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Glandorf K, Rothaus K, Baquet-Walscheid K, Heinz C, Heiligenhaus A. Surgical Glaucoma Treatment in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis: Results after Trabeculectomy or Ahmed Glaucoma Valve Implantation. Ocul Immunol Inflamm 2024; 32:636-641. [PMID: 36898006 DOI: 10.1080/09273948.2023.2185263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Patients with juvenile idiopathic arthritis (JIA) associated uveitis (JIAU) are at risk for secondary glaucoma, frequently requiring surgical management. We compared the success rates for trabeculectomy (TE) and Ahmed glaucoma valve (AGV) implantation. METHODS We conducted a retrospective analysis of TE (45 eyes), primary AGV (pAGV) (7 eyes), or secondary AGV (sAGV) implantation after TE (11 eyes) in JIAU at the 2-year follow-up. RESULTS All groups achieved significant pressure reduction. After 1 year, the overall success rate was higher in the Ahmed groups (p = 0.03). After adjusting the p-value according to Benjamin Hochberg, there is no significant difference between the groups in the Kaplan-Meier, despite a significant logrank test between all groups (p = 0.0194) and a better performance in the Ahmed groups. CONCLUSION Slightly better success rates were achieved with pAGV in managing JIAU patients with glaucoma refractory to medical treatment.
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Affiliation(s)
- Karen Glandorf
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Kai Rothaus
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Karoline Baquet-Walscheid
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
- Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
- Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
- Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany
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2
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Zhang T, Liu Z, Li N. The application of dexamethasone implants in uveitis treatment. Front Med (Lausanne) 2024; 11:1402396. [PMID: 39005654 PMCID: PMC11239344 DOI: 10.3389/fmed.2024.1402396] [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: 03/17/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Uveitis refers to a group of ocular inflammatory diseases that can significantly impair vision. Although systemic corticosteroid therapy has shown substantial efficacy in treating uveitis, extensive use of corticosteroids is associated with significant adverse effects. Recently, a biodegradable, sustained-release implant, namely dexamethasone intravitreal implant (Ozurdex), has been reported for treating non-infectious and infectious uveitis. This review aims to summarize the experiences with Ozurdex treatment across various forms of uveitis and to assist readers in understanding the appropriate timing and potential side effects of Ozurdex in uveitis treatment, thereby maximizing patient benefits in uveitis management.
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Affiliation(s)
- Tian Zhang
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Zhutao Liu
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Na Li
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
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3
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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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4
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Gentile P, Ragusa E, Bolletta E, De Simone L, Gozzi F, Cappella M, Fastiggi M, De Fanti A, Cimino L. Epidemiology of Pediatric Uveitis. Ocul Immunol Inflamm 2023; 31:2050-2059. [PMID: 37922466 DOI: 10.1080/09273948.2023.2271988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/12/2023] [Indexed: 11/05/2023]
Abstract
Uveitis is uncommon in children and its diagnosis and treatment are challenging. Little is known of the epidemiology of pediatric uveitis. Indeed, population-based studies in the literature are rare. However, there are many tertiary referral center reports that describe the patterns of uveitis in childhood, although few are from developed countries, and their comparison presents some issues. Anterior uveitis is the most frequent entity worldwide, especially in Western countries, where juvenile idiopathic arthritis is diffuse. Most cases of intermediate uveitis do not show any association with infectious or noninfectious systemic diseases. In low- and middle-income countries, posterior uveitis and panuveitis are prevalent due to the higher rates of infectious etiologies and systemic diseases such as Behçet disease and Vogt-Koyanagi-Harada disease. In recent decades, idiopathic uveitis rate has decreased thanks to diagnostic improvements.
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Affiliation(s)
- P Gentile
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Ragusa
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - E Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - L De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Cappella
- Pediatric Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Fastiggi
- Pediatric Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A De Fanti
- Pediatrics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - L Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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5
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van Meerwijk C, Kuiper J, van Straalen J, Ayuso VK, Wennink R, Haasnoot AM, Kouwenberg C, de Boer J. Uveitis Associated with Juvenile Idiopathic Arthritis. Ocul Immunol Inflamm 2023; 31:1906-1914. [PMID: 37966463 DOI: 10.1080/09273948.2023.2278060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common cause of uveitis in children. While symptoms are usually mild, persistent eye inflammation could lead to severe complications and impaired vision. It is essential that JIA patients at risk are diagnosed with uveitis early, receive adequate treatment, and avoid developing complications, such as cataract, glaucoma, and amblyopia. The purpose of this mini-review is to summarize the screening strategies and clinical management for JIA-associated uveitis (JIA-U) as well as the current state of molecular markers linked to this condition. Because glaucoma is one of the most common causes of visual loss in JIA-U, special focus will be put on this serious complication. We conclude by describing the current evidence regarding the long-standing question of whether chronic anterior uveitis without arthritis may be the same disease entity as JIA-U.
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Affiliation(s)
- Charlotte van Meerwijk
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jonas Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joeri van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Viera Kalinina Ayuso
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roos Wennink
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anne-Mieke Haasnoot
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carlijn Kouwenberg
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joke de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Chaudhary A, Nadeem M, Townsend J, Miller VJ, Hajrasouliha AR. Perinatal events and development of juvenile idiopathic arthritis-associated uveitis. Sci Rep 2023; 13:17576. [PMID: 37845273 PMCID: PMC10579364 DOI: 10.1038/s41598-023-44208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
Uveitis is one of the most common manifestations of juvenile idiopathic arthritis (JIA). Currently, JIA is associated with decreased gut microbiota diversity. Studies confirm that perinatal events can cause aberrant microbial colonization. The objective of this study is to determine if JIA is associated with perinatal events with a secondary focus on these variables to the development of JIA-uveitis. 369 patients with strabismus (n = 200) or JIA (n = 196) were included in the study. Completed surveys (JIA 37; strabismus 18) collected data about birth route, pregnancy and labor complications, JIA medications, and the presence of eye disorders. Analysis indicates that there is no relationship between JIA development and the perinatal events investigated. Similarly, no significance was found between JIA-uveitis and birth route or labor complications. Pregnancy complications, namely gestational diabetes (GD), were statistically higher in the JIA group with uveitis compared to JIA without uveitis. The data from this survey study showed that JIA-uveitis was highly associated with pregnancy complications, particularly with GD. However, no statistically significant association was found between JIA and route of delivery, labor complications, or pregnancy complications. Further studies are needed to understand the ways that GD interrelates with the development of uveitis in JIA patients.
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Affiliation(s)
- Aysha Chaudhary
- Eugene and Marilyn Glick Eye Institute and Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN, 46202, USA
| | - Manahil Nadeem
- Eugene and Marilyn Glick Eye Institute and Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN, 46202, USA
| | - Jack Townsend
- Eugene and Marilyn Glick Eye Institute and Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN, 46202, USA
| | - Victoria J Miller
- Eugene and Marilyn Glick Eye Institute and Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN, 46202, USA
| | - Amir R Hajrasouliha
- Eugene and Marilyn Glick Eye Institute and Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN, 46202, USA.
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7
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Siiskonen M, Hirn I, Pesälä R, Ohtonen P, Hautala N. Encouraging visual outcomes in children with idiopathic and JIA associated uveitis: a population-based study. Pediatr Rheumatol Online J 2023; 21:56. [PMID: 37322490 DOI: 10.1186/s12969-023-00841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/04/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Pediatric uveitis is typically asymptomatic and may become chronic affecting ocular structures and vision. We evaluated visual outcomes, clinical features, medication, and uveitis activity in children with either idiopathic uveitis (idio-U) or juvenile idiopathic arthritis associated uveitis (JIA-U). METHODS A longitudinal, population-based cohort study of children with uveitis in 2008-2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution, etiology, systemic association, uveitis activity, medication, and visual outcomes. RESULTS A total of 119 patients aged < 16 years with uveitis were included. Uveitis was idio-U in 23% and associated with JIA in 77% of cases. 37% of the patients in the idio-U group and 65% in the JIA-U were girls (p = 0.014). The mean age at first uveitis was 10.0 (SD 3.4) years in idio-U and 5.5 (SD 3.3) years in JIA-U (p < 0.001). Anterior location of uveitis was noted in 74% in idio-U and 99% in JIA-U (p < 0.001). Mostly, uveitis was chronic (59% in idio-U and 75% in JIA-U) and bilateral (56% in idio-U and 64% in JIA-U). Topical corticosteroids were initially used by 89% and 100%, systemic corticosteroids by 30% and 27% in some extent during the follow-up, disease-modifying antirheumatic drugs (DMARDs) by 33% and 85% (p < 0.001) of the patients in idio-U and JIA-U, respectively. Biologic disease-modifying antirheumatic drugs (bDMARDs) were more common in JIA-U (55% vs. 15% in idio-U, respectively, p < 0.001). Most patients had normal visual acuity (Snellen > 0.8, [6/7.5]) in the affected eye and bilaterally in 85% idio-U and 70% JIA-U. Only 5 patients (4%) had visual impairment in one, but none in both eyes. Uveitis activity by SUN classification was 0 + in 81% and 72%, 0.5 + in 19% and 25%, and 1 + in 0% and 3% in the idio-U and JIA-U, respectively. CONCLUSIONS Children with uveitis have good visual acuity and a low rate for visual impairment. In addition, modern treatment with DMARDs and bDMARDs seems to save vision.
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Affiliation(s)
- Mira Siiskonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu, Finland
| | - Iida Hirn
- Research Unit of Clinical Medicine, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu, Finland
| | - Roosa Pesälä
- Research Unit of Clinical Medicine, Oulu, Finland
- Medical Research Center, University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- The Research Unit of Surgery, Anesthesia and Intensive care, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Nina Hautala
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
- Research Unit of Clinical Medicine, Oulu, Finland.
- Medical Research Center, University of Oulu, Oulu, Finland.
- Research Unit of Clinical Medicine and MRC Oulu, Department of Ophthalmology, University of Oulu, Oulu University Hospital, Oulu, P.O.Box 21, 90029 OYS, Finland.
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8
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Kim J, Park MS, Kwon S, Kim KN, Kim HW, Cho BJ. Clinical Features and Risk Factors of Uveitis in Korean Children with Juvenile Idiopathic Arthritis: A Retrospective Cohort Study. J Clin Med 2023; 12:jcm12103438. [PMID: 37240542 DOI: 10.3390/jcm12103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to investigate the clinical features and risk factors of uveitis in Korean children with juvenile idiopathic arthritis (JIA). The medical records of JIA patients diagnosed between 2006 and 2019 and followed up for ≥1 year were retrospectively reviewed, and various factors including laboratory findings were analyzed for the risk of developing uveitis. JIA-associated uveitis (JIA-U) developed in 30 (9.8%) of 306 JIA patients. The mean age at the first uveitis development was 12.4 ± 5.7 years, which was 5.6 ± 3.7 years after the JIA diagnosis. The common JIA subtypes in the uveitis group were oligoarthritis-persistent (33.3%) and enthesitis-related arthritis (30.0%). The uveitis group had more baseline knee joint involvement (76.7% vs. 51.4%), which increased the risk of JIA-U during follow-up (p = 0.008). Patients with the oligoarthritis-persistent subtype developed JIA-U more frequently than those without it (20.0% vs. 7.8%; p = 0.016). The final visual acuity of JIA-U was tolerable (0.041 ± 0.103 logMAR). In Korean children with JIA, JIA-U may be associated with the oligoarthritis-persistent subtype and knee joint involvement.
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Affiliation(s)
- Jinsoo Kim
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Min Seon Park
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Soonil Kwon
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Kwang Nam Kim
- Department of Pediatrics, Myongji Hospital, Hanyang University College of Medicine, Goyang 10475, Republic of Korea
| | - Han Wool Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Bum-Joo Cho
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
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Martins A, Ganhão S, Oliveira Pinheiro F, Granjo Morais C, Rodrigues M, Leuzinger-Dias M, Figueira L, Brito I. Uveitis in patients with oligoarticular juvenile idiopathic arthritis and juvenile spondyloarthritis/enthesitis related arthritis: is there any difference? Reumatismo 2023; 75. [PMID: 37154253 DOI: 10.4081/reumatismo.2023.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/07/2023] [Indexed: 05/10/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common systemic disease causing uveitis in childhood and adolescence.
