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Chen WD, Wu CH, Wu PY, Lin CP, Ou LS, Hwang DK, Sheu SJ, Chiang WY, Chang YC, Lin CJ, Chan WC, Fang YF, Chien-Chieh Huang J, Kao TE, Chiu FY, Hsia NY, Hwang YS. Taiwan ocular inflammation society consensus recommendations for the management of juvenile idiopathic arthritis-associated uveitis. J Formos Med Assoc 2024:S0929-6646(24)00110-4. [PMID: 38423923 DOI: 10.1016/j.jfma.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/06/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
We presented the development of a consensus guideline for managing juvenile idiopathic arthritis-associated uveitis (JIAU) in Taiwan, considering regional differences in manifestation and epidemiology. The Taiwan Ocular Inflammation Society (TOIS) committee formulated this guideline using a modified Delphi approach with two panel meetings. Recommendations were based on a comprehensive evidence-based literature review and expert clinical experiences, and were graded according to the Oxford Centre for Evidence-Based Medicine's "Levels of Evidence" guideline (March 2009). The TOIS consensus guideline consists of 10 recommendations in four categories: screening and diagnosis, treatment, complications, and monitoring, covering a total of 27 items. These recommendations received over 75% agreement from the panelists. Early diagnosis and a coordinated referral system between ophthalmologists and pediatric rheumatologists are crucial to prevent irreversible visual impairment in children with JIAU. However, achieving a balance between disease activity and medication use remains a key challenge in JIAU management, necessitating further clinical studies.
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Affiliation(s)
- Wei-Dar Chen
- Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsiu Wu
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Po-Yi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chang-Ping Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Shiou Ou
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - De-Kuang Hwang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Yu Chiang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yo-Chen Chang
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Optometry, Asia University, Taichung, Taiwan
| | - Wei-Chun Chan
- Department of Ophthalmology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yueh-Fu Fang
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | | | - Tzu-En Kao
- Cheng-Ching Eye Center, Kaohsiung, Taiwan
| | - Fang-Yi Chiu
- Department of Ophthalmology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yih-Shiou Hwang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Department of Ophthalmology, Xiamen Chang Gung Memorial Hospital, Xiamen, China; Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan.
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Psychological Effects and Quality of Life in Parents and Children with Jia-Associated Uveitis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121864. [PMID: 36553308 PMCID: PMC9777304 DOI: 10.3390/children9121864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease common in children and young adults. Uveitis is the most frequent serious extra-articular JIA manifestation and can lead to severe ocular complications, vision loss, and permanent blindness. This study aims to evaluate the psychological condition and the quality of life of children affected by JIA associated with uveitis (JIA-U) and the repercussion of this condition on parents. Thirty children and adolescents with active uveitis (Uveitis group) and comorbid joint symptoms of JIA were referred to the Unit of Ophthalmology, Giovanni XXIII Hospital of Bari, and 30 age-matched healthy controls (Healthy group) were enrolled with their parents. Four questionnaires were administered: Child Behaviour Checklist (CBCL), Parent Stress Index in Short Form (PSI), Pediatric Quality of Life Inventory (PedsQL), and Coping Inventory for Stressful Situations (CISS). The data were collected from February 2021 to December 2021. No significant differences between the two groups in CBCL, PSI, or CISS tests were shown (p > 0.05). Conversely, significant differences between the two groups were observed in the PedsQL (p < 0.05). This study shows how several ocular complications, recurrent eye examinations, and the rigor of long-term treatment may negatively influence health-related quality of life in children with JIA-U.
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Abstract
Childhood noninfectious uveitis leads to sight-threatening complications. Idiopathic chronic anterior uveitis and juvenile idiopathic arthritis-associated uveitis are most common. Inflammation arises from an immune response against antigens within the eye. Ophthalmic work-up evaluates anatomic involvement, disease activity, ocular complications, and disease course. Local and/or systemic glucocorticoids are initial treatment, but not as long-term sole therapy to avoid glucocorticoids-induced toxicity or persistent ocular inflammation. Children with recurrent, refractory, or severe disease require systemic immunosuppression with methotrexate and/or anti-tumor necrosis factor monoclonal antibody medications (adalimumab, infliximab). Goals of early detection and treatment are to optimize vision in childhood uveitis.
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Affiliation(s)
- Margaret H Chang
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Fegan 6, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jessica G Shantha
- Department of Ophthalmology, Emory University, Emory Eye Center, 1365 Clifton Road, Clinic Building B, Atlanta, GA 30326, USA
| | - Jacob J Fondriest
- Department of Internal Medicine, Summa Health System, Internal Medicine Center, 55 Arch Street, Suite 1B, Akron, OH 44304, USA; Rush Eye Center, 1725 West Harrison Street, Suite 945, Chicago, IL 60612, USA
| | - Mindy S Lo
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Fegan 6, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Sheila T Angeles-Han
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA; Division of Ophthalmology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA.
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Cooper AM, Flanagan ER, Ronis T, Goldberg B, Sherman AK, Smith C, Holland GN. Knowledge about juvenile idiopathic arthritis-associated uveitis: more frequent reminders are associated with higher patient and family uveitis knowledge. Pediatr Rheumatol Online J 2021; 19:149. [PMID: 34600529 PMCID: PMC8487555 DOI: 10.1186/s12969-021-00639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic anterior uveitis is a sight-threatening complication of juvenile idiopathic arthritis (JIA) and a primary contributor to long-term morbidity in people with JIA. Levels of knowledge about uveitis among JIA patients and their parents are unknown. A survey of JIA patients and parents was conducted to assess knowledge about uveitis complications and recommended screening. METHODS A survey was developed consisting of six demographic questions, six arthritis/uveitis history questions, and nine uveitis knowledge questions. The survey was administered to JIA patients age 14 and older and parents of patients with JIA at three pediatric rheumatology practices and online through the Patients, Advocates, and Rheumatology Teams Network for Research and Service (PARTNERS) network. ANOVA, chi-square and Fisher's exact tests were used to look for relationships between survey questions and demographic variables. RESULTS Thirty-three patients and 111 parents completed the survey. Overall, 17.4% reported a history of uveitis, and 89.6% had heard of uveitis. The mean composite knowledge score was 6.46 ± 2.6 out of 9. Patients and parents with a history of uveitis had higher composite knowledge scores than their counterparts without a uveitis history (p = 0.01 and p < 0.01, respectively). Parents whose rheumatologist reminded them about eye exams at every visit had higher knowledge of the risk of blindness (p = 0.04), the risk for uveitis when arthritis is controlled (p = 0.02), the need for ongoing eye exams when off of medications (p = 0.01), and had a higher overall score (p = 0.02) than those who were reminded at some visits or not at all. CONCLUSIONS JIA patients and parents report variable levels of knowledge regarding uveitis complications and recommended screening. Frequent discussion between the rheumatology provider and family about uveitis screening is associated with higher uveitis knowledge. Incorporating detailed and frequent education about uveitis into rheumatology clinic appointments may improve early uveitis detection and visual outcomes.
