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
Diagnos...
.... Terms, definitions, and medication interv...
.... A, Ophthalmic screening examinations; B, Ophtha...
...tical and important outcomesaHaving t...
Treatment
Treatment
...mendations for topical glucocorticoi...
...e 3. Recommendations for ophthalmic screen...
...ommendations for ophthalmic screeningIn chi...
...ations for ophthalmic monitoring...
...ring or discontinuing topical glucocorticoids,...
...able therapy, ophthalmic monitoring no...
...scontinuing systemic therapy, opht...
...ommendations for glucocorticoi...
...adolescents with JIA and active CAU:...
...olone acetate 1% topical drops is cond...
...reasing topical glucocorticoids fo...
...dren and adolescents with JIA and CAU s...
...t on systemic therapy, adding systemic ther...
...f still requiring 1–2 drops/day of prednisolon...
...children and adolescents with JIA who d...
...ations for DMARDs and biologics...
...ic treatment for uveitis: Using subcutaneous me...
...ting a TNFi: Starting a monoclonal antibod...
...ve CAU and sight-threatening complic...
...dequate response to one monoclonal...
...monoclonal antibody TNFi at above-stan...
...ailed methotrexate and 2 monoclonal ant...
...ons for education about and treatmen...
...ngly recommend education regarding the w...
...olled with systemic immunosuppressive therapy (...
...ecommendations for tapering therapy for uveit...
...n children and adolescents with JIA and...
...ildren and adolescents with JIA and uveiti...
...dation had very low quality level of eviden...