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Affiliation(s)
- A Martins
- Rheumatology Department, University Hospital of São João, Porto; Medicine Department, Faculty of Medicine, University of Porto.
| | - S Ganhão
- Pediatric and Young Adult Rheumatology Unit, University Hospital of São João, Porto.
| | - F Oliveira Pinheiro
- Rheumatology Department, University Hospital of São João, Porto; Medicine Department, Faculty of Medicine, University of Porto.
| | - C Granjo Morais
- Medicine Department, Faculty of Medicine, University of Porto; Pediatrics Department, University Hospital of São João, Porto.
| | - M Rodrigues
- Medicine Department, Faculty of Medicine, University of Porto; Pediatric and Young Adult Rheumatology Unit, University Hospital of São João, Porto.
| | - M Leuzinger-Dias
- Ophthalmology Department, University Hospital of São João, Porto.
| | - L Figueira
- Ophthalmology Department, University Hospital of São João, Porto; Pharmacology and Therapeutics Department, Faculty of Medicine, University of Porto.
| | - I Brito
- Medicine Department, Faculty of Medicine, University of Porto; Pediatric and Young Adult Rheumatology Unit, University Hospital of São João, Porto.
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Tocilizumab in Juvenile Idiopathic Arthritis Associated Uveitis, a Narrative Review. CHILDREN 2023; 10:children10030434. [PMID: 36979992 PMCID: PMC10047268 DOI: 10.3390/children10030434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023]
Abstract
Juvenile idiopathic arthritis (JIA) associated uveitis (JIA-U) is the most common extra-articular manifestation of JIA, affecting 10–15% of patients, especially in oligoarticular JIA where its course may be faint. Therefore, JIA-U is one of the most challenging pediatric uveitis, associated with major ocular morbidity and possibly leading to irreversible structural ocular damage and to vision-threatening complications. Adequate management is crucial for avoiding visual impairment complications. Since the introduction of biologic disease modifying anti-rheumatic drugs (bDMARDS), the visual prognosis of JIA-U has dramatically improved over the decades. Tumor necrosis factor-α (TNF-α) blockers are the most used bDMARDs in treating JIA-U with large evidence of efficacy. However, inadequate response to these agents, either due to intolerance or inefficacy, may be observed, requiring a swap to other classes of immunosuppressive agents, including anti-IL-6, anti-CD20, and, more recently, JAK inhibitors. Tocilizumab is a humanized monoclonal antibody to the interelukin-6 receptor preventing IL-6 from binding to its soluble and membrane-bound receptors. A growing body of literature provides promising results about the efficacy of intravenous and subcutaneous tocilizumab in the treatment of JIA-U. A narrative review of the literature on this topic will improve our knowledge on the potential use of tocilizumab in JIA-U.
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Marelli L, Dallos T, Miserocchi E, Nucci P, Tombolini B, De Lucia O, Gattinara M, Caporali R, Marino A. Case report: Prader-Willi syndrome and inflammatory arthritis-An important consideration. Front Pediatr 2023; 11:1102382. [PMID: 37009284 PMCID: PMC10063871 DOI: 10.3389/fped.2023.1102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/20/2023] [Indexed: 04/04/2023] Open
Abstract
Background Prader-Willi syndrome (PWS) is a multisystemic genetically determined disorder. Musculoskeletal manifestations are common in most patients. We report the cases of two children with PWS who developed inflammatory arthritis, complicated with chronic anterior bilateral uveitis in one case. To our knowledge, no previous reports of such an association exist. Case presentation Case 1 was of a 3-year-old girl diagnosed with PWS who developed arthritis of the right knee with morning stiffness, joint swelling, and limited range of motion. Other causes of arthritis were ruled out. Increased inflammatory markers, antinuclear antibody (ANA) positivity, and hypertrophic synovitis on ultrasound confirmed the diagnosis of inflammatory arthritis compatible with juvenile idiopathic arthritis (JIA). Despite the treatment with methotrexate, arthritis progressed, and etanercept was added. The patient reached and maintained articular remission while on combined MTX and etanercept treatment during 9 years of follow-up. Case 2 was of a 6-year-old boy diagnosed with PWS who developed arthritis of the right knee. Laboratory investigations showed mildly increased acute phase reactants, microcytic anemia, and ANA positivity at high titer (titer 1:1,280). Infectious and other causes of arthritis were excluded. Ultrasound confirmed the presence of joint effusion and synovial thickening, and synovial fluid analysis was consistent with inflammatory arthrosynovitis (white blood cell count of 14,200/µl) compatible with JIA. Shortly after the diagnosis, the ophthalmologic evaluation revealed the presence of bilateral anterior uveitis. Despite MTX and topical corticosteroid, ocular inflammation persisted and adalimumab was added. At the last follow-up, 9 months later, the child experienced inactivity of arthritis and uveitis with normal growth. Conclusions We aim to raise awareness of this possible association among pediatricians since arthritis might be underestimated due to high pain tolerance, behavioral disturbances, and other musculoskeletal abnormalities in PWS patients.
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Affiliation(s)
- Luca Marelli
- Eye Clinic San Giuseppe Hospital, IRCCS Multimedica Scientific Institute, Milan, Italy
| | - Tomáš Dallos
- Second Department of Pediatrics, Comenius University Medical School, Bratislava, Slovakia
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Correspondence: Elisabetta Miserocchi
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Orazio De Lucia
- Division of Clinical Rheumatology, ASST G.Pini-CTO, Milano, Italy
| | | | - Roberto Caporali
- Division of Clinical Rheumatology, ASST G.Pini-CTO, Milano, Italy
- Unit of Pediatric Rheumatology, ASST G.Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health and Research Center for Pediatric and Adult Rheumatic Diseases (RECAP.RD), University of Milan, Milan, Italy
| | - Achille Marino
- Unit of Pediatric Rheumatology, ASST G.Pini-CTO, Milan, Italy
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12
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Kim BH, Chang IB, Lee S, Oh BL, Hong IH. Incidence and Prevalence of Pediatric Noninfectious Uveitis in Korea: A Population-Based Study. J Korean Med Sci 2022; 37:e344. [PMID: 36536545 PMCID: PMC9763706 DOI: 10.3346/jkms.2022.37.e344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Uveitis is less common in children than in adults; however, pediatric uveitis has a relatively severe disease course that affects the quality of life. Although it is important to understand the epidemiological characteristics of pediatric uveitis, few studies have been conducted in large populations without referral bias. This study investigated the nationwide incidence and prevalence of pediatric uveitis in South Korea according to period, age, anatomic type, and systemic associations. METHODS This nationwide population-based cohort study used data from the Korean National Health Insurance Service from 2002 to 2018. This study included patients younger than 19 years of age with noninfectious uveitis with at least three claims of diagnostic codes of uveitis on separate days with at least once claim of prescription codes of steroid and immunosuppressive agents. All the cases were classified as anterior or non-anterior uveitis, and the overall incidence and prevalence were estimated by age, sex, and period. Patients with noninfectious uveitis were categorized by the presence of associated systemic conditions. RESULTS A total of 10,862,616 patients over 128,688,078 person-years were evaluated from 2005 to 2016. Overall, 5,368 cases of anterior uveitis and 604 cases of non-anterior uveitis were identified. The incidence and prevalence of pediatric noninfectious uveitis were 4.64 per 100,000 person-years (95% confidence interval [CI], 4.52-4.76) and 8.25 per 100,000 persons (95% CI, 8.09-8.41). Both the incidence and prevalence of pediatric uveitis increased with age. Anterior uveitis accounted for 84.7% of pediatric noninfectious uveitis prevalent cases (6.99 per 100,000 persons). Cases of juvenile idiopathic arthritis (JIA)-associated uveitis accounted for 8.7% (926 cases) of pediatric noninfectious uveitis cases with a prevalence of 0.72 per 100,000 (95% CI, 0.67-0.77). The proportion of systemic associations was higher and JIA-related uveitis accounted for 11.2% (803 cases) of recurrent or chronic noninfectious uveitis cases with a prevalence of 0.62 per 100,000. CONCLUSION This is the first population-based study investigating the largest population of pediatric patients with uveitis in Korea. The nationwide incidence and prevalence of pediatric noninfectious uveitis in 2005-2016 were 4.64 per 100,000 person-years and 8.25 per 100,000, respectively. The proportion of JIA in pediatric noninfectious uveitis was 8.7%. These population-based study findings provide a better understanding of the public health burden and aid in the planning of health-care strategies for pediatric patients with uveitis.
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Affiliation(s)
- Bo Hee Kim
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | - In Hwan Hong
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea.
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Huguet Rodríguez B, Ortueta Olartecoechea AI, Seoane Sanz A, Tejada Palacios P, de Inocencio Arocena J. Morbidity of uveitis associated with juvenile idiopathic arthritis: The silent disease. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:356-358. [DOI: 10.1016/j.anpede.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/09/2022] [Indexed: 10/14/2022] Open
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Skarin A, Berthold E, Rauer O, Bengtsson-Stigmar E. Uveitis associated with juvenile arthritis: a continued cohort study 40 years after uveitis onset. Pediatr Rheumatol Online J 2022; 20:47. [PMID: 35804416 PMCID: PMC9264563 DOI: 10.1186/s12969-022-00704-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A third follow-up study, mean 40.7 years after uveitis onset, of a cohort originally consisting of 55 Swedish patients with uveitis associated with juvenile arthritis. METHOD A retrospective study of the patients' ophthalmic medical records. The results were compared to those of the same cohort previously studied at mean 7.2 and 24.0 years after uveitis onset. In the present follow-up study, 30 of the original 55 patients consented to participate. Of these, 26 had ophthalmic medical records that were reviewed. RESULTS In the 30 participants, active uveitis was seen in 43.4%, cataracts in 66.6% and glaucoma in 40.0%. When comparing data from previous follow-ups of the same cohort, a total of 61.8% were reported to have had cataracts at any of the three follow-ups, 29.0% had glaucoma or ocular hypertension and 12.7% had severe visual impairment in both eyes. At mean 40.7 years after uveitis onset 20% of patients in the original uveitis cohort were deceased. In 4 of the 11 deceased individuals, rheumatic disease was stated as the main cause of death, and in 3 it was considered a contributory factor in the patients deaths. CONCLUSIONS Uveitis associated with juvenile arthritis can be active into midlife and possibly longer. Ocular complications and visual loss increased up to 40 years after uveitis diagnosis. The mortality rate of this cohort was higher than that of a corresponding Swedish population. Lifelong ophthalmic check-ups are probably necessary for patients diagnosed with this type of uveitis.
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Affiliation(s)
- Angelika Skarin
- Department of Ophthalmology, Clinical Sciences Lund, Skåne University Hospital, Kioskgatan 1, 22242, Lund, Sweden.
| | - Elisabet Berthold
- grid.411843.b0000 0004 0623 9987Department of Rheumatology, Clinical Sciences Lund, Skåne University Hospital, Kioskgatan 5, 222 42 Lund, Sweden
| | - Ola Rauer
- grid.411843.b0000 0004 0623 9987Department of Ophthalmology, Clinical Sciences Lund, Skåne University Hospital, Kioskgatan 1, 22242 Lund, Sweden
| | - Elisabeth Bengtsson-Stigmar
- grid.411843.b0000 0004 0623 9987Department of Ophthalmology, Clinical Sciences Lund, Skåne University Hospital, Kioskgatan 1, 22242 Lund, Sweden
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Huguet Rodríguez B, Ortueta Olartecoechea AI, Seoane Sanz A, Tejada Palacios P, de Inocencio Arocena J. Morbilidad de la uveítis asociada a artritis idiopática juvenil: la enfermedad silente. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Julian LK, Balfour G, Forgues RF, de Smet M, Suburo A. Uveitis Patterns and Severity: An Epidemiologic Study from a Tertiary Care Private Referral Center in Buenos Aires, Argentina. Ocul Immunol Inflamm 2022; 31:710-716. [PMID: 35404742 DOI: 10.1080/09273948.2022.2053546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report uveitis' spectrum in a private practice cohort in the city of Buenos Aires, Argentina. METHODS Retrospective review at Instituto de la Visión (November 2011-October 2015). Standard demographics, ethnicity and Native American aboriginal ancestry were recorded. RESULTS Among 212 patients, median age 45 (6-97), 10% pediatric, 35% bilateral, 72% non-idiopathic, 36% infectious. Anterior uveitis presented in 50%, followed by posterior (32%), intermediate (9%) and panuveitis (8%). Frequent visits (≥ 6 per year) needed by 29%: posterior, non-idiopathic disease with 79% systemic immunosuppression requirement was their main presentation. Native American aboriginal ancestry was reported by 22.64% of the whole cohort and 37% of frequent visits' subgroup. CONCLUSIONS Unilateral, non-idiopathic, non-infectious anterior uveitis was the most frequent presentation, in agreement with reports coming from western developed cities. The multi-racial Argentinian population with specific Native American aboriginal ancestry might contribute to certain forms of posterior uveitis and their response to treatment.
