
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petah-Tikva, Israel
| | - Lazha Sharief
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Sue Lightman
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, Bnai Zion Medical Center, Technion, Israel Institute of Technology, Haifa, Israel.
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84
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Drozdova EA, Yadykina EV, Mezentseva EA, Nikushkina KV. [Cytokine profile changes in children with juvenile idiopathic arthritis-associated uveitis]. Vestn Oftalmol 2017; 133:27-31. [PMID: 28291196 DOI: 10.17116/oftalma2017133127-31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM to identify the differences between serum cytokine profiles in juvenile idiopathic arthritis (JIA) with or without uveal tract inflammation. MATERIAL AND METHODS Serum cytokine profiles were studied in two groups of patients: 20 children with JIA and JIA-associated uveitis and 33 children, who had no signs of uveitis under basic therapy for their JIA. All the patients showed drug remission of articular syndrome. Inflammation of the choroid took the form of chronic anterior uveitis. The process was active in 95% of cases. The control group consisted of 35 children without rheumatic disease or other acute condition at the time of examination. Groups were comparable in terms of age and sex. Serum levels of TNF-α, IFN-γ, IL-17, IL-10 were measured by the enzyme multiplied immunoassay technique. RESULTS A statistically significant increase in TNF-α, IFN-γ, IL-17, and IL-10 levels was found in all patients as compared to the control group. A comparison drawn between serum cytokine levels of JIA patients and those, who also suffered from JIA-associated uveitis, revealed a decrease in IFN-γ and an increase in IL-10 in the latter group. There was also a statistically significant positive correlation between TNF-α and IFN-γ serum levels in patients with JIA-associated uveitis. CONCLUSION Development of uveitis in patients with drug remission of JIA occurs on the background of cytokine imbalance in the serum, in particular, increased concentrations of proinflammatory TNF-α and IL-17 cytokines along with reduced IFN-γ and increased IL-10 levels. This may be regarded as risk factors for ocular inflammation and should be taken into account when making treatment decisions.
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Affiliation(s)
- E A Drozdova
- South Ural State Medical University, 64 Vorovskogo St., Chelaybinsk, Russian Federation, 454092
| | - E V Yadykina
- South Ural State Medical University, 64 Vorovskogo St., Chelaybinsk, Russian Federation, 454092
| | - E A Mezentseva
- South Ural State Medical University, 64 Vorovskogo St., Chelaybinsk, Russian Federation, 454092
| | - K V Nikushkina
- South Ural State Medical University, 64 Vorovskogo St., Chelaybinsk, Russian Federation, 454092
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Increasing risk of cataract in HCV patients receiving anti-HCV therapy: A nationwide cohort study. PLoS One 2017; 12:e0173125. [PMID: 28264004 PMCID: PMC5338813 DOI: 10.1371/journal.pone.0173125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/15/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose Hepatitis C virus (HCV) infection is associated with increased systemic oxidative stress, which leads to cardiovascular events, diabetes, and chronic kidney disease. Similarly, cataract is also associated with increased oxidative stress. The association between HCV infection and increased risk of cataract remains unclear. Methods A total of 11,652 HCV-infected patients and 46,608 age- and sex-matched non-HCV infected patients were identified during 2003–2011. All patient data were tracked until a diagnosis of cataract, death, or the end of 2011. Cumulative incidences and hazard ratios (HRs) were calculated. Results The mean follow-up durations were 5.29 and 5.86 years for the HCV and non-HCV cohorts, respectively. The overall incidence density rate for cataract was 1.36 times higher in the HCV cohort than in the non-HCV cohort (1.86 and 1.37 per 100 person-y, respectively). After adjusting for age, sex, comorbidities of diabetes, hypertension, hyperlipidemia, asthma, chronic obstructive pulmonary disease, coronary artery disease, and anxiety, patients with HCV infection had an increased risk of cataract compared with those without HCV infection [adjusted HR = 1.23, 95% confidence interval (CI) = 1.14–1.32]. HCV-infected patients receiving interferon–ribavirin therapy had a 1.83 times higher (95% CI = 1.40–2.38) risk of cataract than non-HCV infected patients did. Conclusion HCV infection, even without the complication of cirrhosis, is associated with an increased risk of cataract, and this risk is higher in HCV-infected patients undergoing interferon–ribavirin therapy.
