Juvenile Idiopathic Arthritis Uveitis

Publication Date: April 25, 2019

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...

...definitions, and medication interv...


...gure 1. A, Ophthalmic screening examination...


...ical and important outcomesaHaving tro...


Treatment

...reatment...

...endations for topical glucocorticoids in patients...


...Recommendations for ophthalmic screening, o...

...endations for ophthalmic screeningIn children and...

...ations for ophthalmic monitoring...

...discontinuing topical glucocorticoids, ophtha...

...herapy, ophthalmic monitoring no less frequentl...

...scontinuing systemic therapy, opht...

...ecommendations for glucocorticoid use...

...and adolescents with JIA and active CA...

...ednisolone acetate 1% topical drops is conditional...

...or increasing topical glucocortic...

...hildren and adolescents with JIA and CAU stil...

...not on systemic therapy, adding systemic ther...

...requiring 1–2 drops/day of predni...

...children and adolescents with JIA who devel...

...mendations for DMARDs and biologic...

...stemic treatment for uveitis: Using...

...i: Starting a monoclonal antibody T...

...CAU and sight-threatening complications: Startin...

...te response to one monoclonal TNFi a...

...d a first monoclonal antibody TNFi at above-standa...

...exate and 2 monoclonal antibody TNFi at above-st...

...for education about and treatment of AAU...

...y recommend education regarding the warn...

...ell-controlled with systemic immunosuppressive...

Recommendations for tapering therapy...

...en and adolescents with JIA and CAU...

...ren and adolescents with JIA and uve...

...commendation had very low quality...