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Affiliation(s)
- L. K. Julian
- Department of Ophthalmology, Instituto de la Visión, Buenos Aires, Argentina
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - G. Balfour
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
| | - R. F. Forgues
- Department of Ophthalmology, Instituto de la Visión, Buenos Aires, Argentina
| | - M.D. de Smet
- Department of Ophthalmology, MicroInvasive Ocular Surgery Center (MIOS), Lausanne, Switzerland
- Department of Ophthalmology, Leiden University, The Netherlands
| | - A. Suburo
- School of Biomedical Sciences, Austral University, Buenos Aires, Argentina
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Baquet-Walscheid K, Wildschütz L, Kasper M, Busch M, Thanos S, Bauer D, Stoll M, König S, Heiligenhaus A. Assessment of angiogenesis-related parameters in juvenile idiopathic arthritis-associated uveitis. Mol Biol Rep 2022; 49:6093-6102. [PMID: 35359237 DOI: 10.1007/s11033-022-07398-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Juvenile idiopathic arthritis-associated uveitis (JIAU) may run a chronic and treatment-resistant course, and occasionally, alterations of the iris vasculature may be observed clinically. METHODS Iris tissue (IT), aqueous humor (AH) and serum samples from patients with clinically inactive JIAU (n = 30), acute anterior uveitis (AAU; n = 18), and primary open angle glaucoma (POAG; n = 20) were obtained during trabeculectomy or cataract surgery. Samples were analyzed by RNA-Seq, qRT-PCR, LC-IMS, Western-Blot, and LEGENDplex™ analysis. Pattern of iris vasculature in JIAU patients was assessed qualitatively via fluorescein and indocyanine green angiography (FLA/ICGA). RESULTS RNA-Seq of IT showed significantly differential expression (DE) of 136 genes between JIAU and POAG, of which 15 were associated with angiogenesis. qRT-PCR, performed to validate RNA-Seq results, showed upregulation of the angiogenesis-related genes Kdr, Angpt-1, Tie-1, Tie-2 and Mmrn2 in IT (JIAU vs POAG, p > 0.05). LC-IMS of IT revealed a total number of 56 DE proteins (JIAU vs POAG), of which Angiopoetin, Lumican and Decorin were associated with angiogenesis and showed increased (p > 0.05) expression on Western-Blot analysis. LEGENDplex™ analysis showed upregulation of ANGPT-2 in AH from JIAU compared to AAU and POAG, whereas VEGF was upregulated in AAU. Iris vascular leakage, hypoperfusion and neovascularization were observed by FLA/ICGA in JIA patients with treatment-refractory complicated course of uveitis. CONCLUSION Angiogenesis-related factors could play a role in long-standing complicated JIAU, leading to clinically visible alterations in selected cases.
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Affiliation(s)
- Karoline Baquet-Walscheid
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Germany. .,University of Duisburg-Essen, Essen, Germany.
| | - Lena Wildschütz
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Germany
| | - Maren Kasper
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Germany
| | - Martin Busch
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Germany
| | - Solon Thanos
- Institute of Experimental Ophthalmology, University of Muenster, Münster, Germany
| | - Dirk Bauer
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Germany
| | - Monika Stoll
- Core Facility Genomics, University of Muenster, Münster, Germany.,Department "Genetic Epidemiology", Institute of Human Genetics, University of Münster, Münster, Germany
| | - Simone König
- Core Unit Proteomics, Interdisciplinary Center for Clinical Research, University of Muenster, Münster, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology and Ophtha-Lab, St. Franziskus-Hospital, Hohenzollernring 74, 48145, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
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18
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Kumar P, Gupta A, Bansal R, Suri D, Gupta V, Gupta A, Singh S. Chronic Uveitis in Children. Indian J Pediatr 2022; 89:358-363. [PMID: 34731440 DOI: 10.1007/s12098-021-03884-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the experience of managing chronic childhood uveitis from a tertiary care center in India. METHODS All children diagnosed as chronic uveitis between January 2005 and December 2012 and on follow-up in Pediatric Rheumatology Clinic and Uveitis Clinic, were eligible for enrollment. Information regarding demographics, type of uveitis, treatment, complications, and surgical procedures was obtained from clinic records. All the enrolled patients were assessed for outcome prospectively and underwent a detailed ophthalmological examination to document visual acuity, refraction, intraocular pressure (IOP), slit lamp examination, fundus examination, and vitreous haze findings. RESULTS Sixty-seven children with chronic uveitis were enrolled in the study. Anterior uveitis was the commonest type seen in 45 children. Juvenile idiopathic arthritis (JIA) was the commonest known etiology and diagnosis of uveitis was made during routine screening in a majority of the JIA patients. No cause could be identified in 43% patients. After a mean follow-up period of 3.95 ± 1.99 y, only 16% eyes were in remission and off therapy. Prolonged oral glucocorticoids were required, besides other immunosuppressants, to control inflammation in 50% patients. Ocular complications were seen in 87% cases with posterior synechiae, band-shaped keratopathy and cataracts being the commonest complications. CONCLUSIONS Among patients with chronic uveitis, 43% had no identifiable cause. JIA was the commonest known cause. Significant ocular complications were common. Even after a mean follow-up of 3.95 ± 1.99 y, a vast majority continued to need immunosuppression for control of disease activity.
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Affiliation(s)
- Pawan Kumar
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigrah, 160012, India
| | - Anju Gupta
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigrah, 160012, India.
| | - Reema Bansal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigrah, 160012, India
| | - Vishali Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigrah, 160012, India
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Jones JT, Kitchen J, Talib N. Down Syndrome-Associated Arthritis (DA): Diagnostic and Management Challenges. Pediatric Health Med Ther 2022; 13:53-62. [PMID: 35311022 PMCID: PMC8932915 DOI: 10.2147/phmt.s282646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/07/2022] [Indexed: 12/24/2022] Open
Abstract
Down syndrome (DS) is one of the most common birth defects in the United States, the most common genomic disorder of intellectual disability, and results from trisomy 21. This chromosome disorder causes an extensive, heterogenous phenotype that results in a broad presentation of symptoms that includes atlantoaxial instability, congenital heart defects, muscle hypotonia, hypothyroidism, hematologic disorders, recurrent infections, and autoimmune diseases. The autoimmune diseases are caused by immune system dysregulation that results in increased pro-inflammatory cytokines, along with other innate and adaptive immune system dysregulation. This is the likely cause of the increased risk of inflammatory arthritis or Down syndrome-associated arthritis (DA) seen in individuals with DS. Most individuals with DA present with polyarticular (five or more joints with arthritis at presentation of disease), rheumatoid factor and anti-nuclear antibody negative disease that is aggressive with bone and joint damage at presentation. There is notable delay in diagnosis of DA as there are no formal guidelines on screening or monitoring for inflammatory arthritis in individuals with DS. Once diagnosed, and despite aggressive therapy with disease modifying antirheumatic drugs, disease burden is high for those with DA. Therapy can also be challenging for those with DA as many require second and third-line disease modifying therapies. Many also struggle with medication toxicity and ineffectiveness that further causes challenges with management and outcomes. The purpose of this current review is to provide an up-to-date summary of the literature related to DA in children and adolescents with focus on presentation, diagnosis, and management considerations, along with current barriers that inhibit optimal care.
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Affiliation(s)
- Jordan T Jones
- Division of Rheumatology, Children's Mercy Kansas City, Kansas City, MO, USA.,Division of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.,Division of Pediatrics, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jacqueline Kitchen
- Division of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Nasreen Talib
- Division of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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20
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Kostik MM, Gaidar EV, Sorokina LS, Avrusin IS, Nikitina TN, Isupova EA, Chikova IA, Korin YY, Orlova ED, Snegireva LS, Masalova VV, Dubko MF, Kalashnikova OV, Chasnyk VG. Uveitis Is a Risk Factor for Juvenile Idiopathic Arthritis' Significant Flare in Patients Treated With Biologics. Front Pediatr 2022; 10:849940. [PMID: 35783325 PMCID: PMC9240648 DOI: 10.3389/fped.2022.849940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Uveitis is the most frequent extra-articular manifestation of juvenile idiopathic arthritis (JIA). Our study is aimed to evaluate the possible difference in arthritis course depending on uveitis presence in patients with JIA, treated with biologics. METHODS From our database of patients with JIA treated with biologics, we extracted patients to whom the first agent was administrated with or without MTX. The exclusion criteria included treatment with current systemic corticosteroids, infliximab, rituximab, observation period <3 years, and no missing data. After selection, 175 patients were eligible for analysis. We evaluated clinically significant flare with joint involvement (which required change of biologic or non-biologic DMARD) and time to flare. We compared two groups: (i) patients with uveitis (n = 32) and (ii) patients without uveitis (n = 143). For statistical analysis, we used Cox's regression models, the log-Rank test, x 2 test, and the Mann-Whitney test. RESULTS There was no difference in gender distribution and achievement of arthritis remission between groups. Patients in the non-uveitis group predominantly received etanercept (64.3%). In the uveitis group, the most prescribed biologic agent was adalimumab (71.9%). The presence of uveitis increased the risk of JIA flare, OR = 3.8 (95% CI: 1.7; 8.7), and the cumulative probability of joint flare, RR = 4.5 (95% CI: 1.7; 12.1), p =.003, after adjustment on methotrexate, RR = 3.1 (1.6; 6.), p =.0008. In the subgroup of patients treated with adalimumab, the absence of methotrexate increased the cumulative probability of flare [RR = 6.5 (95% CI: 1.4; 31.1), p = 0.02]. CONCLUSION The presence of uveitis proved to be a risk factor in JIA flare. Methotrexate can decrease the cumulative flare probability. Further trials are required.
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Affiliation(s)
- Mikhail M Kostik
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Ekaterina V Gaidar
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Lubov S Sorokina
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Ilya S Avrusin
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Tatiana N Nikitina
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Eugenia A Isupova
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Irina A Chikova
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Yuri Yu Korin
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Elizaveta D Orlova
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia.,Pediatric Research and Clinical Center for Infection Diseases, Saint Petersburg, Russia
| | - Ludmila S Snegireva
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Vera V Masalova
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Margarita F Dubko
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Olga V Kalashnikova
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
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Del Giudice E, Simio C, Scala A, Di Coste A, La Torre G, Spadea L, Lubrano R, Duse M, Paroli MP. Juvenile idiopathic arthritis-associated uveitis in the era of biological therapy: how the disease changed in more than 20 years of observation in a tertiary referral center in Rome (Italy). Int Ophthalmol 2021; 42:775-784. [PMID: 34669094 PMCID: PMC8917035 DOI: 10.1007/s10792-021-02043-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/22/2021] [Indexed: 11/12/2022]
Abstract
Objectives To describe the ophthalmological characteristics in a Juvenile idiopathic arthritis (JIA) cohort and to evaluate how therapeutic advances have changed the course of the uveitis. Methods Analysis of a retrospective cohort study of consecutive JIA pediatric patients including JIA-associated uveitis (JIA-U) and comparison with a previous study in the same uveitis center assessed before the wide-spread of biological therapy. Results The total of 49 JIA patients were analyzed, of whom 18 JIA-U, compared with a JIA-U past cohort of 66 patients. Systemic corticosteroids were used significantly less in the current JIA-U group (p = 0.008) than in the past one. JIA-U present cohort was on therapy more frequently with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) than the past group (p = 0.039), mostly treated with methotrexate (93.3%). Furthermore, a larger use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) was described in the current JIA-U group (p = 0.005) also associated with csDMARDs (p = 0.003). Adalimumab was used more (72.7%) in the present JIA-U cohort compared to a larger treatment with infliximab (61.5%) in the past (p = 0.005). Higher number of uveitis recurrences was observed in the previous cohort compared to the current one (p = 0.005). Fewer complications were described in this study than in the previous: posterior synechiae (p = 0.007), cataract (p < 0.001), band keratopathy (p < 0.001), and elevated intraocular pressure (IOP) (p = 0.047). Conclusion Current therapies reduced the uveitis recurrences and ocular complications including cataract due also to the lower use of corticosteroids. The new close collaboration with the pediatric rheumatologic center in the same University has contributed to the care improvement and decrease of uveitis complications.