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86
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Sood AB, Angeles-Han ST. An Update on Treatment of Pediatric Chronic Non-Infectious Uveitis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2017; 3:1-16. [PMID: 28944162 PMCID: PMC5604477 DOI: 10.1007/s40674-017-0057-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are no standardized treatment protocols for pediatric non-infectious uveitis. Topical corticosteroids are the typical first-line agent, although systemic corticosteroids are used in intermediate, posterior and panuveitic uveitis. Corticosteroids are not considered to be long-term therapy due to potential ocular and systemic side effects. In children with severe and/or refractory uveitis, timely management with higher dose disease-modifying antirheumatic drugs (DMARDs) and biologic agents is important. Increased doses earlier in the disease course may lead to improved disease control and better visual outcomes. In general, methotrexate is the usual first-line steroid-sparing agent and given as a subcutaneous weekly injection at >0.5 mg/kg/dose or 10-15 mg/m2 due to better bioavailability. Other DMARDs, for instance mycophenolate, azathioprine, and cyclosporine are less common treatments for pediatric uveitis. Anti-tumor necrosis factor-alpha agents, primarily infliximab and adalimumab are used as second line agents in children refractory to methotrexate, or as first-line treatment in those with severe complicated disease at presentation. Infliximab may be given at a minimum of 7.5 mg/kg/dose every 4 weeks after loading doses, up to 20 mg/kg/dose. Adalimumab may be given up to 20 or 40 mg weekly. In children who fail anti-tumor necrosis factor-alpha agents, develop anti-tumor necrosis factor-alpha antibodies, experience adverse effects, or have difficulty with tolerance, there is less data available regarding subsequent treatment. Promising results have been noted with tocilizumab infusions every 2-4 weeks, abatacept monthly infusions and rituximab.
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Ocular Hypotony in Patients With Juvenile Idiopathic Arthritis-Associated Uveitis. Am J Ophthalmol 2017; 173:45-55. [PMID: 27664701 DOI: 10.1016/j.ajo.2016.09.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE To analyze occurrence, risk factors, and course of ocular hypotony (OH) in juvenile idiopathic arthritis-associated uveitis (JIAU). DESIGN Cohort study. METHODS Epidemiologic and ophthalmologic data at baseline and during follow-up of JIAU patients with and without ocular hypotony were evaluated. RESULTS OH developed in 57 of the 365 JIAU patients during the follow-up (mean 4.5 ± 3.5 years). In 40 patients with follow-up ≥12 months, OH was unrelated to previous ocular surgery: risk factors at baseline (univariate logistic regression analysis) included longer total duration of uveitis (odds ratio [OR] 1.13, P < .001), bilateral uveitis (OR 3.51, P = .009), low visual acuity (OR 5.1, P = .001), high laser-flare (LF) values (OR 1.74, P = .01), and presence of posterior synechiae (OR 3.28, P = .004). Increased anterior chamber (AC) cell and LF values were observed within 3 months prior to onset of transient (≤3 months; 37.5%) or persistent OH (>3 months; 62.5%). AC cell and LF values decreased within 3 months after onset of transient OH, while LF levels remained elevated ≥12 months in persistent OH. Optic disc edema and epiretinal membrane formation was found more frequently after OH onset. CONCLUSIONS OH was observed in 15.6% of JIAU patients. Longer total uveitis duration, bilateral uveitis, low visual acuity, high AC flare and LF grades, and presence of posterior synechiae at baseline were risk factors for subsequent OH. Burden of OH might be improved with immunosuppression.
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Abstract
Non-infectious uveitis mainly affects the working-age population and can contribute to significant social and economic burden. It comprises a heterogeneous group of conditions with varied aetiology. Precise and early diagnosis, excluding masquerade syndromes, is the key to early therapeutic intervention. Treatment should be appropriately selected according to the anatomical sites of inflammation, the diagnosis and known prognosis, and whether there is a systemic inflammatory drive. Corticosteroids in the form of local or systemic therapy form the mainstay of treatment; however, due to unacceptable side effects, the need for long-term use or suboptimal response, corticosteroid-sparing medications may need to be considered early on in the management of non-infectious uveitis. With newer insights into the immunopathology of uveitis and the availability of biologic agents, treatment can be tailored according to individual needs. Many patients have systemic involvement, and hence a multidisciplinary approach is often required to achieve the best outcome in an individual. Patient involvement in the management of non-infectious uveitis, ensuring compliance, and continual monitoring of both the treatment and therapeutic response are the key to achieving optimal outcomes.