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Affiliation(s)
- Ashley M. Cooper
- grid.239559.10000 0004 0415 5050Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108 USA ,grid.266756.60000 0001 2179 926XUniversity of Missouri Kansas City School of Medicine, Kansas City, MO USA
| | - Elaine R. Flanagan
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, GA USA
| | - Tova Ronis
- grid.239560.b0000 0004 0482 1586Children’s National Hospital and George Washington University, Washington, DC USA
| | - Baruch Goldberg
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, GA USA
| | - Ashley K. Sherman
- grid.239559.10000 0004 0415 5050Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108 USA
| | - Chelsey Smith
- grid.239559.10000 0004 0415 5050Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108 USA
| | - Gary N. Holland
- grid.19006.3e0000 0000 9632 6718UCLA Stein Eye Institute and the Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA USA
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Occurrence and Risk Factors for Macular Edema in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis. J Clin Med 2021; 10:jcm10194513. [PMID: 34640527 PMCID: PMC8509447 DOI: 10.3390/jcm10194513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 01/24/2023] Open
Abstract
Purpose: To analyze occurrence and risk factors for macular edema (ME) in juvenile idiopathic arthritis-associated uveitis (JIA-U). Methods: Retrospective analysis of patients with JIA-U at a tertiary referral uveitis center between 2000 and 2019. Epidemiological data and clinical findings before ME onset were evaluated. Results: Out of 245 patients, ME developed in 41 (18%) of the 228 JIA-U patients for whom data documentation was complete during the follow-up (mean 4.0 ± 3.8 years). Risk factors (univariable logistic regression analysis) at baseline for subsequent ME onset included older age at initial documentation at institution (hazard ratio, HR 1.19, p < 0.0001), longer duration of uveitis at initial documentation (HR 1.17, p < 0.0001), worse best-corrected visual acuity (BCVA; HR 2.49, p < 0.0001), lower intraocular pressure (IOP; HR 0.88, p < 0.01), band keratopathy (HR 2.29, p < 0.01), posterior synechiae (HR 2.55, p < 0.01), epiretinal membrane formation (HR 6.19, p < 0.0001), optic disc swelling (HR 2.81, p < 0.01), and cataract (HR 4.24, p < 0.0001). Older age at initial documentation at institution (HR 1.55, p < 0.001), worse BCVA (HR 28.56, p < 0.001), and higher laser-flare photometry (LFM) values (HR 1.003, p = 0.01) were independent risk factors for ME manifestation. Patients with ME revealed significant changes in BCVA, LFM, and IOP and new optic disc swelling at 6 and 3 months before ME onset compared to timepoint of ME occurrence (p < 0.05, each). Conclusion: ME is a common complication of JIA-U. Demographic risk factors and courses of IOP, BCVA, and LFM may indicate patients at risk for ME onset.
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de Oliveira RJ, Kishimoto ST, de Souza DP, Fernandes PT, Marini R, Appenzeller S. The importance of transition from pediatric to adult rheumatology care in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2021; 17:155-161. [PMID: 33393405 DOI: 10.1080/1744666x.2020.1865157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Juvenile idiopathic arthritis (JIA) is the most common rheumatic inflammatory condition in childhood. The long-term morbidity, mortality, and quality of life have improved with the earlier use of disease-modifying drugs (DMARDs) and the availability of biology disease-modifying drugs (bDMARDs). Despite the improvement of treatment, around 50% of the patients reach adulthood with articular and/or extra articular disease activity. A careful planned transition from pediatric to adult care is necessary to reduce the loss of follow-up that is associated with stopping medications, flares, and disability due to untreated arthritis or uveitis.Areas covered: This narrative review provides an overview of the importance of transition in JIA Articles were selected from Pubmed searches.Expert opinion: JIA patients, family, and healthcare workers have to be trained to provide an effective transition plan, based on local and national policies. Important aspects such as expectations, maturation, disease characteristics, disease activity, adherence, disability, and psychological aspects among others have to be considered and addressed during the transition phase to improve self-esteem, self-assurance, and quality of life.
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Affiliation(s)
- Rodrigo Joel de Oliveira
- School of Medical Science, University of Campinas, Campinas, Brazil.,Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Simone Thiemi Kishimoto
- Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil.,Pathophysiology Program, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Débora Pessoa de Souza
- School of Medical Science, University of Campinas, Campinas, Brazil.,Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Paula Teixeira Fernandes
- Department of Sport Sciences, Faculty of Physical Education, University of Campinas, Campinas, Brazil
| | - Roberto Marini
- Department of Orthopedics, School of Medical Sciences and University of Campinas (UNICAMP), Campinas, Brazil
| | - Simone Appenzeller
- Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil.,Rheumatology Unit-Department of Medicine, School of Medical Sciences and University of Campinas (UNICAMP), São Paulo, Brazil
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Orès R, Terrada C, Errera MH, Thorne JE, Doukhan R, Cassoux N, Penaud B, LeHoang P, Quartier PM, Bodaghi B. Laser Flare Photometry: A Useful Tool for Monitoring Patients with Juvenile Idiopathic Arthritis-associated Uveitis. Ocul Immunol Inflamm 2020; 30:118-128. [PMID: 32835572 DOI: 10.1080/09273948.2020.1792511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE We evaluated laser flare photometry (LFP) values in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. METHODS Retrospective study. A decrease of the LFP value between baseline visit and 1 month after anti-inflammatory treatment intensification allowed us to define two groups of patients: group 1 (decreased LFP value ≥50%) and group 2 (<50%). We evaluated the prevalence of vision-threatening complications in both groups. RESULTS Fifty-four patients (87 eyes) were followed for 9.9 ± 5 years. Group 1 eyes (n = 54) had significantly fewer ocular complications than group 2 eyes (n = 33) at both 5 years visit (p = .03) and final visit (p = .047). At the final visit, group 2 eyes had significantly more band keratopathy, trabeculectomy, cataract surgery, glaucoma and papille edema. Group 1 eyes kept a better visual acuity (p < .0001). CONCLUSION The decrease of LFP values ≥50% of the initial value 1 month after treatment intensification is a good early prognostic factor.
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Affiliation(s)
- Raphaëlle Orès
- Department of Ophthalmology, La Pitié-Salpétrière Hospital, DHU View Restore, Paris, France.,Department of Ophthalmology, Quinze-Vingts National Eye Hospital, DHU View Restore, INSERM-DHOS CIC, Sorbonne Universités, UPMC Paris VI University, Paris, France
| | - Céline Terrada
- Department of Ophthalmology, La Pitié-Salpétrière Hospital, DHU View Restore, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France
| | - Marie-Hélène Errera
- Department of Ophthalmology, Quinze-Vingts National Eye Hospital, DHU View Restore, INSERM-DHOS CIC, Sorbonne Universités, UPMC Paris VI University, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France
| | - Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raphaël Doukhan
- Department of Ophthalmology, La Pitié-Salpétrière Hospital, DHU View Restore, Paris, France
| | - Nathalie Cassoux
- Department of Ophthalmology, La Pitié-Salpétrière Hospital, DHU View Restore, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France.,Department of Ophthalmology, Curie Institute, Paris, France
| | - Benjamin Penaud
- Department of Ophthalmology, La Pitié-Salpétrière Hospital, DHU View Restore, Paris, France
| | - Phuc LeHoang
- Department of Ophthalmology, La Pitié-Salpétrière Hospital, DHU View Restore, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France
| | - Pierre Marie Quartier
- Imagine Institute, Paris Descartes University, Paris, France.,Necker Hospital for Sick Children, Pediatric Hematology-Immunology and Rheumatology Unit, AP-HP, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, La Pitié-Salpétrière Hospital, DHU View Restore, Paris, France.,Sorbonne University, UPMC University Paris 06, Paris, France
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Horton S, Jones AP, Guly CM, Hardwick B, Beresford MW, Lee RW, Dick AD, Ramanan AV. Adalimumab in Juvenile Idiopathic Arthritis-Associated Uveitis: 5-Year Follow-up of the Bristol Participants of the SYCAMORE Trial. Am J Ophthalmol 2019; 207:170-174. [PMID: 31201796 DOI: 10.1016/j.ajo.2019.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine longer-term outcomes of participants enrolled from a single center in the SYCAMORE trial, a randomized placebo-controlled trial of adalimumab vs placebo in children with juvenile idiopathic arthritis-associated uveitis (JIA-U) uncontrolled on methotrexate. DESIGN Retrospective interventional case series. METHODS Medical records of all 28 SYCAMORE participants recruited at the Bristol Eye Hospital were reviewed at approximately 3-monthly intervals up to 5 years from the trial randomization date. Uveitis activity, treatment course, visual outcomes, ocular complications, and adverse events were recorded. Data are presented using summary statistics. RESULTS Following withdrawal of the investigational medicinal product (IMP), 25 of the 28 participants were started on adalimumab for active JIA-U. Of the 12 participants in the active treatment arm of the SYCAMORE study, 11 (92%) were restarted on adalimumab after withdrawal of the IMP for active JIA-U (median time to flare 188 days [range 42-413 days). Two participants stopped adalimumab for uncontrolled JIA-U. One participant had a reduction in vision to 0.3 owing to cataract. Mean visual acuity for the remaining 27 participants was -0.04 (right eye) and -0.05 (left eye). CONCLUSIONS Drug-induced remission of JIA-U did not persist when adalimumab was withdrawn after 1-2 years of treatment. Adalimumab was well tolerated and visual acuity outcomes were excellent.