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Affiliation(s)
- E Del Giudice
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Italy
| | - C Simio
- Department of Sense Organs, Eye Clinic, Uveitis Unit, Sapienza University of Rome, V.le del Policlinico 155, 00161, Rome, Italy
| | - A Scala
- Department of Sense Organs, Eye Clinic, Uveitis Unit, Sapienza University of Rome, V.le del Policlinico 155, 00161, Rome, Italy
| | - A Di Coste
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - G La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - L Spadea
- Department of Sense Organs, Eye Clinic, Uveitis Unit, Sapienza University of Rome, V.le del Policlinico 155, 00161, Rome, Italy
| | - R Lubrano
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Italy
| | - M Duse
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - M P Paroli
- Department of Sense Organs, Eye Clinic, Uveitis Unit, Sapienza University of Rome, V.le del Policlinico 155, 00161, Rome, Italy.
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22
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Assessment of systemic and ocular inflammation in juvenile idiopathic arthritis via choroidal vascularity index. Rheumatol Int 2021; 42:1187-1196. [PMID: 34633494 DOI: 10.1007/s00296-021-05023-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
We aimed to evaluate the retina and the choroid in children with juvenile idiopathic arthritis (JIA) employing optical coherence tomography (OCT). This cross-sectional study, carried out between June 2017-December 2019, included JIA patients with (JIAU; n = 28) and without (JIAN; n = 65) uveitis and age-matched healthy controls (HC) (n = 102). Laboratory and demographic information of the children were obtained from hospital records. Activity of the disease was evaluated by the Juvenile Arthritis Disease Activity Score-71 (JADAS-71). Choroidal scans were obtained with spectral domain-OCT in enhanced-depth imaging (EDI)-OCT mode to assess choroidal thickness (ChT) at five locations (under the fovea, at 750 and 1500 μm nasal and temporal sections), luminal area (LA), stromal area (SA), total subfoveal choroidal area (TCA) and CVI (choroidal vascularity index). Central foveal thickness (CFT) and 1-mm diameter foveal thickness (FT) were calculated automatically through macular volume scan analysis. The choroid was significantly thicker in JIAU and JIAN patients than in HC at the subfoveal and at the 750N, 750T, 1500T points (p < 0.001, p = 0.009, p < 0.001, and p < 0.001, respectively). The CVI was lower in JIAU patients than in JIAN patients and HC (p = 0.02). Conversely, CFT was greater in JIAU patients as compared to the JIAN patients and HC (p = 0.02). Changes in chorioretinal OCT parameters in the absence of uveitis in JIA patients may reflect subclinical choroidal inflammation in these patients. Ophthalmologic examination, including choroidal imaging in a larger cohort, may clarify this aspect.
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23
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Lazăr C, Spîrchez M, Ştefan M, Predeţeanu D, Nicoară S, Crişan M, Man O. Diagnosis and treatment of uveitis associated with juvenile idiopathic arthritis. Med Pharm Rep 2021; 94:S28-S32. [PMID: 34527905 DOI: 10.15386/mpr-2224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in pediatric population, with uveitis as the most common and severe extra-articular manifestation. Eye damage (bilateral in 70-80% of cases) is usually anterior, chronic and asymptomatic. Young age, female gender, oligoarticular form and ANA positivity are risk factors for chronic anterior uveitis (CAU). Acute anterior uveitis (AAU) frequently occurs in HLA-B27 positive boys with enthesitis-related arthritis. The onset is on average 1.8 years after the onset of JIA, but it may also precede the articular manifestations. Ophthalmological screening for JIA is recommended every 3 or 6-12 months depending on the combination of risk factors for associated uveitis. The major purpose of the treatment is to minimize the loss of visual acuity. The treatment is topical (corticosteroids, cycloplegics) and systemic (short-term glucocorticoids, methotreexate, biological drugs). Biological therapy (indicated if previous treatments are ineffective) is using anti-TNF drugs as first choice (most studies are indicating sup erior efficiency for Adalimumab). Usually AAU is treated promptly and no systemic treatment is needed. In some cases the evolution of CAU can lead to severe complications (synechiaes, cataract, glaucoma, even blindness). Interdisciplinary approach involving the pediatric rheumatologist and ophthalmologist is essential for correct monitoring of this disease.
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Affiliation(s)
- Călin Lazăr
- Department of Pediatrics Clinic I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Pediatrics Clinic I, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Mihaela Spîrchez
- Department of Pediatrics Clinic II, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Pediatrics Clinic II, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | | | - Denisa Predeţeanu
- Rheumatology Clinic, "Sfânta Maria" Clinical Hospital, Bucharest, Romania
| | - Simona Nicoară
- Department of Ophthalmology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mirela Crişan
- Department of Pediatrics Clinic I, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Oana Man
- Department of Pediatrics Clinic I, Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
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Diagnostic and therapeutic considerations in pediatric uveitis. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-021-00503-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Sahin S, Acari C, Sonmez HE, Kilic FZ, Sag E, Dundar HA, Adrovic A, Demir S, Barut K, Bilginer Y, Sozeri B, Unsal E, Ozen S, Kasapcopur O. Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER. Pediatr Rheumatol Online J 2021; 19:134. [PMID: 34425847 PMCID: PMC8383412 DOI: 10.1186/s12969-021-00613-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/13/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA), is the most common pediatric rheumatologic disorder with unknown etiology. Currently, no population-based data are available regarding the distribution of categories and frequency of uveitis in patients with JIA in Turkey. The purpose of this study was to evaluate the frequency of JIA-associated uveitis (JIAU) and distribution of JIA categories in a Turkish JIA cohort. METHODS This was a retrospective study of 500 randomized patients in four pediatric rheumatology clinics in Turkey. RESULTS Oligoarticular JIA (oJIA) was the most common JIA disease category in this study cohort (38.8%). The frequencies of the other categories were as follows: enthesitis-related arthritis (ERA), 23.2%; rheumatoid factor (RF)-negative polyarthritis, 15.6%; systemic arthritis, 12.2%; juvenile psoriatic arthritis, 5.2%; undifferentiated arthritis, 2.8%; and RF-positive polyarthritis, 2.2%. JIA-associated uveitis was observed in 6.8% of patients at a mean (Standard Deviation, SD) age of 9.1 (3.8) years over a mean JIA disease duration of 4 (1.9) years. Uveitis developed after joint disease, with a mean (SD) duration of 1.8 (1.9) years. Patients with oJIA had the highest rate of uveitis (12.9%) followed by patients with ERA (5.2%) and polyarticular RF-negative disease (3.8%). Compared with persistent oJIA, the extended oJIA category had a > 3-fold higher risk of uveitis (11.3% vs 27.7%; odds ratio, 3.38 [95% Confidence Interval, 1.09-10.4]). The most frequently administered drug after development of uveitis was tumor necrosis factor-alpha inhibitors (38.2%). Five patients (14.7%) had uveitis-related complications that required surgical intervention. CONCLUSIONS Turkish pediatric patients with JIA experience a lower frequency of oJIA and higher frequency of ERA than their white European counterparts; the occurrence of uveitis is also somewhat lower than expected. Geographic and ethnic factors may affect these differences and need further investigation.
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Affiliation(s)
- Sezgin Sahin
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Ceyhun Acari
- Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | | | | | - Erdal Sag
- Hacettepe University, School of Medicine, Ankara, Turkey
| | | | - Amra Adrovic
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Selcan Demir
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Kenan Barut
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Yelda Bilginer
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Betul Sozeri
- Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Erbil Unsal
- Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Seza Ozen
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ozgur Kasapcopur
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey.
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Maleki A, Anesi SD, Look-Why S, Manhapra A, Foster CS. Pediatric uveitis: A comprehensive review. Surv Ophthalmol 2021; 67:510-529. [PMID: 34181974 DOI: 10.1016/j.survophthal.2021.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
Pediatric uveitis accounts for 5-10% of all uveitis. Uveitis in children differs from adult uveitis in that it is commonly asymptomatic and can become chronic and cause damage to ocular structures. The diagnosis might be delayed for multiple reasons, including the preverbal age and difficulties in examining young children. Pediatric uveitis may be infectious or noninfectious in etiology. The etiology of noninfectious uveitis is presumed to be autoimmune or autoinflammatory. The most common causes of uveitis in this age group are idiopathic and juvenile idiopathic arthritis-associated uveitis. The stepladder approach for the treatment of pediatric uveitis is based on expert opinion and algorithms proposed by multidisciplinary panels. Uveitis morbidities in pediatric patients include cataract, glaucoma, and amblyopia. Pediatric patients with uveitis should be frequently examined until remission is achieved. Once in remission, the interval between follow-up visits can be extended; however, it is recommended that even after remission the child should be seen every 8-12 weeks depending on the history of uveitis and the medications used. Close follow up is also necessary as uveitis can flare up during immunomodulatory therapy. It is crucial to measure the impact of uveitis, its treatment, and its complications on the child and the child's family. Visual acuity can be considered as an acceptable criterion for assessing visual function. Additionally, the number of cells in the anterior chamber can be a measure of disease activity. We review different aspects of pediatric uveitis. We discuss the mechanisms of noninfectious uveitis, including autoimmune and autoinflammatory etiologies, and the risks of developing uveitis in children with systemic rheumatologic diseases. We address the risk factors for developing morbidities, the Standardization of Uveitis Nomenclature (SUN) criteria for timing and anatomical classifications, and describe a stepladder approach in the treatment of pediatric uveitis based on expert opinion and algorithms proposed by multi-disciplinary panels. In this review article, We describe the most common entities for each type of anatomical classification and complications of uveitis for the pediatric population. Additionally, we address monitoring of children with uveitis and evaluation of Quality of Life.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Stephen D Anesi
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Sydney Look-Why
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA; The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA; Harvard Medical School, Department of Ophthalmology, Boston, MA, USA.
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27
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van Straalen JW, Giancane G, Amazrhar Y, Tzaribachev N, Lazar C, Uziel Y, Telcharova-Mihaylovska A, Len CA, Miniaci A, Boteanu AL, Filocamo G, Mastri MV, Arkachaisri T, Magnolia MG, Hoppenreijs E, de Roock S, Wulffraat NM, Ruperto N, Swart JF. A clinical prediction model for estimating the risk of developing uveitis in patients with juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 60:2896-2905. [PMID: 33274366 PMCID: PMC8213427 DOI: 10.1093/rheumatology/keaa733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/02/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To build a prediction model for uveitis in children with JIA for use in current clinical practice. METHODS Data from the international observational Pharmachild registry were used. Adjusted risk factors as well as predictors for JIA-associated uveitis (JIA-U) were determined using multivariable logistic regression models. The prediction model was selected based on the Akaike information criterion. Bootstrap resampling was used to adjust the final prediction model for optimism. RESULTS JIA-U occurred in 1102 of 5529 JIA patients (19.9%). The majority of patients that developed JIA-U were female (74.1%), ANA positive (66.0%) and had oligoarthritis (59.9%). JIA-U was rarely seen in patients with systemic arthritis (0.5%) and RF positive polyarthritis (0.2%). Independent risk factors for JIA-U were ANA positivity [odds ratio (OR): 1.88 (95% CI: 1.54, 2.30)] and HLA-B27 positivity [OR: 1.48 (95% CI: 1.12, 1.95)] while older age at JIA onset was an independent protective factor [OR: 0.84 (9%% CI: 0.81, 0.87)]. On multivariable analysis, the combination of age at JIA onset [OR: 0.84 (95% CI: 0.82, 0.86)], JIA category and ANA positivity [OR: 2.02 (95% CI: 1.73, 2.36)] had the highest discriminative power among the prediction models considered (optimism-adjusted area under the receiver operating characteristic curve = 0.75). CONCLUSION We developed an easy to read model for individual patients with JIA to inform patients/parents on the probability of developing uveitis.