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90
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Foeldvari I. Managing uveitis in patients with juvenile idiopathic arthritis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1176909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ivan Foeldvari
- Hamburger Zentrum für Kinder-und Jugendrheumatologie, Lehrbereich des Asklepios Campus der Semmelweis-Universität, Budapest, Ungarn
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91
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Suelves AM, Lamba N, Meese HK, Foster CS, González-Martín JM, Díaz-Llopis M, Christen WG. Nuclear cataract as an early predictive factor for recalcitrant juvenile idiopathic arthritis-associated uveitis. J AAPOS 2016; 20:232-238.e1. [PMID: 27164426 DOI: 10.1016/j.jaapos.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/08/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze factors predictive of having treatment-resistant uveitis in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. METHODS The medical records of patients diagnosed with JIA-associated uveitis treated at a single tertiary referral center from October 2005 to March 2013 were reviewed retrospectively. The main outcome measures were demographic characteristics, ocular comorbidity, clinical course, treatments, and baseline risk factors associated with poor response to first-line therapies. RESULTS A total of 96 patients (175 eyes) were included. Of these, 58 patients (108 eyes) required biologic disease-modifying antirheumatic drugs or alkylating agents for their uveitis during follow-up (recalcitrant group), and 38 patients (67 eyes) did not (nonrecalcitrant group). Eyes of the recalcitrant group tended to have a higher incidence of cataract at baseline (49%; P < 0.0001). In the nonrecalcitrant group, the most frequent complications were cataract (20.9%) and secondary glaucoma (20.9%). The mean number of flares in the recalcitrant group was significantly reduced from 3.7/eye/year prior to cataract surgery to 1.6/eye/year after (P < 0.0001). Nuclear cataract was found to be an independent predictor for a severe course of JIA-associated uveitis. Any other type of cataract, posterior synechiae, male sex, or active uveitis at baseline were not found to be independently associated with recalcitrant uveitis. CONCLUSIONS Nuclear cataract at baseline evaluation is a risk factor for poor response to first-line therapies in JIA-associated uveitis patients.
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Affiliation(s)
- Ana M Suelves
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Neerav Lamba
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - Halea K Meese
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | | | - Manuel Díaz-Llopis
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - William G Christen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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92
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Manage non-infectious uveitis in adults with individualized immunosuppressive therapy and regular monitoring. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tappeiner C, Schenck S, Niewerth M, Heiligenhaus A, Minden K, Klotsche J. Impact of Antiinflammatory Treatment on the Onset of Uveitis in Juvenile Idiopathic Arthritis: Longitudinal Analysis From a Nationwide Pediatric Rheumatology Database. Arthritis Care Res (Hoboken) 2016. [PMID: 26212111 PMCID: PMC5064660 DOI: 10.1002/acr.22649] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective Based on a nationwide database, this study analyzed the influence of methotrexate (MTX), tumor necrosis factor (TNF) inhibitors, and a combination of the 2 medications on uveitis occurrence in juvenile idiopathic arthritis (JIA) patients. Methods Data from the National Paediatric Rheumatological Database in Germany were used in this study. Between 2002 and 2013, data from JIA patients were annually documented at the participating pediatric rheumatologic sites. Patients with a JIA disease duration of <12 months at initial documentation and ≥2 years of followup were included in this study. The impact of antiinflammatory treatment on the occurrence of uveitis was evaluated by discrete‐time survival analysis. Results A total of 3,512 JIA patients (mean ± SD age 8.3 ± 4.8 years, 65.7% female, 53.2% antinuclear antibody positive, and mean ± SD age at arthritis onset 7.8 ± 4.8 years) fulfilled the inclusion criteria. Mean ± SD total followup time was 3.6 ± 2.4 years. Uveitis developed in a total of 180 patients (5.1%) within 1 year after arthritis onset. Uveitis onset after the first year was observed in another 251 patients (7.1%). Disease‐modifying antirheumatic drug (DMARD) treatment in the year before uveitis onset significantly reduced the risk for uveitis as follows: MTX: hazard ratio (HR) 0.63, P = 0.022; TNF inhibitors: HR 0.56, P < 0.001; and a combination of the 2 medications: HR 0.10, P < 0.001. Patients treated with MTX within the first year of JIA had an even a lower uveitis risk (HR 0.29, P < 0.001). Conclusion The use of DMARDs in JIA patients significantly reduced the risk for uveitis onset. Early MTX use within the first year of disease and the combination of MTX with a TNF inhibitor had the highest protective effect.