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Affiliation(s)
- Sarah Horton
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ashley P Jones
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Catherine M Guly
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ben Hardwick
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard W Lee
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; University of Bristol, Bristol, United Kingdom
| | - Andrew D Dick
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; University of Bristol, Bristol, United Kingdom; National Institute of Health Research and Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Athimalaipet V Ramanan
- University of Bristol, Bristol, United Kingdom; Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
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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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Cervantes-Castañeda R, Bhat P, Fortuna E, Acevedo S, Foster C. Induction of Durable Remission in Ocular Inflammatory Diseases. Eur J Ophthalmol 2018; 19:118-23. [DOI: 10.1177/112067210901900117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To describe a paradigm of care for patients with ocular inflammatory diseases aimed at induction of durable remission. Methods Retrospective cohort study. The records of 399 patients with ocular inflammatory diseases treated with systemic immunomodulatory therapy (IMT) at the Massachusetts Eye Research and Surgery Institution were reviewed. Durable remission was defined as control of inflammation in the absence of systemic IMT for at least 1 year. Fifty patients met the inclusion criteria. Results Mean age was 46±22.5 years (range 18–88). All the patients had corticosteroid therapy and failed this therapy before having IMT. Fifty-two percent of the patients had used methotrexate alone or in combination with other medications. Thirty percent of the patients required at least 2 years of therapy with systemic IMT to obtain durable remission, while 44% required 2 to 5 years of therapy to achieve the same. Twenty percent continued to stay in remission, off immunomodulatory drugs, between 2 and 5 years and 18% were in remission for more than 5 years after therapy discontinuation. Conclusions IMT can be sight saving in patients. It can be tapered and discontinued successfully without the return of ocular inflammation. Durable drug-free remission is an achievable goal, and should be pursued by ocular inflammatory disease specialists.
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Affiliation(s)
| | - P. Bhat
- Massachusetts Eye Research and Surgery Institution, Cambridge
| | - E. Fortuna
- Massachusetts Eye Research and Surgery Institution, Cambridge
| | - S. Acevedo
- Massachusetts Eye Research and Surgery Institution, Cambridge
| | - C.S. Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge
- Harvard Medical School and Ocular Immunology and Uveitis Foundation, Cambridge, MA - USA
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Haasnoot AMJW, Sint Jago NFM, Tekstra J, de Boer JH. Impact of Uveitis on Quality of Life in Adult Patients With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2017; 69:1895-1902. [DOI: 10.1002/acr.23224] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/14/2017] [Indexed: 11/08/2022]
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12
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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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Kolomeyer AM, Crane ES, Tu Y, Liu D, Chu DS. Adult patients with uveitis associated with juvenile idiopathic arthritis: a retrospective review. Can J Ophthalmol 2017; 52:458-462. [PMID: 28985804 DOI: 10.1016/j.jcjo.2017.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/19/2016] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe clinical characteristics and outcomes of adults with uveitis associated with juvenile idiopathic arthritis (JIA). METHODS Retrospective chart review from 2001 to 2014 of adult patients with JIA and follow-up ≥2 months. Outcome measures included visual acuity, intraocular pressure (IOP), inflammation grade, ocular findings/complications, immunosuppressive therapies, and surgeries. RESULTS Nineteen patients were included (95% female, 84% bilateral uveitis, 47% anterior uveitis). Mean (SD) ages at presentation and JIA diagnosis were 25.6 (7.8) years and 8.9 (5.6) years, respectively. Visual acuity and IOP did not significantly change throughout the study. Mean (SD) presenting inflammation grade was significantly decreased at 6 and 12 months. Fifteen (79%) patients were on topical medications, and 17 (89%) were on systemic immunosuppression. Two (12%) patients developed side effects requiring medication cessation. CONCLUSION Uveitis associated with JIA may extend into adulthood despite the use of topical medications and/or systemic immunosuppression and result in significant ocular morbidity, including the need for surgical intervention.
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Affiliation(s)
- Anton M Kolomeyer
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Pennsylvania
| | - Elliot S Crane
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yufei Tu
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Dan Liu
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - David S Chu
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey; Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey.
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Haasnoot AMJW, Vernie LA, Rothova A, v. d. Doe P, Los LI, Schalij-Delfos NE, de Boer JH. Impact of Juvenile Idiopathic Arthritis Associated Uveitis in Early Adulthood. PLoS One 2016; 11:e0164312. [PMID: 27723840 PMCID: PMC5056754 DOI: 10.1371/journal.pone.0164312] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Typically juvenile idiopathic arthritis (JIA)-associated uveitis (further referred as 'JIA-uveitis') has its onset in childhood, but some patients suffer its, sometimes visual threatening, complications or ongoing disease activity in adulthood. The objective of this study was to analyze uveitis activity, complications and visual prognosis in adulthood. METHODS In this multicenter study, 67 adult patients (129 affected eyes) with JIA-uveitis were retrospectively studied for best corrected visual acuity, visual fields, uveitis activity, topical/systemic treatments, ocular complications, and ocular surgeries during their 18th, 22nd and 30th year of life. Because treatment strategies changed after the year 1990, outcomes were stratified for onset of uveitis before and after 1990. RESULTS Sixty-two of all 67 included patients (93%) had bilateral uveitis. During their 18th life year, 4/52 patients (8%) had complete remission, 28/52 (54%) had uveitis activity and 37/51 patients (73%) were on systemic immunomodulatory treatment. Bilateral visual impairment or legal blindness occurred in 2/51 patients (4%); unilateral visual impairment or legal blindness occurred in 17/51 patients (33%) aged 18 years. The visual prognosis appeared to be slightly better for patients with uveitis onset after the year 1990 (for uveitis onset before 1990 (n = 7) four patients (58%) and for uveitis onset after 1990 (n = 44) 13 patients (30%) were either visual impaired or blind). At least one ocular surgery was performed in 10/24 patients (42%) between their 18th and 22nd year of life. CONCLUSIONS Bilateral visual outcome in early adulthood in patients with JIA-uveitis appears to be fairly good, although one third of the patients developed one visually impaired or blind eye. However, a fair amount of the patients suffered from ongoing uveitis activity and needed ongoing treatment as well as surgical interventions. Awareness of these findings is important for ophthalmologists and rheumatologists treating patients with JIA-uveitis, as well as for the patients themselves.