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Affiliation(s)
- Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Yasmine Amazrhar
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | | | - Calin Lazar
- Pediatrics, Spitalul Clinic de Urgenta pentru Copii, Cluj-Napoca, Romania
| | - Yosef Uziel
- Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Claudio A Len
- Pediatrics Department, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Angela Miniaci
- Salute della Donna, del Bambino e dell’Adolescente-Padiglione 16 Ambulatorio di reumatologia, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Alina L Boteanu
- Pediatric Rheumatology Unit, University Hospital Ramón y Cajal, Madrid, Spain
| | - Giovanni Filocamo
- Pediatric Rheumatology, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariel V Mastri
- Unidad de Reumatologia, Hospital Sor Maria Ludovica, La Plata, Argentina
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Maria G Magnolia
- Paediatrics, Santa Maria della Stella Hospital, Ciconia, Orvieto (TR), Italy
| | - Esther Hoppenreijs
- Pediatric Rheumatology, Radboud University Medical Center/Sint Maartenskliniek, Nijmegen, Netherlands
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, Netherlands
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Neves LM, Haefeli LM, Hopker LM, Ejzenbaum F, Moraes do Nascimento H, Aikawa N, Hilario MO, Magalhães CS, Terreri MT, Sztajnbok F, Silva C, Rossetto JD. Monitoring and Treatment of Juvenile Idiopathic Arthritis-associated Uveitis: Brazilian Evidence-based Practice Guidelines. Ocul Immunol Inflamm 2021; 30:1384-1398. [PMID: 33826468 DOI: 10.1080/09273948.2021.1876886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To present a national guideline for ophthalmologic care and surveillance of juvenile idiopathic arthritis-associated uveitis (JIA-uveitis).Methods: Review article based on medical literature and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology/Brazilian Council of Ophthalmology and the Brazilian Society of Pediatrics/Brazilian Society of Rheumatology. Studies with a high level of evidence were selected by searching the PubMed/Medline database. The final document was approved by the experts.Results: The main recommendations are that children/adolescents with JIA should undergo screening according to their risk factors. Ophthalmological checkups should also consider ocular inflammation and therapy. Topical glucocorticoids should be the first line of therapy, with systemic glucocorticoids acting as bridge treatments in severe uveitis. Methotrexate should be the first-line systemic therapy and anti-tumor necrosis factor (anti-TNF alpha) the second for uncontrolled uveitis.Conclusions: This evidence-based guideline for JIA-uveitis will be useful for both ophthalmology and rheumatology practice.
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Affiliation(s)
- L M Neves
- Ophthalmology Department, Instituto Nacional De Saúde Da Mulher, Da Criança E Do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio De Janeiro, RJ, Brazil.,Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil
| | - L M Haefeli
- Ophthalmology Department, Instituto Nacional De Saúde Da Mulher, Da Criança E Do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio De Janeiro, RJ, Brazil.,Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil
| | - L M Hopker
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Ophthalmology Department, Hospital De Olhos Do Paraná, Curitiba/PR, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil
| | - F Ejzenbaum
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Ophthalmology Department, Santa Casa De Misericórdia De São Paulo Sao Paulo/SP, Brazil
| | - H Moraes do Nascimento
- Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Ophthalmology and Visual Science Department, Federal University of Sao Paulo - UNIFESP, São Paulo, SP, Brazil
| | - N Aikawa
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, SP, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil
| | - M O Hilario
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Department, Santa Casa De Misericórdia De Porto Alegre, Porto Alegre/RS, Brazil
| | - C S Magalhães
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Rheumatology Division, São Paulo State University (UNESP), Botucatu/SP, Brazil
| | - M T Terreri
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Rheumatology Unit, Federal University of São Paulo - UNIFESP, São Paulo/SP, Brazil
| | - F Sztajnbok
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Department, Instituto De Puericultura E Pediatria Martagão Gesteira - IPPMG/Federal University of Rio De Janeiro - UFRJ - Rio De Janeiro/RJ, Brazil
| | - Caa Silva
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, SP, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil
| | - J D Rossetto
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Ophthalmology and Visual Science Department, Federal University of Sao Paulo - UNIFESP, São Paulo, SP, Brazil.,Pediatric Department, Instituto De Puericultura E Pediatria Martagão Gesteira - IPPMG/Federal University of Rio De Janeiro - UFRJ - Rio De Janeiro/RJ, Brazil
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Slamang W, Tinley C, Brice N, Scott C. Paediatric non-infectious uveitis in Cape Town, South Africa: a retrospective review of disease characteristics and outcomes on immunomodulating treatment. Pediatr Rheumatol Online J 2021; 19:50. [PMID: 33794930 PMCID: PMC8017656 DOI: 10.1186/s12969-021-00537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Non-infectious uveitis is a well-reported cause of blindness in more developed countries, however data from sub-Saharan Africa is lacking. Here we aim to describe the diseases associated with paediatric non-infectious uveitis and the effect of currently available treatment in this setting. METHODS A retrospective observational analysis of children with non-infectious uveitis from January 2010 to December 2017, attending the tertiary paediatric rheumatology and ophthalmology referral units in Cape Town was conducted. Statistical analysis utilising STATA13 software was performed with p < 0.05 considered significant. RESULTS Twenty-nine children were identified: median age at first visit of 74 months (IQR 49-86 months), female to male ratio of 0.9:1, predominantly of mixed ancestry (72.4%). Juvenile idiopathic arthritis associated uveitis (JIAU) (48.3%), idiopathic uveitis (41.4%), sarcoidosis (6.9%) and Behcet's disease (3.5%) were diagnosed. Chronic anterior uveitis (72.4%) was the most frequent finding. Fifty-five percent had complications at presentation and all children with idiopathic uveitis presented with cataracts. Only 6.5% of the JIA cohort had JIAU. All JIA children had chronic anterior uveitis. There were no differences between JIA children with uveitis and those without uveitis, for sex (p = 0.68) and race (p = 0.58). Significantly, children with uveitis presented at an overall younger age (p = 0.008), had oligo-articular JIA (p = 0.01) and were antinuclear antibody positive (p < 0.001). Children with idiopathic uveitis were predominantly male (66.6%) with chronic anterior uveitis (41.7%). Nineteen children (65.5%) in the cohort had inactive disease on treatment at 12 months from diagnosis, which included 10 on topical corticosteroid therapy. At the last clinical visit 17 (58.6%) on standard initial therapy, 8 (27.6%) on tumour necrosis factor inhibitors and 2 on additional DMARDs were in remission. Five of these children still required topical corticosteroids. Surgery was performed in 41.4%, primarily in the idiopathic group. Visual acuity improved or was maintained on treatment. CONCLUSION Current practice seems to detect children with potentially sight-threatening disease but the high rate of complications and the low percentage of children with JIAU raises concerns of delayed healthcare intervention. Tumour necrosis factor inhibitors have improved outcomes in refractory cases in this cohort, however further studies are needed.
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Affiliation(s)
- Waheba Slamang
- Department of Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Cape Town, 7700, South Africa.
- University of Cape Town South Africa, Rondebosch, Cape Town, South Africa.
| | - Christopher Tinley
- University of Cape Town South Africa, Rondebosch, Cape Town, South Africa
- Department of Paediatric Ophthalmology, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Cape Town, 7700, South Africa
| | - Nicola Brice
- Department of Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Cape Town, 7700, South Africa
- University of Cape Town South Africa, Rondebosch, Cape Town, South Africa
| | - Christiaan Scott
- Department of Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Cape Town, 7700, South Africa.
- University of Cape Town South Africa, Rondebosch, Cape Town, South Africa.
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30
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Li Y, Mao X, Tang X, Mao H. Efficacy and Safety of Anti-TNFα Therapy for Uveitis Associated with Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analysis. Rheumatol Ther 2021; 8:711-727. [PMID: 33721267 PMCID: PMC8217376 DOI: 10.1007/s40744-021-00296-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/13/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction To investigate the efficacy and safety of anti-TNFα therapy in patients with juvenile idiopathic arthritis associated uveitis (JIA-U). Methods Embase, PubMed, Cochrane Library, and Web of Science were systematically searched for studies reporting anti-TNFα treatment in patients with JIA-U. The primary outcome was the control of intraocular inflammation (CII). The pooled proportion of CII was assessed by the random-effects method when I2 > 50%, otherwise, by the fixed-effect method. This study was registered with PROSPERO (CRD42020161749). Results Three randomized clinical trials (RCTs), twelve case series, three retrospective cohort studies, and three case reports were identified. A total of 399 patients were receiving anti-TNFα therapy, of which 201 patients were treated with adalimumab (ADA), 139 with infliximab (IFX), 36 with etanercept (ETA), 20 with golimumab (GLM), and 3 with certolizumab pegol (CZP). The pooled proportions of CII on observational studies were 82% (95% CI 63–96%) in patients receiving ADA, 56% (95% CI 30–80%) in IFX, 38% (95% CI 8–73%) in ETA and 65% (95% CI 42–86%) in GLM, respectively. All three patients treated with CZP reached improved activity. ADA therapy led to a significantly higher proportion of CII compared to IFX therapy (χ2 = 26.24, P < 0.001), or to ETA therapy (χ2 = 13.43, P < 0.001); but no statistical difference was observed between IFX and ETA (χ2 = 0.13, P = 0.71). As to safety, most reported adverse events were tolerable and two cohort studies consistently showed that ADA was safer than IFX. Conclusions The existing evidence suggests that ADA is better than IFX regarding efficacy and safety. The effectiveness of IFX is higher than ETA with no statistical difference. GLM and CZP may be proxies for ADA but the evidence is limited. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00296-x.
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Affiliation(s)
- Yulu Li
- Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaolan Mao
- Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Tang
- Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Huawei Mao
- Department of Rheumatology and Immunology, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Department of Immunology, National Center for Children's Health, Beijing Children's Hospital of Capital Medical University, Beijing, China.
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31
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Siiskonen M, Hirn I, Pesälä R, Hautala T, Ohtonen P, Hautala N. Prevalence, incidence and epidemiology of childhood uveitis. Acta Ophthalmol 2021; 99:e160-e163. [PMID: 32588987 DOI: 10.1111/aos.14535] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To analyse the prevalence, incidence and aetiology of paediatric uveitis. METHODS A retrospective, population-based cohort study of Finnish children with uveitis in Northern Ostrobothnia Hospital District in 2008-2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution of the disease, aetiology and systemic association. RESULTS One hundred fifty patients aged <16 years (mean age 6.9 ± 3.9 years) with uveitis were included, out of whom 53% were girls. The first uveitis episode occurred at 1-6 years in 59%, and 62% of them were girls. In the age group of 7-15 years, boys were diagnosed with uveitis more frequently than girls (61% versus 39%, respectively). Seventy percent of the girls were diagnosed with their first uveitis episode at the age of 1-6 years, whereas only 48% of the boys were diagnosed at that age. The prevalence of uveitis increased from 64/100 000 children <16 years in 2008 (95% CI, 47.7-84.2) to 106/100 000 in 2017 (95% CI, 84.6-130.2). The incidence of childhood uveitis in 2008-2017 was 14/100 000 person-years in children <16 years (95% CI, 11.3-16.5). Eighty-seven percent of the cases were non-infectious, 9% were infectious, and 3% had masquerade syndromes. Sixty-one percent of patients had juvenile idiopathic arthritis (JIA). CONCLUSION The prevalence of paediatric uveitis has increased during the last decade in both genders. Uveitis is more frequent in girls, and they were diagnosed at a younger age than boys. Idiopathic cases and JIA accounted for a majority of aetiological features.
