Juvenile Idiopathic Arthritis Uveitis
Key Points
Key Points
- Uveitis is the most common extraarticular manifestation of juvenile idiopathic arthritis (JIA) and can be a chronic or acute disease.
- Chronic anterior uveitis (CAU) develops in 10–20% of children with JIA, is usually asymptomatic, and there is rarely external evidence of inflammation.
- Acute anterior uveitis (AAU) is a distinctly different form of uveitis. It is typically associated with HLA–B27 and occurs in children with spondyloarthritis (i.e., those with enthesitis-related or psoriatic arthritis).
- AAU differs from CAU in that AAU is episodic, unilateral, characterized by the sudden onset of erythema, pain, and photophobia, and generally does not require systemic treatment.
- Uncontrolled CAU can lead to sight-threatening complications such as synechiae, cataracts, and glaucoma in 25–50% and vision loss in 10–20% of children with uveitis.
- Early detection through regular ophthalmic screening with timely and appropriate treatment can improve visual outcomes and prevent ocular complications.
Diagnosis
...Diagnosi...
...able 1. Terms, definitions, and medic...
...Ophthalmic screening examinations; B,...
...le 2. Critical and important outcomesaHaving t...
Treatment
...Treat...
...ure 2. Recommendations for topical glucoco...
...Table 3....
...commendations for ophthalmic screeningIn childre...
...ns for ophthalmic monitoring...
...iscontinuing topical glucocorticoids, opht...
...stable therapy, ophthalmic monitoring no les...
...discontinuing systemic therapy, oph...
...Recommenda...
In children and adolescents with JIA and a...
...isolone acetate 1% topical drops is conditional...
...ng or increasing topical glucocort...
...en and adolescents with JIA and CAU sti...
...on systemic therapy, adding systemic...
...equiring 1–2 drops/day of prednisolon...
...children and adolescents with JIA wh...
Recommendations for DMARDs and bio...
...ic treatment for uveitis: Using subcutaneous...
...TNFi: Starting a monoclonal antibody TN...
...ere active CAU and sight-threatenin...
...response to one monoclonal TNFi at...
...d a first monoclonal antibody TNFi at above-s...
...ed methotrexate and 2 monoclonal antibody TN...
...s for education about and treatmen...
...recommend education regarding the warning signs o...
...d with systemic immunosuppressive therap...
...Recommendations...
...adolescents with JIA and CAU that is controlle...
...adolescents with JIA and uveitis that is well...
...dation had very low quality level o...