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Affiliation(s)
| | - Lenneke A. Vernie
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Leonoor I. Los
- Department of Ophthalmology, Groningen University Medical Center, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | | | - Joke H. de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
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Mannion ML, Xie F, Baddley J, Chen L, Curtis JR, Saag K, Zhang J, Beukelman T. Analysis of health care claims during the peri-transfer stage of transition from pediatric to adult care among juvenile idiopathic arthritis patients. Pediatr Rheumatol Online J 2016; 14:49. [PMID: 27596158 PMCID: PMC5012002 DOI: 10.1186/s12969-016-0107-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the utilization of health care services before and after transfer from pediatric to adult rheumatology care in clinical practice. METHODS Using US commercial claims data from January 2005 through August 2012, we identified individuals with a JIA diagnosis code from a pediatric rheumatologist followed by any diagnosis code from an adult rheumatologist. Individuals had 6 months observable time before the last pediatric visit and 6 months after the first adult visit. Medication, emergency room, physical therapy use, and diagnosis codes were compared between the pediatric and adult interval using McNemar's test. The proportion of days covered (PDC) of TNFi for the time between last pediatric and first adult visit was calculated. RESULTS We identified 58 individuals with JIA who transferred from pediatric to adult rheumatology care after the age of 14. The median age at the last pediatric rheumatology visit was 18.1 years old and the median transfer interval was 195 days. 29 % of patients received NSAIDs in the adult interval compared to 43 % in the pediatric interval (p = 0.06). In the pediatric interval, 71 % received a JRA and 0 % received an RA physician diagnosis code compared to 28 and 45 %, respectively, in the adult interval. The median PDC for patients receiving a TNFi was 0.75 during the transfer interval. CONCLUSION Individuals with JIA who transferred to adult care were more likely receive a diagnosis of RA instead of JRA and were less likely to receive NSAIDs, but had no significant immediate changes to other medication use.
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Affiliation(s)
- Melissa L. Mannion
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, 1600 7th Ave S, CPPN M10, Birmingham, AL 35209 USA
| | - Fenglong Xie
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL 35294 USA
| | - John Baddley
- Department of Medicine, Division of Infectious Disease, University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL 35294 USA
| | - Lang Chen
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL 35294 USA
| | - Jeffrey R. Curtis
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL 35294 USA
| | - Kenneth Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL 35294 USA
| | - Jie Zhang
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL 35294 USA
| | - Timothy Beukelman
- Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, 1600 7th Ave S, CPPN M10, Birmingham, AL 35209 USA
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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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Ocular morbidities of juvenile idiopathic arthritis-associated uveitis in adulthood: results from a tertiary center study. Graefes Arch Clin Exp Ophthalmol 2016; 254:1841-9. [DOI: 10.1007/s00417-016-3340-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 02/06/2023] Open
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18
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Kolomeyer AM, Tu Y, Miserocchi E, Ranjan M, Davidow A, Chu DS. Chronic Non-infectious Uveitis in Patients with Juvenile Idiopathic Arthritis. Ocul Immunol Inflamm 2016; 24:377-85. [PMID: 26902465 DOI: 10.3109/09273948.2015.1125509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe clinical findings and analyze treatment evolution of chronic, non-infectious uveitis in patients with juvenile idiopathic arthritis (JIA). METHODS A total of 82 patients (147 eyes) with JIA-related uveitis treated for ≥2 months were included (78% females; 79% bilateral uveitis; 74% anterior uveitis). Outcome measures were visual acuity (VA), inflammation control, side-effects, and surgical procedures. RESULTS Mean ± SD age at diagnosis was 4.9 ± 3.8 years; mean ± SD follow-up time was 8.7 ± 7.8 years. Mean VA did not significantly change throughout the study. Three (2%) eyes resulted in no light perception (NLP) vision. Thirty (37%) patients underwent 69 procedures. In total, 41 (50%) patients achieved inflammation control. TNF-α inhibitors were significantly associated with inflammation control. Seven (8.5%) patients stopped treatment due to side-effects. CONCLUSIONS JIA is a cause of significant ocular morbidity. TNF-α inhibitor use was associated with inflammation control. Prospective, randomized, double blind clinical trials in this regard are warranted.
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Affiliation(s)
- Anton M Kolomeyer
- a Department of Ophthalmology , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
| | - Yufei Tu
- b Institute of Ophthalmology and Visual Science , Rutgers University , Newark , New Jersey , USA
| | - Elisabetta Miserocchi
- c Department of Ophthalmology and Visual Sciences, Scientific Institute San Raffaele , University Vita-Salute , Milan , Italy
| | - Mangala Ranjan
- d Department of Quantitative Methods , Rutgers University , Newark , New Jersey , USA
| | - Amy Davidow
- d Department of Quantitative Methods , Rutgers University , Newark , New Jersey , USA
| | - David S Chu
- b Institute of Ophthalmology and Visual Science , Rutgers University , Newark , New Jersey , USA.,e Metropolitan Eye Research and Surgery Institute , Palisades Park, New Jersey , USA
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Taddio A, Cattalini M, Simonini G, Cimaz R. Recent advances in the use of Anti-TNFα therapy for the treatment of juvenile idiopathic arthritis. Expert Rev Clin Immunol 2016; 12:641-9. [DOI: 10.1586/1744666x.2016.1146132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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20
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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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Amin RM, Miserocchi E, Thorne JE, Hornbeak D, Jabs DA, Zierhut M. Treatment Options for Juvenile Idiopathic Arthritis (JIA) Associated Uveitis. Ocul Immunol Inflamm 2015; 24:81-90. [DOI: 10.3109/09273948.2015.1077976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rowayda M. Amin
- Department of Ophthalmology, Alexandria University, Alexandria, Egypt
| | - Elisabetta Miserocchi
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Jennifer E. Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dana Hornbeak
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Douglas A. Jabs
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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Angeles-Han ST, McCracken C, Yeh S, Jenkins K, Stryker D, Travers C, Rouster-Stevens K, Vogler LB, Lambert SR, Drews-Botsch C, Prahalad S. The Association of Race With Childhood Uveitis. Am J Ophthalmol 2015; 160:919-928.e1. [PMID: 26255577 DOI: 10.1016/j.ajo.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/01/2015] [Accepted: 08/02/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To identify risk factors for a severe uveitis course among children with noninfectious uveitis. DESIGN Retrospective cohort study. METHOD This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3-6 months (2011-2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications, and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African-American and non-Hispanic white children only. RESULTS Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African-American and white children showed an increased prevalence of VA ≤20/200 in non-Hispanic African-Americans (18/25; 72% vs 4/43; 9%). Non-Hispanic African-Americans were more likely to be diagnosed at an older age (P = .030) and to have intermediate uveitis (P = .026), bilateral disease (P = .032), a history of VA ≤20/50 (P = .002), VA ≤20/200 (P < .001), and a higher rate of complications (P < .001). On multivariable analysis, non-Hispanic African-American race was a significant predictor of blindness (OR = 31.6, 95% CI 5.9-168.5, P < .001), after controlling for uveitis duration. Non-Hispanic African-Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic whites when controlling for uveitis type and duration. CONCLUSIONS There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African-American children with non-juvenile idiopathic arthritis-associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations.
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Affiliation(s)
- Sheila T Angeles-Han
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Steven Yeh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Daneka Stryker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Larry B Vogler
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Scott R Lambert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
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24
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Haasnoot AJW, van Tent-Hoeve M, Wulffraat NM, Schalij-Delfos NE, Los LI, Armbrust W, Zuithoff NPA, de Boer JH. Erythrocyte sedimentation rate as baseline predictor for the development of uveitis in children with juvenile idiopathic arthritis. Am J Ophthalmol 2015; 159:372-7.e1. [PMID: 25447121 DOI: 10.1016/j.ajo.2014.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE To analyze inflammatory parameters as possible predictors for the development of uveitis in juvenile idiopathic arthritis (JIA) patients. Further, to analyze the predictive value of demographic and clinical factors at the onset of arthritis. DESIGN Retrospective cohort study. METHODS In 358 children with oligoarthritis and rheumatoid factor-negative polyarthritis, erythrocyte sedimentation rate (ESR), C-reactive protein, leukocyte count, presence of antinuclear antibodies (ANA), presence of human leukocyte antigen (HLA-)B27, age of onset of JIA, and sex were analyzed for their predictive value for the onset of uveitis. RESULTS One hundred forty-seven patients (41%) were diagnosed with chronic anterior uveitis. Young age of onset, presence of ANA, and elevated ESR appeared to be predictive factors according to univariate analyses (P = .029, P = .007, and P = 5E(-4), respectively). According to multivariate analysis, young age of onset and elevated ESR appeared to be predictive after adjusting for the other relevant factors (P = .004 and P = .001, respectively). A prediction model was developed. CONCLUSIONS Elevated ESR appears to be a predictor for the occurrence of uveitis in patients with JIA. Since ESR is already routinely tested in patients with recently diagnosed arthritis, its use as a biomarker can easily be implemented in daily practice.