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Affiliation(s)
- Mira Siiskonen
- Department of Ophthalmology Oulu University Hospital Oulu Finland
- PEDEGO Research Unit Oulu Finland
- Medical Research Center University of Oulu Oulu Finland
- Division of Operative Care Oulu University Hospital Oulu Finland
| | - Iida Hirn
- PEDEGO Research Unit Oulu Finland
- Medical Research Center University of Oulu Oulu Finland
| | - Roosa Pesälä
- PEDEGO Research Unit Oulu Finland
- Medical Research Center University of Oulu Oulu Finland
| | - Timo Hautala
- Research Unit of Biomedicine University of Oulu Oulu Finland
| | - Pasi Ohtonen
- Medical Research Center University of Oulu Oulu Finland
- Division of Operative Care Oulu University Hospital Oulu Finland
| | - Nina Hautala
- Department of Ophthalmology Oulu University Hospital Oulu Finland
- PEDEGO Research Unit Oulu Finland
- Medical Research Center University of Oulu Oulu Finland
- Division of Operative Care Oulu University Hospital Oulu Finland
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Marelli L, Romano M, Pontikaki I, Gattinara MV, Nucci P, Cimaz R, Miserocchi E. Long Term Experience in Patients With JIA-Associated Uveitis in a Large Referral Center. Front Pediatr 2021; 9:682327. [PMID: 34262889 PMCID: PMC8273291 DOI: 10.3389/fped.2021.682327] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/02/2021] [Indexed: 01/26/2023] Open
Abstract
Objectives: To describe demographic, clinical and therapeutic findings of a large cohort of patients with JIA-associated uveitis in a nationwide referral pediatric rheumatology and uveitis center in Northern Italy. Methods: Retrospective study of 125 patients with JIA-associated uveitis followed from 2009 to 2019. Demographic and rheumatologic features including JIA ILAR classification, age at onset, and laboratory data were recorded. Ocular findings collected were: anatomic location of uveitis, laterality, type, recurrence rate, visual acuity, ocular complications, and local therapy. Systemic therapy with conventional and biologic immunosuppressants, occurrence of adverse events, and duration of treatments were recorded. Results: One hundred and twenty-five patients with JIA-associated uveitis were followed for a meantime of 9.2 (±1.7) years. Oligoarticular JIA was present in 92.8% of patients and anterior uveitis in 96%. The most common ocular complications recorded in our sample were posterior synechiae (37.6%), cataract (20.8%), band keratopathy (19.2%), glaucoma (7.2%), and macular edema (5.6%). Conventional immunosuppressants were used in 75.2% of patients with a mean duration of 9.1 years (±5.4), while biologics were administered in 47.2% of them for a period of 5.4 years. Adverse events (AE) were seen in 23% of patients being treated with Methotrexate, in 10.4% of patients treated with Adalimumab, in 38.5% of patients in therapy with Infliximab, and in 14.3% of patients being treated with Tocilizumab. No AE were reported in patients treated with Golimumab, Certolizumab, Abatacept and Rituximab. Conclusions: An aggressive treatment approach for patients with JIA-associated uveitis ensured a low number of ocular complications with a good safety profile.
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Affiliation(s)
- Luca Marelli
- Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, Milan, Italy
| | - Micol Romano
- Pediatric Rheumatology Unit, Azienda Socio-Sanitaria Territoriale (ASST) G. Pini-Centro Traumatologico Ortopedico (CTO), Milan, Italy
| | - Irene Pontikaki
- Pediatric Rheumatology Unit, Azienda Socio-Sanitaria Territoriale (ASST) G. Pini-Centro Traumatologico Ortopedico (CTO), Milan, Italy
| | - Maurizio Virgilio Gattinara
- Pediatric Rheumatology Unit, Azienda Socio-Sanitaria Territoriale (ASST) G. Pini-Centro Traumatologico Ortopedico (CTO), Milan, Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rolando Cimaz
- Pediatric Rheumatology Unit, Azienda Socio-Sanitaria Territoriale (ASST) G. Pini-Centro Traumatologico Ortopedico (CTO), Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
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Petty RE, Zheng Q. Uveitis in juvenile idiopathic arthritis. World J Pediatr 2020; 16:562-565. [PMID: 31965444 DOI: 10.1007/s12519-019-00331-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Ross E Petty
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Qi Zheng
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, 57# Zhu Gan Road Zhejiang Province, Hangzhou, 310000, China
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Childhood uveitis not associated with juvenile idiopathic arthritis: a national survey of incidence, management and visual outcomes. Eye (Lond) 2020; 35:2573-2578. [PMID: 33199865 DOI: 10.1038/s41433-020-01267-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/08/2022] Open
Abstract
AIMS To estimate the incidence of childhood uveitis not associated with juvenile idiopathic arthritis (JIA) in the United Kingdom. METHODS Children under 16 years who presented with a new diagnosis of uveitis from November 2014 to October 2015 were identified prospectively through the British and Scottish Ophthalmological Surveillance Unit reporting card system. Incident questionnaires were sent to reporting ophthalmologists at presentation and 12 months. RESULTS From 1st November 2014 to 31st October 2015, 119 cases were reported. Thirty-nine cases were excluded. The estimated minimum annual incidence of non-JIA uveitis in children younger than 16 years is 0.66 per 100,000 (95% CI 0.52-0.82). Median age at presentation was 10 years. 73% had bilateral uveitis. Median (IQR) BCVA in the worse eye was 0.3 (IQR 0.1-0.66) logMAR. The location of uveitis was: anterior 36%, intermediate 24%, posterior 6.8% and panuveitis 30%. 70% of cases were idiopathic. Most children were started on topical corticosteroids at presentation (86%, n = 51). At presentation, 31% (n = 19) were on started on systemic corticosteroids. At 1 year only 13% (n = 7) remained on corticosteroids, with the majority transitioned to steroid-sparing agents: methotrexate (30.8%, n = 16), mycophenolate (5.8%) and anti-TNF agents 5 (9.6%). At 1 year, 46% had ongoing intraocular inflammation despite treatment. The most common ocular adverse event was raised intraocular pressure (13.5%, n = 7). CONCLUSION Our study provides the first national population-based data of non-JIA childhood uveitis. Most children remain on treatment at 1 year, but visual acuity improves and none were eligible for sight-impairment registration.
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Rahman N, Petrushkin H, Solebo AL. Paediatric autoimmune and autoinflammatory conditions associated with uveitis. Ther Adv Ophthalmol 2020; 12:2515841420966451. [PMID: 33225212 PMCID: PMC7649876 DOI: 10.1177/2515841420966451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
Childhood uveitis comprises a collection of heterogenous ocular phenotypes which are associated with a diverse range of childhood autoimmune and autoinflammatory disorders. Of these genetic and/or acquired disorders, juvenile idiopathic arthritis is the most common, affecting 30-80% of children with uveitis. Up to a third of children with uveitis have 'isolated' idiopathic disease and do not have an associated systemic disease which manifests in childhood. However, uveitis may be the presenting manifestation of disease; thus, the apparently well child who presents with uveitis may have isolated idiopathic disease, but they may have an evolving systemic disorder. The diagnosis of most of the associated disorders is reliant on clinical features rather than serological or genetic investigations, necessitating detailed medical history taking and systemic examination. Adequate control of inflammation is key to good visual outcomes, and multidisciplinary care is key to good broader health outcomes.
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Affiliation(s)
- Najiha Rahman
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ameenat Lola Solebo
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Sezer M, Aydın F, Kurt T, Tekgöz N, Tekin ZE, Karagöl C, Çakar N, Acar B. Prediction of inactive disease and relapse in oligoarticular juvenile idiopathic arthritis. Mod Rheumatol 2020; 31:1025-1030. [PMID: 33050742 DOI: 10.1080/14397595.2020.1836788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study is to describe clinical features of patients with oligoarticular juvenile idiopathic arthritis (JIA) who achieved inactive disease at 3rd month and also to determine the predictors of relapse and extended course. METHODS In the cohort study, 88 patients with oligoarticular JIA were retrospectively analyzed. The demographic data, clinical features, medications, relapse rates were recorded. Juvenile Arthritis Disease Activity Score (JADAS) and American College of Rheumatology Pediatric criteria were used to measure disease activity and treatment response at 3, 6 and 12 months. RESULTS Fifty-nine (67%) patients were females and the mean age at diagnosis was 7.9 ± 4.3 years. The odds of achieving inactive disease (JADAS ≤1) at 3rd month were increased by a lower JADAS27 score at admission. Forty-one (48.8%) of 84 patients relapsed. Ankle involvement at onset, high JADAS27 score at admission, increased ESR at admission and presence of synovial hypertrophy in imaging were risk factors for occurrence of relapse. CONCLUSION Our results show that a significant proportion of oligoarticular JIA patients relapse after inactive period. JADAS is a useful tool to guide the treatment decisions of patients who may be at risk of high disease activity and relapse.
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Affiliation(s)
- Müge Sezer
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Fatma Aydın
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Tuba Kurt
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nilüfer Tekgöz
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Zahide Ekici Tekin
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cüneyt Karagöl
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nilgün Çakar
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Banu Acar
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Rypdal V, Glerup M, Songstad NT, Bertelsen G, Christoffersen T, Arnstad ED, Aalto K, Berntson L, Fasth A, Herlin T, Ekelund M, Peltoniemi S, Toftedal P, Nielsen S, Leinonen S, Bangsgaard R, Nielsen R, Rygg M, Nordal E. Uveitis in Juvenile Idiopathic Arthritis: 18-Year Outcome in the Population-based Nordic Cohort Study. Ophthalmology 2020; 128:598-608. [PMID: 32866542 DOI: 10.1016/j.ophtha.2020.08.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To assess the long-term outcome of uveitis in juvenile idiopathic arthritis (JIA). DESIGN Population-based, multicenter, prospective JIA cohort, with a cross-sectional assessment of JIA-associated uveitis (JIA-U) 18 years after the onset of JIA. PARTICIPANTS A total of 434 patients with JIA, of whom 96 had uveitis, from defined geographic areas of Denmark, Finland, Norway, and Sweden. METHODS Patients with onset of JIA between January 1997 and June 2000 were prospectively followed for 18 years. Pediatric rheumatologists and ophthalmologists collected clinical and laboratory data. MAIN OUTCOME MEASURES Cumulative incidence of uveitis and clinical characteristics, JIA and uveitis disease activity, ocular complications, visual outcome, and risk factors associated with the development of uveitis-related complications. RESULTS Uveitis developed in 96 (22.1%) of 434 patients with JIA. In 12 patients (2.8%), uveitis was diagnosed between 8 and 18 years of follow-up. Systemic immunosuppressive medication was more common among patients with uveitis (47/96 [49.0%]) compared with patients without uveitis (78/338 [23.1%]). Active uveitis was present in 19 of 78 patients (24.4%) at the 18-year visit. Ocular complications occurred in 31 of 80 patients (38.8%). Short duration between the onset of JIA and the diagnosis of uveitis was a risk factor for developing ocular complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8). Patients with a diagnosis of uveitis before the onset of JIA all developed cataract and had an OR for development of glaucoma of 31.5 (95% CI, 3.6-274). Presence of antinuclear antibodies (ANAs) was also a risk factor for developing 1 or more ocular complications (OR, 3.0; 95% CI, 1.2-7.7). Decreased visual acuity (VA) <6/12 was found in 12 of 135 eyes (8.9%) with uveitis, and 4 of 80 patients (5.0%) with JIA-U had binocular decreased VA <6/12. CONCLUSIONS Our results suggest that uveitis screening should start immediately when the diagnosis of JIA is suspected or confirmed and be continued for more than 8 years after the diagnosis of JIA. Timely systemic immunosuppressive treatment in patients with a high risk of developing ocular complications must be considered early in the disease course to gain rapid control of ocular inflammation.
