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
Diagno...
...rms, definitions, and medication interventionsHa...
...igure 1. A, Ophthalmic screening examinations;...
...itical and important outcomesaHaving troubl...
Treatment
Treatme...
...Recommendations for topical glucocorticoids...
...Recommendations for ophthalmic screening, opht...
...tions for ophthalmic screeningIn children an...
...ndations for ophthalmic monitorin...
...r discontinuing topical glucocorticoids, ophthal...
...stable therapy, ophthalmic monitorin...
...discontinuing systemic therapy, ophthalmic monito...
...ommendations for glucocorticoid u...
...en and adolescents with JIA and act...
...ne acetate 1% topical drops is con...
...or increasing topical glucocorticoids for s...
...ldren and adolescents with JIA and CAU...
...t on systemic therapy, adding syst...
...iring 1–2 drops/day of prednisolon...
...and adolescents with JIA who develop new CA...
...commendations for DMARDs and biologics...
...systemic treatment for uveitis: Using s...
...g a TNFi: Starting a monoclonal antibody TN...
Severe active CAU and sight-threatening compl...
...ponse to one monoclonal TNFi at standard JI...
...first monoclonal antibody TNFi at...
...otrexate and 2 monoclonal antibody TNFi at...
...commendations for education about and tre...
...trongly recommend education regarding the warni...
...ntrolled with systemic immunosuppressive therap...
...ecommendations for tapering therapy for...
...n children and adolescents with JIA and CAU that i...
...and adolescents with JIA and uveitis that i...
...mendation had very low quality level of evide...