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Affiliation(s)
- Arenda J W Haasnoot
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, Netherlands.
| | | | - Nico M Wulffraat
- Department of Pediatric Rheumatology, Utrecht University Medical Center, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | | | - Leonoor I Los
- Department of Ophthalmology, Groningen University Medical Center, Groningen, Netherlands
| | - Wineke Armbrust
- Department of Pediatric Rheumatology, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, Netherlands
| | - Nicolaas P A Zuithoff
- Department of Biostatistics and Research Support, Julius Center, Utrecht University Medical Center, Utrecht, Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, Netherlands
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Garin N, Olaya B, Lara E, Moneta MV, Miret M, Ayuso-Mateos JL, Haro JM. Visual impairment and multimorbidity in a representative sample of the Spanish population. BMC Public Health 2014; 14:815. [PMID: 25103270 PMCID: PMC4139603 DOI: 10.1186/1471-2458-14-815] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/26/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning. METHODS Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity. RESULTS The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning. CONCLUSIONS Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.
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Affiliation(s)
- Noe Garin
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
- />Fundació Sant Joan de Déu, Santa Rosa, 39-57, 08950 Barcelona, Esplugues de Llobregat, Spain
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
| | - Beatriz Olaya
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
- />Fundació Sant Joan de Déu, Santa Rosa, 39-57, 08950 Barcelona, Esplugues de Llobregat, Spain
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
| | - Elvira Lara
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
| | - Maria Victoria Moneta
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
| | - Marta Miret
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
- />Department of Psychiatry, Universidad Autónoma de Madrid, Arzobispo Morcillo s/n, 28029 Madrid, Spain
| | - Jose Luis Ayuso-Mateos
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
- />Department of Psychiatry, Universidad Autónoma de Madrid, Arzobispo Morcillo s/n, 28029 Madrid, Spain
- />Instituto de Investigación Sanitaria Princesa (IP), Diego de León, 62, 28006 Madrid, Spain
| | - Josep Maria Haro
- />Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Dr Antoni Pujades, 42, 08830 Barcelona, Sant Boi de Llobregat, Spain
- />Fundació Sant Joan de Déu, Santa Rosa, 39-57, 08950 Barcelona, Esplugues de Llobregat, Spain
- />Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3–5. Pabellón 11, 28029 Madrid, Spain
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Cordero-Coma M, Garzo I, Calleja S, Galán E, Franco M, Ruíz de Morales JG. Preoperative cataract surgery use of an intravitreal dexamethasone implant (Ozurdex) in a patient with juvenile idiopathic arthritis and chronic anterior uveitis. J AAPOS 2013; 17:632-4. [PMID: 24215803 DOI: 10.1016/j.jaapos.2013.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/10/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Abstract
We report a 6-year-old boy with anterior uveitis associated with juvenile idiopathic arthritis (JIA) who underwent cataract extraction in his right eye. One month before surgery he received an intravitreal sustained-release dexamethasone implant. During 10 months' follow-up, his uveitis remained quiet. To our knowledge this is the first report using an intravitreal sustained-release dexamethasone implant as a perioperative anti-inflammatory medication.
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Affiliation(s)
- Miguel Cordero-Coma
- Department of Ophthalmology, University Hospital of León, León, Spain; Uveitis Unit, University Hospital of León, León, Spain.
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Angeles-Han ST, Pelajo CF, Vogler LB, Rouster-Stevens K, Kennedy C, Ponder L, McCracken C, Lopez-Benitez J, Drews-Botsch C, Prahalad S. Risk markers of juvenile idiopathic arthritis-associated uveitis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol 2013; 40:2088-96. [PMID: 24187099 DOI: 10.3899/jrheum.130302] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To characterize the epidemiology and clinical course of children with juvenile idiopathic arthritis-associated uveitis (JIA-U) in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry and explore differences between African American (AA) and non-Hispanic white (NHW) children. METHODS There were 4983 children with JIA enrolled in the CARRA Registry. Of those, 3967 NHW and AA children were included in this study. Demographic and disease-related data were collected from diagnosis to enrollment. Children with JIA were compared to those with JIA-U. Children with JIA-U were also compared by race. RESULTS There were 459/3967 children (11.6%) with JIA-U in our cohort with a mean age (SD) of 11.4 years (± 4.5) at enrollment. Compared to children with JIA, they were younger at arthritis onset, more likely to be female, had < 5 joints involved, had oligoarticular JIA, and were antinuclear antibody (ANA)-positive, rheumatoid factor (RF)-negative, and anticitrullinated protein antibody-negative. Predictors of uveitis development included female sex, early age of arthritis onset, and oligoarticular JIA. Polyarticular RF-positive JIA subtype was protective. Nearly 3% of children with JIA-U were AA. However, of the 220 AA children with JIA, 6% had uveitis; in contrast, 12% of the 3721 NHW children with JIA had uveitis. CONCLUSION In the CARRA registry, the prevalence of JIA-U in AA and NHW children is 11.6%. We confirmed known uveitis risk markers (ANA positivity, younger age at arthritis onset, and oligoarticular JIA). We describe a decreased likelihood of uveitis in AA children and recommend further exploration of race as a risk factor in a larger population of AA children.
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Affiliation(s)
- Sheila T Angeles-Han
- From the Department of Pediatrics, and Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Vitale AT, Graham E, de Boer JH. Juvenile Idiopathic Arthritis-Associated Uveitis: Clinical Features and Complications, Risk Factors for Severe Course, and Visual Outcome. Ocul Immunol Inflamm 2013; 21:478-85. [DOI: 10.3109/09273948.2013.815785] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Angeles-Han ST, Yeh S, Vogler LB. Updates on the risk markers and outcomes of severe juvenile idiopathic arthritis-associated uveitis. ACTA ACUST UNITED AC 2013; 8. [PMID: 24187594 DOI: 10.2217/ijr.12.83] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis, which is the most common systemic cause of uveitis in children. Known risk factors for uveitis include antinuclear antibody seropositivity, young age of arthritis onset, specific juvenile idiopathic arthritis subtype and short duration of disease. Risk markers for severe ocular disease include gender, age and complications at initial visit. Due to the risk for vision-compromising sequelae such as cataracts, band keratopathy, glaucoma, vision loss and blindness, an understanding of the risk factors for uveitis development and severe ocular disease is crucial to help prevent serious visual disability and complications. This paper reviews the pathogenesis of uveitis, known risk factors for uveitis development and severe visual outcome, and addresses the need for additional biomarkers of uveitis risk, prognosis and remission.
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Affiliation(s)
- Sheila T Angeles-Han
- Emory University, Atlanta, GA 30322, USA ; Children's Healthcare of Atlanta, Atlanta, GA, USA
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Prevention and management of cataracts in children with juvenile idiopathic arthritis-associated uveitis. Curr Rheumatol Rep 2012; 14:142-9. [PMID: 22201032 DOI: 10.1007/s11926-011-0229-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Juvenile idiopathic arthritis (JIA)-associated uveitis can be associated with vision-compromising complications such as cataracts, glaucoma, synechiae, and band keratopathy. Of these, cataracts are one of the most common sequelae of JIA-associated uveitis and can result in significant visual disability. Risk factors for cataracts include posterior synechiae and longstanding ocular inflammation. Prevention of cataract development is crucial through appropriate control of uveitis. However, not all preventive measures are successful, and further management consisting of medical and surgical techniques is often necessary. Various factors should be taken into consideration when deciding on cataract management, including timing of surgery and placement of an intraocular lens. Continued partnership between pediatric rheumatologists and pediatric ophthalmologists can help ensure favorable visual outcomes.