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Affiliation(s)
- Veronika Rypdal
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Nils Thomas Songstad
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Geir Bertelsen
- Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
| | - Terje Christoffersen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway
| | - Ellen D Arnstad
- Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristiina Aalto
- Department of Pediatrics, University of Helsinki, Helsinki, Finland
| | - Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Ekelund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Ryhov County Hospital, Jonkoping, Sweden
| | - Suvi Peltoniemi
- Department of Pediatrics, University of Helsinki, Helsinki, Finland
| | - Peter Toftedal
- Department of Pediatrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Susan Nielsen
- Department of Pediatrics, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Sanna Leinonen
- Department of Ophthalmology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Regitze Bangsgaard
- Department of Ophthalmology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Rasmus Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Ellen Nordal
- Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
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Walscheid K, Glandorf K, Rothaus K, Niewerth M, Klotsche J, Minden K, Heiligenhaus A. Enthesitis-related Arthritis: Prevalence and Complications of Associated Uveitis in Children and Adolescents From a Population-based Nationwide Study in Germany. J Rheumatol 2020; 48:262-269. [DOI: 10.3899/jrheum.191085] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 12/11/2022]
Abstract
Objective.Enthesitis-related arthritis (ERA) represents a subgroup of juvenile idiopathic arthritis (JIA) that is regularly accompanied by anterior uveitis. This study describes the prevalence and characteristics of ERA-related uveitis.Methods.Cross-sectional data from the National Pediatric Rheumatological Database (NPRD) were used to characterize ERA-related uveitis (ERA-U). In addition to sociodemographic variables, we documented the occurrence of uveitis and course of disease, including symptoms, visual acuity, and complications, as well as JIA characteristics such as disease activity (Juvenile Arthritis Disease Activity Score 10), functional ability (Childhood Health Assessment Questionnaire score), laboratory variables, and treatment.Results.In the years from 2002 to 2014, there were 3778 (15.2%) of a total of 24,841 JIA patients recorded in the NPRD who had ERA, and 280 (7.4%) of them had developed uveitis. Detailed ophthalmological documentation by a uveitis add-on module was available for 22.9% of these patients. Uveitis onset was acutely symptomatic in 63% of patients. Patients with uveitis were more frequently male, HLA-B27–positive, younger at ERA onset, and they had higher erythrocyte sedimentation rate values at first uveitis documentation than those without uveitis. Uveitis was diagnosed at a mean age of 11.5 (± 3.9) years (50% within 2 years after ERA onset). Systemic treatment with corticosteroids and synthetic and biologic disease-modifying antirheumatic drugs was associated with a (not significantly) lower risk of developing uveitis.Conclusion.The course of disease in ERA-U patients is frequently similar to HLA-B27–associated uveitis in adults; however, a subgroup of patients presents with asymptomatic uveitis.
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Rodriguez-Smith J, Yeh S, Angeles-Han S. Improving quick and accurate diagnosis of childhood JIA-uveitis from a pediatric rheumatology perspective. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 15:101-109. [PMID: 32313548 PMCID: PMC7170263 DOI: 10.1080/17469899.2020.1739521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease associated with uveitis. JIA-associated uveitis (JIA-U) is typically asymptomatic, chronic, and can lead to sight-threatening complications. This review will provide approaches to improve the diagnosis and outcomes of children with JIA-U. AREAS COVERED We will provide updates on risk factors for uveitis onset and ocular complications, improvements in the ophthalmic screening schedule for uveitis detection, and potential strategies to advance the diagnosis and monitoring of JIA-U using advanced ophthalmic imaging and diagnostic equipment and laboratory biomarkers. EXPERT OPINION There is a lack of high-quality research in JIA-U and few randomized controlled trials, underscoring the urgent need for further studies in this population. Early uveitis diagnosis combined with timely and appropriate treatment can improve visual outcomes. Improved knowledge of uveitis pathogenesis, risk factors for uveitis onset, measurement of uveitis outcomes, and optimal treatment are crucial.
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Affiliation(s)
- Jackeline Rodriguez-Smith
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, 3333 Burnett Avenue, Cincinnati, Ohio 45229-3026, United States
| | - Steven Yeh
- Emory Eye Center, Department of Ophthalmology, Atlanta, Georgia 30322-1013, United States
| | - Sheila Angeles-Han
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, 3333 Burnett Avenue, Cincinnati, Ohio 45229-3026, United States
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Kasper M, Walscheid K, Laffer B, Bauer D, Busch M, Loser K, Vogl T, Langmann T, Ganser G, Rath T, Heiligenhaus A. Phenotype of Innate Immune Cells in Uveitis Associated with Axial Spondyloarthritis- and Juvenile Idiopathic Arthritis-associated Uveitis. Ocul Immunol Inflamm 2020; 29:1080-1089. [PMID: 32160102 DOI: 10.1080/09273948.2020.1715449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: To analyze circulating immune cells in patients with anterior uveitis (AU) associated to axial spondyloarthritis (SpA), or juvenile idiopathic arthritis (JIA).Methods: Venous blood samples were collected from healthy controls (n = 16), and either SpA (n = 19) or JIA (n = 23) patients with associated anterior uveitis (AU) during active flare, or after ≥3 months of inactivity. Frequencies of CD56+, MHC-I+, and S100A9+ monocytes, CCR7+ dendritic cells, CD56+dim natural killer (NK) cells and CD3+CD56bright T-cells were analyzed via flow cytometry. Serum S100A8/A9 levels were determined via ELISA.Results: SpA patients showed a reduced frequency of CD56+dim NK cells during uveitis activity, a constitutively activated monocyte phenotype, and elevated S100A8/A9 serum levels. In contrast, JIAU patients showed elevated frequencies of CD56+ monocytes and CCR7+ DC.Conclusion: Phenotype of peripheral immune cells differ between patients, probably contributing to different courses of acute onset AU in SpA and insidious onset AU in JIAU patients.Abbreviations: AU: anterior uveitis, AR: arthritis, JIA: juvenile idiopathic arthritis, SpA: axial spondyloarthritis.
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Affiliation(s)
- Maren Kasper
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Karoline Walscheid
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
| | - Björn Laffer
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
| | - Dirk Bauer
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Martin Busch
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany
| | - Karin Loser
- Department of Dermatology, Experimental Dermatology and Immunobiology of the Skin University of Münster, Münster, Germany
| | - Thomas Vogl
- Department of Immunology, University of Münster, Münster, Germany
| | - Thomas Langmann
- Experimental Immunology of the Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Gerd Ganser
- Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Thomas Rath
- Department of Nephrology, Immunology and Osteology of St. Franziskus Hospital, Münster, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology, Ophtha-Lab at St. Franziskus Hospital, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
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An Unusual Retinal Vessel Modification in Patients Affected by JIA-Uveitis with a Follow-Up Longer Than 16 Years. Case Rep Ophthalmol Med 2020; 2020:4720819. [PMID: 32082664 PMCID: PMC7008287 DOI: 10.1155/2020/4720819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/14/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To report unusual and rare clinical changes of retinal vessel pattern in a series of patients affected by Juvenile Idiopathic Arthritis (JIA) uveitis with a follow-up longer than 16 years. Methods A series of three patients with JIA-uveitis followed at the University of Rome “Sapienza” from 1998 to 2014 were reported. The retinal vessels were analyzed with fluorescein angiography using Heidelberg Retinal Angiogram-2 (HRA-2; Heidelberg Engineering GmBH, Dossenheim, Germany) and the Topcon TRC-50LX retinal camera (Topcon Europe, The Netherlands). A Spectralis Domain OCT (SD-OCT) (Spectralis Family Heidelberg, Germany) was performed to evaluate vessel anatomy. Results Fundus photography showed sheathed vessels localized around the optic disc in every case. Angiography revealed a normal physiology of vessel walls and flow; no sheathing or leakage of dye was observed. SD-OCT demonstrated reflective vessel walls. Vessel lumen appeared patent, and the normal “hourglass configuration” was blurred, but identifiable. Conclusions Vessel modifications observed in long-standing JIA-uveitis are not signs of vascular inflammation and are not associated to hypoperfusion. In these cases, ophthalmologists should avoid further invasive investigation and should consider introducing SD-OCT as a routine method to evaluate the vessel changes during the follow-up.
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Malcová H, Dallos T, Bouchalova K, Brejchová I, Brichová M, Bušányová B, Fabianová J, Fráňová J, Furdová A, Jarošová K, Kobrová K, Kostolná B, Košková E, Lokaj M, Macků M, Melocíková J, Michaličková M, Minxová L, Moravčíková D, Němcová D, Pískovský T, Říhová E, Schüller M, Skalická E, Svozílková P, Tomčíková D, Vargová V, Vrtíková E, Doležalová P, Heissigerová J. Recommendations for the Management of Uveitis Associated With Juvenile Idiopathic Arthritis: The Czech and Slovak adaptation of SHARE Initiative. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2020; 76:1-15. [PMID: 33086847 DOI: 10.31348/2020/7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is its most important extra-articular manifestation. Evidence-based recommendations are available only to a limited extent and therefore JIA associated uveitis management is mostly based on physicians experience. Consequently, treatment practices differ widely, both nationally and internationally. Therefore, an effort to optimize and publish recommendations for the care of children and young adults with rheumatic diseases was launched in 2012 as part of the international project SHARE (Single Hub and Access Point for Pediatric Rheumatology in Europe) to facilitate clinical practice for paediatricians and (paediatric) rheumatologists. The aim of this work was to translate published international SHARE recommendations for the diagnosis and treatment of JIA associated uveitis and to adapt them for use in the Czech and Slovak Republics. International recommendations were developed according to the standard methodology of the European League against Rheumatism (EULAR) by a group of nine experienced paediatric rheumatologists and three experts in ophthalmology. It was based on a systematic literature review and evaluated in the form of an online survey and subsequently discussed using a nominal group technique. Recommendations were accepted if > 80% agreement was reached (including all three ophthalmologists). A total of 22 SHARE recommendations were accepted: 3 on diagnosis, 5 on disease activity assessment, 12 on treatment and 2 on future recommendations. Translation of the original text was updated and modified with data specific to the czech and slovak health care systems and supplemented with a proposal for a protocol of ophthalmological dispensarization of paediatric JIA patients and a treatment algorithm for JIA associated uveitis. Conclusion: The aim of the SHARE initiative is to improve and standardize care for paediatric patients with rheumatic diseases across Europe. Therefore, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated based on the evidence and agreement of leading European experts in this field.
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Gaggiano C, Rigante D, Tosi GM, Vitale A, Frediani B, Grosso S, Fabiani C, Cantarini L. Treating juvenile idiopathic arthritis (JIA)-related uveitis beyond TNF-α inhibition: a narrative review. Clin Rheumatol 2019; 39:327-337. [PMID: 31823144 DOI: 10.1007/s10067-019-04763-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022]
Abstract
Chronic anterior uveitis is the most frequent among extra-articular manifestations of juvenile idiopathic arthritis (JIA) and a relevant cause of ocular morbidity in children. Asymmetric arthritis, early onset disease, female sex, and anti-nuclear antibody (ANA) positivity are counted among risk factors for developing this complication. It usually has insidious onset and asymptomatic chronic-relapsing course, but the persistence of low-grade chronic inflammation can lead to irreversible structural ocular damage and to vision-threatening complications. For such reasons, achieving a complete absence of inflammation through early targeted and aggressive treatments is a primary therapeutic goal in these patients. This review is aimed at summarizing scientific evidence about biologic rescue therapy of JIA-related uveitis in patients who fail to achieve clinical remission, in spite of being treated with conventional disease-modifying anti-rheumatic drugs (cDMARDs) and at least one biologic tumor necrosis factor (TNF)-α inhibitor. Interleukin (IL)-6 inhibition appears a promising and safe option for refractory JIA-related uveitis. Abatacept and rituximab proved to be beneficial as well, but their efficacy together with some safety concerns needs to be more extensively evaluated.
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Affiliation(s)
- Carla Gaggiano
- Clinical Pediatrics, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Periodic Fever Research Center, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.