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Affiliation(s)
- Christoph Tappeiner
- German Rheumatism Research Centre Berlin, Leibniz Institute, Berlin, St. Franziskus Hospital, Muenster, Germany, and Inselspital, University of Bern, Bern, Switzerland
| | - Sandra Schenck
- German Rheumatism Research Centre Berlin, Leibniz Institute, Berlin, Germany
| | - Martina Niewerth
- German Rheumatism Research Centre Berlin, Leibniz Institute, Berlin, Germany
| | - Arnd Heiligenhaus
- St. Franziskus Hospital, Muenster, and University Duisburg-Essen, Essen, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin, Leibniz Institute, and Charité University Medicine Berlin, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, Leibniz Institute, and Charité University Medicine Berlin, Berlin, Germany
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Clarke SLN, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J 2016; 14:27. [PMID: 27121190 PMCID: PMC4848803 DOI: 10.1186/s12969-016-0088-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/21/2016] [Indexed: 12/14/2022] Open
Abstract
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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Affiliation(s)
- Sarah L. N. Clarke
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK ,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Ethan S. Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK ,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Athimalaipet V. Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK ,School of Clinical Sciences, University of Bristol, Bristol, UK
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Castiblanco C, Meese H, Foster CS. Treatment of pediatric uveitis with adalimumab: the MERSI experience. J AAPOS 2016; 20:145-7. [PMID: 27079596 DOI: 10.1016/j.jaapos.2015.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate adalimumab therapy in children with uveitis. METHODS The electronic health records of pediatric patients diagnosed with uveitis and treated with adalimumab therapy were reviewed retrospectively. Demographic information, site and degree of intraocular inflammation, visual acuity, underlying systemic disorders, duration of therapy, side effects, and ability to obtain steroid-free remission were recorded. RESULTS A total of 17 patients were included, 16 patients with anterior uveitis and 1 with panuveitis; 14 patients had bilateral disease. Juvenile idiopathic arthritis had been diagnosed in 14 patients, sarcoidosis in 1 patient, and idiopathic etiology in 2 patients. Of the 17 patients, 13 (about 77%) achieved steroid-free remission, and 4 did not. Six patients flared after discontinuation of adalimumab, with evidence of inflammation noted 3-7 months later. Adalimumab therapy was of 12-64 months' duration (mean, 36 months). At the time of initiation, 14 patients were using other agents concomitantly with adalimumab; 3 patients were on adalimumab monotherapy. At 1 year's follow-up, 12 patients were using combination therapy, and 3 patients were on adalimumab monotherapy: 11 patients had no evidence of inflammation. Side effects included pain at site of injection in 3 patients, anemia in 1 patient, and depression in 1 patient. CONCLUSIONS In our study cohort, adalimumab was effective in inducing steroid-free remission. It was well tolerated, especially in combination with other immunomodulatory agents. The dosing and the interval can be adjusted to further improve inflammation control.