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Anesi SD, Foster CS. Importance of recognizing and preventing blindness from juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res (Hoboken) 2012; 64:653-7. [DOI: 10.1002/acr.21599] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wendling D, Paccou J, Berthelot JM, Flipo RM, Guillaume-Czitrom S, Prati C, Dernis E, Direz G, Ferrazzi V, Ristori JM. New Onset of Uveitis During Anti-Tumor Necrosis Factor Treatment for Rheumatic Diseases. Semin Arthritis Rheum 2011; 41:503-10. [DOI: 10.1016/j.semarthrit.2011.05.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 04/30/2011] [Accepted: 05/22/2011] [Indexed: 01/26/2023]
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Angeles-Han ST, Griffin KW, Harrison MJ, Lehman TJA, Leong T, Robb RR, Shainberg M, Ponder L, Lenhart P, Hutchinson A, Srivastava SK, Prahalad S, Lambert SR, Drews-Botsch C. Development of a vision-related quality of life instrument for children ages 8-18 years for use in juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res (Hoboken) 2011; 63:1254-61. [PMID: 21678564 DOI: 10.1002/acr.20524] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the validity and reliability of a novel questionnaire to measure vision-related quality of life (VRQOL) in children ages 8-18 years for use in juvenile idiopathic arthritis (JIA)-associated uveitis: the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q). METHODS Several steps validated the EYE-Q. We interviewed experts and children on how vision affects a child's activities. We developed new items and selected relevant items from existing instruments. We administered initial versions of the EYE-Q to normal-sighted children and those with JIA-associated uveitis. For this study, children with various (or no) ocular conditions were recruited from a clinical population. Visual acuity and contrast sensitivity were performed, and the EYE-Q and Pediatric Quality of Life Inventory (PedsQL) were administered. The EYE-Q was repeated 10 days later. Patients, parents, and physicians rated vision severity. RESULTS Of 120 patients, 48% were female, 46.7% had no visual impairment, and 53.3% had bilateral eye involvement. The mean age was 11.3 years. There were significant differences in the measures based on visual acuity (P < 0.001). Children with more severe visual acuity and bilateral eye involvement had worse EYE-Q scores (P < 0.001). There were significant associations between the EYE-Q and PedsQL (r = 0.375), repeat EYE-Q (r = 0.864), and clinical measures of ocular disease (r = -0.620). CONCLUSIONS Our study provides evidence of the validity and reliability of the EYE-Q in the measurement of VRQOL. The EYE-Q may complement clinical measures of visual impairment and overall QOL and become an important tool in the assessment of QOL in JIA-associated uveitis.
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Association of HLA-A*02:06 and HLA-DRB1*04:05 with clinical subtypes of juvenile idiopathic arthritis. J Hum Genet 2010; 56:196-9. [DOI: 10.1038/jhg.2010.159] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Kenawy N, Cleary G, Mewar D, Beare N, Chandna A, Pearce I. Abatacept: a potential therapy in refractory cases of juvenile idiopathic arthritis-associated uveitis. Graefes Arch Clin Exp Ophthalmol 2010; 249:297-300. [PMID: 20922440 DOI: 10.1007/s00417-010-1523-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common of all systemic conditions associated with childhood uveitis. Visual impairment has been shown to be as high as 40% of which 10% being blind (6/60 or worse). Due to the lack of well-designed randomized control trials for paediatric uveitis and arthritis there are limited comparative data regarding the efficacy of single or combination treatments. Recently, abatacept was shown to control ocular inflammation in a case of psoriatic arthritis- associated uveitis, seven cases of JIA- associated uveitis and in JIA. We present two cases with JIA-associated uveitis who have responded dramatically to abatacept therapy following unsuccessful therapy with other immunosuppressants. Control of arthritis still represents a challenge with this treatment. METHODS Prospective review of two patients with refractory JIA- associated uveitis not responding to maximum conventional treatment. Patients were regularly reviewed in the ophthalmology and rheumatology clinics. Assessment of their ocular condition was characterized according to the Standardization of Uveitis Nomenclature (SUN) group. RESULTS In case 1, ocular inflammation was brought under control after repeated abatacept infusions. Case 2 showed complete resolution of cystoids macular edema CME and improvement of 5 Snellen's lines in best corrected visual acuity. After 9 months, the ocular condition of both patients remains in remission with steroid sparing. Joint disease was brought to clinical remission in case 2, but not in case 1. CONCLUSIONS Abatacept is a promising alternative treatment in refractory cases of JIA uveitis but may not be as successful in controlling joint disease. Larger series with long term follow up of biological therapies in paediatric uveitis are essential to assess the efficacy and cost effectiveness.
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Affiliation(s)
- Nihal Kenawy
- St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
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Moorthy LN, Peterson MGE, Hassett AL, Lehman TJA. Burden of childhood-onset arthritis. Pediatr Rheumatol Online J 2010; 8:20. [PMID: 20615240 PMCID: PMC2914068 DOI: 10.1186/1546-0096-8-20] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 07/08/2010] [Indexed: 03/04/2023] Open
Abstract
Juvenile arthritis comprises a variety of chronic inflammatory diseases causing erosive arthritis in children, often progressing to disability. These children experience functional impairment due to joint and back pain, heel pain, swelling of joints and morning stiffness, contractures, pain, and anterior uveitis leading to blindness. As children who have juvenile arthritis reach adulthood, they face possible continuing disease activity, medication-associated morbidity, and life-long disability and risk for emotional and social dysfunction. In this article we will review the burden of juvenile arthritis for the patient and society and focus on the following areas: patient disability; visual outcome; other medical complications; physical activity; impact on HRQOL; emotional impact; pain and coping; ambulatory visits, hospitalizations and mortality; economic impact; burden on caregivers; transition issues; educational occupational outcomes, and sexuality.The extent of impact on the various aspects of the patients', families' and society's functioning is clear from the existing literature. Juvenile arthritis imposes a significant burden on different spheres of the patients', caregivers' and family's life. In addition, it imposes a societal burden of significant health care costs and utilization. Juvenile arthritis affects health-related quality of life, physical function and visual outcome of children and impacts functioning in school and home. Effective, well-designed and appropriately tailored interventions are required to improve transitioning to adult care, encourage future vocation/occupation, enhance school function and minimize burden on costs.
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Affiliation(s)
- Lakshmi N Moorthy
- Robert Wood Johnson Medical School-UMDNJ, Dept, of Pediatrics Room 1361, 89 French Street, New Brunswick, NJ, USA.