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Juvenile idiopathic arthritis-associated uveitis. Clin Immunol 2019; 211:108322. [PMID: 31830532 DOI: 10.1016/j.clim.2019.108322] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/05/2019] [Indexed: 12/25/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the commonest rheumatic disease in children and JIA-associated uveitis its most frequent extra-articular manifestation. The uveitis is potentially sight-threatening and so carries a considerable risk of morbidity. The commonest form of uveitis seen in JIA is chronic anterior uveitis which is almost always asymptomatic in the initial stages. Therefore, screening for JIA-associated uveitis in at-risk patients is essential. The aim of early detection and treatment is to minimise intra-ocular inflammation and avoid complications leading to visual loss, resulting from both disease activity and medications. There is increasing evidence for the early introduction of systemic immunosuppressive therapies in order to reduce topical and systemic glucocorticoid use. Two randomised controlled trials of adalimumab in JIA-associated uveitis provide convincing evidence for the use of this biologic in patients who fail to respond adequately to methotrexate. Tocilizumab and baricitinib are being investigated as alternatives to anti-tumour necrosis factor drugs.
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Levels of Selected Matrix Metalloproteinases, Their Inhibitors in Saliva, and Oral Status in Juvenile Idiopathic Arthritis Patients vs. Healthy Controls. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7420345. [PMID: 31781639 PMCID: PMC6855065 DOI: 10.1155/2019/7420345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/01/2019] [Indexed: 12/27/2022]
Abstract
Aims Matrix metalloproteinases (MMPs) are a group of calcium-dependent zinc-containing proteinases acting both physiologically and in pathological conditions. The aim of this study was to evaluate the concentration of MMP-2, MMP-8, and MMP-9 and their inhibitors TIMP-1 and TIMP-2 of unstimulated whole saliva (UWS) in correlation with the oral health in juvenile idiopathic arthritis (JIA) children. Methods The study population comprised 34 JIA patients and 34 age- and sex-matched controls (C). They were divided into two groups: with mixed dentition (MD) and with permanent dentition (PD). Dental caries (DMFT/dmft), unstimulated salivary flow rate (SF), and gingival inflammation (Gingival Index (GI) and Papilla Bleeding Index (PBI)) and oral hygiene (Simplified Oral Hygiene Index (OHI-S)) indices were evaluated. Saliva samples were tested with the enzyme-linked immunosorbent assay (ELISA) for MMP-2, MMP-8, MMP-9, TIMP-1, and TIMP-2. Data were statistically analysed with the Mann–Whitney U test and Spearman's rank correlation (p < 0.05). Results There were no differences in dental hygiene or dental and periodontal status between the JIA and C groups. The MMP-9 concentration was higher in the whole JIA group compared with C (p=0.005) and JIA MD groups (p=0.038). A positive correlation of MMP-2 with the OHI-S index and a negative correlation of MMP-2 with SF were found in JIA. MMP-9 and its tissue inhibitor TIMP-1 had a positive mean correlation with the GI. A high correlation of MMP-8 with the number of decayed teeth (D) in JIA MD patients (p=0.037) was revealed. In the JIA-PD patients, there was a positive correlation of MMP-2, -8, and -9 levels with gingival inflammation indices and a negative correlation of MMP-2 and 8 with the SF. Conclusions Despite a comparable clinical oral status of affected and unaffected children, in the JIA patients, a statistically significantly increased level of MMP-9 was found. In reference to the periodontal status, the role of MMPs increased in children with permanent dentition, whereas in reference to dental caries, the period of mixed dentition (MD) was critical.
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Castagna I, Roszkowska AM, Alessandrello F, Oliverio GW, Tumminello G, Gallizzi R, Conti G, Aragona P. Juvenile idiopathic arthritis-associated uveitis: a retrospective analysis from a centre of South Italy. Int Ophthalmol 2019; 40:335-342. [PMID: 31586268 DOI: 10.1007/s10792-019-01184-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the clinical and laboratory characteristics of the children affected by juvenile idiopathic arthritis (JIA) who developed uveitis. METHODS In this retrospective study, we have examined data of 109 patients aged from 3 to 16 years, affected by JIA and followed at Paediatrics Rheumatology Clinic and Ophthalmology Clinic of University Hospital of Messina in the period from 2007 to 2017. The main outcome measures were clinical and laboratory findings related to JIA and ocular involvement. The prevalence of ocular signs and symptoms was determined and correlated with age. RESULTS Twenty-one (19.3%) subjects developed uveitis. Two different peaks of age with ocular involvement were registered. The first occurred between 4 and 6 years and the second between 10 and 12 years. All subjects in the first group resulted to be female, presented oligoarticular arthritis and chronic anterior uveitis. In the second group, the 84% of patients were male with different types of JIA and acute anterior uveitis. The prevalence of ocular complications was higher in the first group. CONCLUSIONS Two peaks of age emerged and were characterized by different clinical outcomes of arthritis and ocular involvement. The first occurred between 4 and 6 years and interested females affected by oligoarticular JIA who develop chronic anterior uveitis. The second appeared at 10-12 years and interested older males affected by different types of JIA with acute anterior uveitis. Early diagnosis and cooperation between paediatric rheumatologist and ophthalmologist are of great importance in the proper management of JIA children with uveitis.
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Affiliation(s)
- I Castagna
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| | - A M Roszkowska
- Ophthalmology Section, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland. .,A.O.U. Policlinico G. Martino Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - F Alessandrello
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| | - G W Oliverio
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| | - G Tumminello
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| | - R Gallizzi
- Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - G Conti
- Pediatric Nephrology and Rheumatology Unit, University Hospital of Messina, Messina, Italy
| | - P Aragona
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
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Busch M, Wefelmeyer KL, Walscheid K, Rothaus K, Bauer D, Deeg CA, Degroote RL, Ackermann D, König S, Thanos S, Kasper M, Heiligenhaus A. Identification of Ocular Autoantigens Associated With Juvenile Idiopathic Arthritis-Associated Uveitis. Front Immunol 2019; 10:1793. [PMID: 31447836 PMCID: PMC6691058 DOI: 10.3389/fimmu.2019.01793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/16/2019] [Indexed: 12/28/2022] Open
Abstract
The purpose of the current study was to analyze the binding patterns of serum autoantibodies from juvenile idiopathic arthritis (JIA) and JIA-associated uveitis (JIAU) patients to proteomes from different ocular tissues and to identify potential ocular autoantigens in JIAU. Proteomes from porcine iris, ciliary body, or retina tissue were isolated, separated using 2D-gel electrophoresis, and transferred to a blotting membrane. The binding pattern of serum antibodies from JIA or JIAU patients or healthy controls to ocular proteins was visualized by using anti-human IgG secondary antibodies and chemiluminescence reaction. Selected protein spots were excised from silver-stained 2D gels and subjected to mass spectrometry. Serum antibodies binding to ocular proteins were detected in all patient groups and healthy controls. Irrespective of the patient groups, serum antibodies bound to 49 different protein spots of the retina proteome, to 53 of the ciliary body proteome, and to 44 of the iris proteome. The relative binding frequency of sera to these iris protein spots was significantly higher in JIAU than in JIA patients or healthy controls. Particularly in JIAU patients, cluster analyses indicated a broad range of serum antibodies directed against ocular antigens, mostly in the iris proteome. Iris proteins frequently bound by serum antibodies in all groups were identified as tubulin beta chain, vimentin, ATP synthase subunit beta, actin, and L-lactate dehydrogenase B chain. Iris proteins exclusively bound by JIAU serum antibodies were heat shock cognate 71 kDa protein and keratin. Although serum autoantibody binding to ocular antigens was not disease-specific, a significant diversity of autoantibodies against a broad range of antigens, particularly from the iris tissue, was detected in JIAU patients. As the iris is a major site of inflammation in JIAU, the present data give further evidence that autoantibodies may be involved in JIAU immunopathology.
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Affiliation(s)
- Martin Busch
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Kira Leona Wefelmeyer
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Karoline Walscheid
- Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Kai Rothaus
- Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Dirk Bauer
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Cornelia A Deeg
- Chair of Animal Physiology, Department of Veterinary Sciences, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Roxane L Degroote
- Chair of Animal Physiology, Department of Veterinary Sciences, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Doreen Ackermann
- IZKF Core Unit Proteomics, University of Münster, Münster, Germany
| | - Simone König
- IZKF Core Unit Proteomics, University of Münster, Münster, Germany
| | - Solon Thanos
- Institute of Experimental Ophthalmology, University of Münster, Münster, Germany
| | - Maren Kasper
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany
| | - Arnd Heiligenhaus
- Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany.,Department of Ophthalmology at St. Franziskus Hospital, Münster, Germany.,University of Duisburg-Essen, Essen, Germany
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Kumar V, Surve A, Azad S, Venkatesh P, Bagri N, Prasad P, Gupta Y. Juvenile idiopathic arthritis-related uveitis mimicking endophthalmitis. J AAPOS 2019; 23:238-241. [PMID: 30959168 DOI: 10.1016/j.jaapos.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 03/17/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a group of disorders occurring in children with arthritis of more than 6 weeks' duration. JIA may have varied systemic and ocular presentations, which can pose a diagnostic challenge. Chronic uveitis with insidious onset is the most common type of ocular presentation. This report highlights a case of enthesitis-related arthritis, a type of JIA, in a 12-year-old boy who presented with severe intermediate uveitis that mimicked endophthalmitis.
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Affiliation(s)
- Vinod Kumar
- Vitreo-retina, Trauma and Uvea Services; Dr. Rajendra Prasad Center for Ophthalmic Sciences; All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Abhidnya Surve
- Vitreo-retina, Trauma and Uvea Services; Dr. Rajendra Prasad Center for Ophthalmic Sciences; All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Shorya Azad
- Vitreo-retina, Trauma and Uvea Services; Dr. Rajendra Prasad Center for Ophthalmic Sciences; All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Pradeep Venkatesh
- Vitreo-retina, Trauma and Uvea Services; Dr. Rajendra Prasad Center for Ophthalmic Sciences; All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Narendra Bagri
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India; Pediatric Rheumatology
| | - Priyanka Prasad
- Dr. Rajendra Prasad Center for Ophthalmic Sciences; All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Yogita Gupta
- Vitreo-retina, Trauma and Uvea Services; Dr. Rajendra Prasad Center for Ophthalmic Sciences; All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Scott D, Scott C, Jelsma J, Abraham D, Verstraete J. Validity and feasibility of the self-report EQ-5D-Y as a generic Health-Related Quality of Life outcome measure in children and adolescents with Juvenile Idiopathic Arthritis in Western Cape, South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1335. [PMID: 31392295 PMCID: PMC6676980 DOI: 10.4102/sajp.v75i1.1335] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background Health-Related Quality of Life (HRQoL) data together with clinical findings allow for monitoring of intervention efficacy and the effect on HRQoL. Children with Juvenile Idiopathic Arthritis (JIA) experience symptoms often persisting into adulthood, emphasising the need to track HRQoL. Objectives The aim of this study was to investigate psychometric properties of the EuroQol five-dimensional youth questionnaire (EQ-5D-Y) in children with JIA. Methods A cross-sectional, analytical study design was used. Children 8 to 15 years were recruited, completing the self-report EQ-5D-Y and two other HRQoL questionnaires. Known group validity was established by comparing the effect size between children with different disease severities. Concurrent validity was tested using Kruskal–Wallis to compare the ranking of scores on different questionnaires. Feasibility was assessed by number of missing responses and time to complete each questionnaire. Results All questionnaires were able to distinguish between children with different JIA severity. There was a significant difference in ranking of most Juvenile Arthritis Multidimensional Assessment Report dimension scores across EQ-5D-Y levels, (p < 0.05), indicating concurrent validity. There was poor concurrent validity with the PedsQL dimensions tested with EQ-5D-Y, except for ‘pain’ (p = 0.001). The EQ-5D-Y was the quickest to complete with no missing values. Conclusion This study showed that the EQ-5D-Y is valid and feasible in measuring HRQoL in JIA children and adequately responsive to detect change over time. Clinical implications It is quick and easy to use in a busy clinical setting, allowing for effective JIA management monitoring.
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Affiliation(s)
- Desiree Scott
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christiaan Scott
- Department of Paediatrics, Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jelsma
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Deepthi Abraham
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Janine Verstraete
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Gupta A, Bagri NK, Tripathy SK, Barwad A, Phulware RH, Hari P. Successful use of tocilizumab in amyloidosis secondary to systemic juvenile idiopathic arthritis. Rheumatol Int 2019; 40:153-159. [DOI: 10.1007/s00296-019-04363-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
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