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Affiliation(s)
- Claudia Castiblanco
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation (OIUF), Waltham, Massachusetts
| | - Halea Meese
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation (OIUF), Waltham, Massachusetts
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution (MERSI), Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation (OIUF), Waltham, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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96
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Phatak S, Lowder C, Pavesio C. Controversies in intraocular lens implantation in pediatric uveitis. J Ophthalmic Inflamm Infect 2016; 6:12. [PMID: 27009616 PMCID: PMC4805676 DOI: 10.1186/s12348-016-0079-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/13/2016] [Indexed: 11/10/2022] Open
Abstract
Cataract is one of the most common and visually debilitating complications of pediatric uveitis. It develops as a consequence of chronic inflammation and steroid use and is seen most often in juvenile idiopathic arthritis (JIA)-associated uveitis. Cataract extraction with intraocular lens (IOL) insertion has been carried out with a measure of success in non-uveitic pediatric eyes, but in cases of uveitis, multiple factors affect the final outcome. Chronic inflammation and its sequelae such as band keratopathy, posterior synechiae, and cyclitic membranes make surgical intervention more challenging and outcome less certain. Postoperative complications like increased inflammation, glaucoma, posterior capsular opacification, retrolental membranes, and hypotony may compromise the visual outcome. Early refractive correction is imperative in pediatric eyes to prevent amblyopia. The use of contact lenses and intraocular lenses in pediatric uveitic eyes were fraught with complications in the past. Surgical interventions such as vitreo-lensectomy followed by contact lens fitting and small incision cataract surgery followed by different types of intraocular lenses have been utilized, and many reports have been published, albeit in small patient groups. This review analyzes and discusses the existing literature on intraocular lens implantation in cases of pediatric uveitic cataract surgery.
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Affiliation(s)
- Sumita Phatak
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Careen Lowder
- Cleveland Clinic Cole Eye Institute, 9500 Euclid Ave, Cleveland, OH, 44106, USA
| | - Carlos Pavesio
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.,Inflammation and Immunotherapy Theme, National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD, UK
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Stroh IG, Moradi A, Burkholder BM, Hornbeak DM, Leung TG, Thorne JE. Occurrence of and Risk Factors for Ocular Hypertension and Secondary Glaucoma in Juvenile Idiopathic Arthritis-associated Uveitis. Ocul Immunol Inflamm 2016; 25:503-512. [PMID: 27003850 DOI: 10.3109/09273948.2016.1142573] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the incidence of ocular hypertension (OHT) and secondary glaucoma (SG) in JIA-associated uveitis, identify risk factors for development of these complications, and describe their effect on visual outcomes. METHODS A retrospective cohort of 108 patients (196 eyes) with JIA-associated uveitis seen over 30 years at an academic practice. RESULTS Of examined eyes, 40% had OHT or SG at presentation. These eyes had a nearly three-fold higher incidence of legal blindness during follow-up, compared with eyes without OHT or SG. An additional 41 eyes developed OHT or SG during follow-up. Presenting with anterior uveitis, active inflammation, and using systemic corticosteroids were risk factors for developing OHT, while use of immunosuppressive medication at presentation reduced this risk. Risk factors for developing SG included anterior uveitis and use of systemic corticosteroids. CONCLUSIONS OHT and SG were common in patients with JIA-associated uveitis. Use of immunosuppressive drugs may decrease the risk of developing OHT.
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Affiliation(s)
- Inna G Stroh
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Ahmadreza Moradi
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Bryn M Burkholder
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Dana M Hornbeak
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Theresa G Leung
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Jennifer E Thorne
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,b Department of Epidemiology , The Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
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Hawkins MJ, Dick AD, Lee RJ, Ramanan AV, Carreño E, Guly CM, Ross AH. Managing juvenile idiopathic arthritis–associated uveitis. Surv Ophthalmol 2016; 61:197-210. [DOI: 10.1016/j.survophthal.2015.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 01/01/2023]
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99
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Henderson LA, Zurakowski D, Angeles-Han ST, Lasky A, Rabinovich CE, Lo MS. Medication use in juvenile uveitis patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2016; 14:9. [PMID: 26879972 PMCID: PMC4755024 DOI: 10.1186/s12969-016-0069-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/04/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is not yet a commonly accepted, standardized approach in the treatment of juvenile idiopathic uveitis when initial steroid therapy is insufficient. We sought to assess current practice patterns within a large cohort of children with juvenile uveitis. METHODS This is a cross-sectional cohort study of patients with uveitis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRAnet) registry. Clinical information including, demographic information, presenting features, disease complications, and medications were collected. Chi-square and Fisher's exact tests were used to assess for associations between medications and clinical characteristics. RESULTS Ninety-two children with idiopathic and 656 with juvenile idiopathic arthritis (JIA)-associated uveitis were identified. Indication (arthritis or uveitis) for medication use was not available for JIA patients; therefore, detailed analysis was limited to children with idiopathic uveitis. In this group, 94 % had received systemic steroids. Methotrexate (MTX) was used in 76 % of patients, with oral and subcutaneous forms given at similar rates. In multivariable analysis, non-Caucasians were more likely to be treated initially with subcutaneous MTX (P = 0.003). Of the 53 % of patients treated with a biologic DMARD, all received a tumor necrosis factor (TNF) inhibitor. TNF inhibitor use was associated with a higher frequency of cataracts (52 % vs 21 %; P = 0.001) and antinuclear antibody positivity (49 % vs 29 %; P = 0.04), although overall complication rates were not higher in these patients. CONCLUSION Among idiopathic uveitis patients enrolled in the CARRAnet registry, MTX was the most commonly used DMARD, with subcutaneous and oral forms equally favored. Patients who received a TNF inhibitor were more likely to be ANA positive and have cataracts.