| | | | - Afton L Hassett
- University of Michigan Medical School, Chronic Pain & Fatigue Research Center, Dept of Anesthesiology, Ann Arbor, MI, USA
| | - Thomas JA Lehman
- Hospital For Special Surgery, 535 East 70th Street, New York, NY, USA,Weill Medical College of Cornell University, New York, NY, USA
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Thorne JE, Woreta FA, Dunn JP, Jabs DA. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology 2010; 117:1436-41. [PMID: 20363502 DOI: 10.1016/j.ophtha.2009.12.003] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 10/23/2009] [Accepted: 12/01/2009] [Indexed: 01/18/2023] Open
Abstract
PURPOSE We sought to investigate the risk of cataract development among patients with juvenile idiopathic arthritis (JIA)-associated uveitis treated with topical corticosteroids. DESIGN Retrospective cohort study. PARTICIPANTS We included 75 patients with JIA-associated uveitis observed from July 1984 through August 2005 at a single academic center. METHODS Clinical data on these patients were collected by chart review and were analyzed. MAIN OUTCOME MEASURES Incidence of new-onset cataract. Risk factors for cataract development were assessed with attention paid to the use of topical corticosteroids. RESULTS Over a median follow-up of 4 years, the incidence of new-onset cataract was 0.04/eye-year (EY; 95% confidence interval [CI], 0.02-0.09). Of the 60 eyes in 40 patients who received topical corticosteroid therapy, there was a dose-dependent increase in the rate of cataract development among eyes receiving topical corticosteroids. The incidence of cataract was 0.01/EY for eyes treated with < or = 3 drops daily and 0.16/EY (P = 0.0006 for log-rank test) for eyes treated with >3 drops daily. Among eyes receiving < or = 2 drops daily, the incidence of cataract was 0/EY (95% CI [1 sided], 0.03/EY). Presence of posterior synechiae, active uveitis, and use of topical corticosteroids at presentation were significantly associated with cataract development after controlling for confounding variables. Use of topical corticosteroids was associated with cataract formation independent of uveitis activity. Using longitudinal data analysis and controlling for duration of uveitis, presence and degree of active uveitis, and concomitant use of other forms of corticosteroids in a time-updated fashion, treatment with < or = 3 drops daily of topical corticosteroid was associated with an 87% lower risk of cataract formation compared with eyes treated with >3 drops daily (relative risk, 0.13; 95% CI, 0.02-0.69; P = 0.02). CONCLUSIONS In our cohort, topical corticosteroid use was associated with an increased risk of cataract formation independent of active uveitis or presence of posterior synechiae. However, chronic use of topical corticosteroids dosed at < or = 3 drops daily seemed to be associated with a lower risk of cataract development relative to eyes receiving higher doses over follow-up in the setting of suppressed uveitis. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Jennifer E Thorne
- Department of Ophthalmology, the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Angeles-Han ST, Griffin KW, Lehman TJA, Rutledge JR, Lyman S, Nguyen JT, Harrison MJ. The importance of visual function in the quality of life of children with uveitis. J AAPOS 2010; 14:163-8. [PMID: 20236847 PMCID: PMC2866793 DOI: 10.1016/j.jaapos.2009.12.160] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 12/18/2009] [Accepted: 12/22/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies of quality of life (QOL) in children with juvenile idiopathic arthritis (JIA) have focused on changes in musculoskeletal function secondary to arthritis. The role of visual functionality as a result of JIA-associated uveitis and its complications has not been examined. We evaluated the individual impact of physical and visual disability on QOL in children with and without uveitis. METHODS We administered patient-based questionnaires that measured visual function, physical function, and overall QOL to 27 children with JIA or idiopathic uveitis. Demographic data, assessed joint involvement, and reviewed medical records were recorded. Groups with and without uveitis were compared for differences in arthritis and uveitis disease characteristics with use of the Wilcoxon-Mann-Whitney, chi2, and Fisher exact tests. Associations between physical or visual function, and overall QOL were measured with use of Pearson's correlation coefficient. RESULTS Of 27 patients, 85.2% had had arthritis and 51.9% had had uveitis. The group without uveitis had increased morning stiffness (p = 0.036). Patients with uveitis reported more eye redness (p = 0.033) and photophobia (p = 0.013) than those without uveitis. We observed moderate associations between overall QOL and visual function in the uveitis group (r = -0.579) and overall QOL and physical function in the nonuveitis group (r = -0.562). CONCLUSIONS This study demonstrates that visual impairment is an important component of QOL in children with uveitis. It suggests that QOL studies should incorporate both visual and physical function measures in their analyses, especially because many children with JIA also suffer from uveitis and visual impairment.
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Affiliation(s)
- Sheila T Angeles-Han
- Emory University, Division of Pediatric Rheumatology, Atlanta, Georgia 30307, USA.
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High-dose daclizumab for the treatment of juvenile idiopathic arthritis-associated active anterior uveitis. Am J Ophthalmol 2009; 148:696-703.e1. [PMID: 19664754 DOI: 10.1016/j.ajo.2009.06.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 05/27/2009] [Accepted: 06/01/2009] [Indexed: 01/01/2023]
Abstract
PURPOSE To provide preliminary data regarding the safety and efficacy of high-dose intravenous daclizumab (Zenapax; Roche Inc, Nutley, New Jersey, USA) therapy for the treatment of juvenile idiopathic arthritis (JIA)-associated active anterior uveitis. DESIGN Interventional case series; open-label prospective, phase II pilot study. METHODS Six patients were recruited into the study and received daclizumab therapy at doses of 8 mg/kg at baseline, 4 mg/kg at week 2, and 2 mg/kg every 4 weeks thereafter, for a total of 52 weeks. The study was done at the National Eye Institute between June 29, 2005 and July 9, 2008. The primary outcome was a two-step decrease in inflammation grade assessed at week 12. Primary safety outcome was assessed at weeks 2 and 4. The ocular inflammation was assessed according to the Standardization of Uveitis Nomenclature criteria. RESULTS Four of the 6 participants achieved two-step reduction in anterior chamber cells according to Standardization of Uveitis Nomenclature Working Group grading scheme for anterior chamber cells 12 weeks into the study and met the primary efficacy endpoint. One additional patient responded to reinduction whereas 1 patient failed reinduction and was considered an ocular treatment failure. Visual acuity improved from a mean of 68 Early Treatment Diabetic Retinopathy Study letters in the worse eye to a mean of 79.6 letters (2 Snellen lines). Three participants were terminated before 52 weeks: First, because of a rash possibly induced by daclizumab; Second, because of ocular treatment failure; and Last, because of uncontrolled systemic manifestations of JIA. CONCLUSION High-dose intravenous daclizumab can help reduce active inflammation in active JIA-associated anterior uveitis; however, patients need to be monitored for potential side effects. Larger randomized trials are needed to better assess treatment effect and safety.
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Camuglia JE, Whitford CL, Hall AJ. Juvenile Idiopathic Arthritis Associated Uveitis in Adults: A Case Series. Ocul Immunol Inflamm 2009; 17:330-4. [DOI: 10.3109/09273940903118626] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Marvillet I, Terrada C, Quartier P, Quoc EB, Bodaghi B, Prieur AM. La menace oculaire au cours des arthrites juvéniles idiopathiques. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.rhum.2008.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marvillet I, Terrada C, Quartier P, Quoc EB, Bodaghi B, Prieur AM. Ocular threat in juvenile idiopathic arthritis. Joint Bone Spine 2009; 76:383-8. [PMID: 19524473 DOI: 10.1016/j.jbspin.2008.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Isabelle Marvillet
- Centre national de référence Arthrite Juvénile, Unité d'Immunologie-Hématologie et Rhumatologie Pédiatriques, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75 015 Paris, France
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Chronic anterior uveitis in children: clinical characteristics and complications. Am J Ophthalmol 2009; 147:667-678.e5. [PMID: 19195641 DOI: 10.1016/j.ajo.2008.11.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 11/05/2008] [Accepted: 11/13/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe clinical features of chronic anterior uveitis in children at presentation to a referral center (baseline); to identify relationships between demographic, medical, and ophthalmic factors at baseline; and to determine baseline factors that predict new complications and vision loss during follow-up. DESIGN Retrospective case series. METHODS Studied were involved eyes of all children (age < or =16 years at disease onset) with chronic anterior uveitis who were examined by 1 clinician from 1993 through 2006. Cross-sectional analyses compared baseline findings. Relationships between potential risk factors and incident adverse events (new complications, vision loss) were studied by Kaplan-Meier and Cox proportional hazards regression models. RESULTS There were 115 patients (200 eyes) who met inclusion criteria. Follow-up (n = 83 patients) ranged from 0.4 to 157.5 months (median, 23.5 months). There were numerous strong relationships between 8 defined complications at baseline in pairwise comparisons. Flare was the inflammatory sign most consistently associated with complications at baseline. Baseline factors that predicted new complications during follow-up included age < or =3 years, elevated cells, elevated flare, keratic precipitates, signs of intermediate uveitis, and papillitis (all P < .043); factors that predicted vision loss included male gender, increased flare, signs of intermediate uveitis, papillitis, and baseline complications (all P < .015). Not related to new complications were presence of juvenile idiopathic uveitis and immunomodulatory therapy. CONCLUSION Chronic anterior uveitis in children is associated with various vision-threatening complications that occur in combinations. Complications develop early in the disease course. Patients with more severe disease at presentation are at increased risk of additional adverse events.