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Affiliation(s)
- Lauren A. Henderson
- Division of Immunology, Boston Children’s Hospital, Boston, MA and Department of Pediatrics, Harvard Medical School, 1 Blackfan Circle, Karp Building, 10th Floor, Boston, MA 02115 USA
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Sheila T. Angeles-Han
- Department of Pediatrics and Ophthalmology, Emory University School of Medicine, Atlanta, GA USA
| | - Andrew Lasky
- Department of Pediatric Rheumatology, Randall Children's Hospital at Legacy Emanuel, Portland, OR, USA.
| | - C. Egla Rabinovich
- Division of Rheumatology, Department of Pediatrics, Duke Children’s, Durham, NC USA
| | - Mindy S. Lo
- Division of Immunology, Boston Children’s Hospital, Boston, MA and Department of Pediatrics, Harvard Medical School, 1 Blackfan Circle, Karp Building, 10th Floor, Boston, MA 02115 USA
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Abu Samra K, Maghsoudlou A, Roohipoor R, Valdes-Navarro M, Lee S, Foster CS. Current Treatment Modalities of JIA-associated Uveitis and its Complications: Literature Review. Ocul Immunol Inflamm 2016; 24:431-9. [PMID: 26765345 DOI: 10.3109/09273948.2015.1115878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Uveitis is a common and serious complication of juvenile idiopathic arthritis. Up to 75% of all cases of anterior uveitis in childhood are associated with juvenile idiopathic arthritis. Despite the remarkable progress in early detection and treatment of inflammation, vision-threatening complications of uveitis still occur in almost 60% of patients. Structural complications include band keratopathy, maculopathy (macular edema, macular cysts, and epiretinal membrane), glaucomatous optic neuropathy, and cataracts. The management of complications in juvenile idiopathic arthritis is usually complex and requires early surgical intervention. In this paper, we review the general concepts of common ocular complications seen in patients with JIA-associated uveitis, with special attention to the recent diagnostic and preferred treatment approaches at the Massachusetts Eye Research and Surgery Institution. Received 9 March 2015; revised 30 September 2015; accepted 30 October 2015; published online 14 January 2016.
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Affiliation(s)
- Khawla Abu Samra
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA
| | - Armin Maghsoudlou
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA.,c Department of Ophthalmology , Scheie Eye Institute, University of Pennsylvania School of Medicine , Philadelphia , Pennsylvania , USA.,d Harvard Medical School , Cambridge , Massachusetts , USA
| | - Ramak Roohipoor
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA.,e Department of Ophthalmology , Farabi Eye Hospital , Tehran , Iran.,f Eye Research Centre , Tehran University of Medical Sciences , Tehran , Iran.,g Massachusetts Eye and Ear Infirmary , Cambridge , Massachusetts , USA
| | - Manuel Valdes-Navarro
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA
| | - Stacey Lee
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA
| | - C Stephen Foster
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA.,d Harvard Medical School , Cambridge , Massachusetts , USA.,g Massachusetts Eye and Ear Infirmary , Cambridge , Massachusetts , USA
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