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Pavesio C, Jones N. Uveitis Related to HLA-B27 and Juvenile Arthritis. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cataract surgery in children with juvenile idiopathic arthritis associated uveitis. Int Ophthalmol Clin 2008; 48:1-7. [PMID: 18427255 DOI: 10.1097/iio.0b013e3181695b80] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Use of tumor necrosis factor-alpha blocking agents to treat chronic pediatric uveitis is becoming recognized as an important therapeutic modality. This review summarizes the rationale for this use, highlighting new studies of these agents in pediatric uveitis. RECENT FINDINGS The majority of patients with pediatric uveitis either have idiopathic uveitis or uveitis associated with juvenile idiopathic arthritis. Ophthalmologic morbidity among these children is common. Most studies evaluating tumor necrosis factor-alpha blockade in pediatric uveitis are retrospective case series, with attendant limitations that are inherent to any retrospective study. Study of uveitis has been hampered by lack of standardization of disease and outcome measures, which has been addressed by uveitis experts with publication of consensus measures. Data to date suggest that tumor necrosis factor-alpha blockade is efficacious in refractory uveitis. Agents with direct tumor necrosis factor-alpha membrane receptor binding activity may be the most efficacious. There remain many unanswered questions in the treatment of pediatric uveitis, including optimal dosing regimen and long-term efficacy. SUMMARY Tumor necrosis factor-alpha blocking agents play an important role in the treatment of chronic pediatric uveitis. Prospective comparative studies are needed so that we may better understand this role.
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Affiliation(s)
- C Egla Rabinovich
- Division of Pediatric Rheumatology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Wright T, Cron RQ. Pediatric rheumatology for the adult rheumatologist II: uveitis in juvenile idiopathic arthritis. J Clin Rheumatol 2007; 13:205-10. [PMID: 17762455 DOI: 10.1097/rhu.0b013e31813c0e36] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Uveitis is an important and frequent extra-articular manifestation of juvenile idiopathic arthritis (JIA) that may result in poor visual outcome. Without early detection and aggressive therapy, the uveitis and topical steroid therapy used to treat it may result in cataracts, glaucoma, and even blindness. Fortunately, a variety of systemically administered anti-inflammatory agents have been found useful for the treatment of JIA associated uveitis. Methotrexate is often the first line disease modifying systemic agent used to help wean topical corticosteroids, but when this is not sufficiently effective there are a variety of other systemic medicines available. In particular, one of the tumor necrosis factor-alpha inhibitors, infliximab, has shown some promising results in difficult to treat JIA associated uveitis. With early screening and detection combined with aggressive therapy in difficult to treat cases, the morbidity associated with uveitis as part of JIA is on the decline.
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Affiliation(s)
- Tracey Wright
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4318, USA
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Thorne JE, Woreta F, Kedhar SR, Dunn JP, Jabs DA. Juvenile idiopathic arthritis-associated uveitis: incidence of ocular complications and visual acuity loss. Am J Ophthalmol 2007; 143:840-846. [PMID: 17362866 DOI: 10.1016/j.ajo.2007.01.033] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 01/06/2007] [Accepted: 01/12/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE To estimate the incidences of ocular complications and vision loss in patients with juvenile idiopathic arthritis (JIA)-associated uveitis, to describe risk factors for vision loss, and to describe the association between therapy and complications and vision loss. DESIGN Retrospective cohort study. METHODS setting: Single-center, academic practice. study population: A total of 75 patients with JIA-associated uveitis evaluated between July 1984 and August 2005. procedures: Clinical data on these patients were analyzed. outcome measures: Occurrence of ocular complications and visions of 20/50 or worse and 20/200 or worse. RESULTS Over a median follow-up of three years, the incidence of any ocular complication was 0.33/eye-year (EY). Rates of vision loss to 20/50 or worse and 20/200 or worse were 0.10/EY and 0.08/EY, respectively. Risk factors at presentation for incident vision loss included presence of posterior synechiae, anterior chamber flare > or = 1+, and abnormal intraocular pressure (IOP). During follow-up, ocular inflammation > or = 0.5+ cells was associated with an increased risk of visual impairment (relative risk [RR] = 2.02, P = .006) and of blindness (RR = 2.99, P = .03). Immunosuppressive drug therapy reduced the risk of hypotony by 74% (P = .002), epiretinal membrane formation by 86% (P = .05), and blindness in the better eye by 60% (P = .04). CONCLUSIONS Incident vision loss and complications were common. Presence of posterior synechiae, anterior chamber flare > or = 1+, and abnormal IOP at presentation were associated with vision loss during follow-up. Use of immunosuppressive drugs reduced the risk of some ocular complications and of blindness in the better-seeing eye.
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Affiliation(s)
- Jennifer E Thorne
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
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Woreta F, Thorne JE, Jabs DA, Kedhar SR, Dunn JP. Risk factors for ocular complications and poor visual acuity at presentation among patients with uveitis associated with juvenile idiopathic arthritis. Am J Ophthalmol 2007; 143:647-55. [PMID: 17224116 PMCID: PMC1892578 DOI: 10.1016/j.ajo.2006.11.025] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Revised: 11/01/2006] [Accepted: 11/03/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the frequencies of and risk factors for ocular complications and poor visual acuity at presentation in a cohort of patients with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN Cross-sectional study. METHODS setting: Single-center, academic practice. study population: Seventy-five patients with JIA-associated uveitis were evaluated between July 1984 and August 2005. observation procedures: Data on patients diagnosed with JIA-associated uveitis were entered retrospectively into a database and analyzed. outcome measures: Visual acuity of 20/50 or worse or 20/200 or worse, and presence of ocular complications (including cataract, posterior synechiae, band keratopathy, elevated intraocular pressure, hypotony, macular edema, and epiretinal membrane) at presentation. RESULTS At presentation, ocular complications were seen in 67% of eyes affected by JIA-associated uveitis. Presence of > or =1+ anterior chamber flare, a positive antinuclear antibody (ANA), and a shorter duration between the diagnosis of arthritis and uveitis were significantly associated with the presence of ocular complication. The frequencies of 20/50 or worse and of 20/200 or worse visual acuities at presentation in affected eyes were 36% and 24%, respectively. The presence of > or =1+ anterior chamber flare and a history of intraocular surgery before presentation were significantly associated with 20/50 or worse and 20/200 or worse vision. Presence of posterior synechiae also was associated with 20/200 or worse vision at presentation. The main causes of poor vision at presentation for affected eyes and better-seeing eyes were cataract, band keratopathy within the visual axis, and glaucoma. CONCLUSIONS Ocular complications and poor vision at presentation were common in our patients with JIA-related uveitis.
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Affiliation(s)
- Fasika Woreta
- Department of Ophthalmology, the Johns Hopkins University School of Medicine
| | - Jennifer E. Thorne
- Department of Ophthalmology, the Johns Hopkins University School of Medicine
- Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Douglas A. Jabs
- Department of Ophthalmology, the Johns Hopkins University School of Medicine
- Department of Medicine, the Johns Hopkins University School of Medicine
- Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sanjay R. Kedhar
- Department of Ophthalmology, the Johns Hopkins University School of Medicine
| | - James P. Dunn
- Department of Ophthalmology, the Johns Hopkins University School of Medicine
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