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...
.... Terms, definitions, and medication interven...
Figure 1. A, Ophthalmic screening exam...
...e 2. Critical and important outcomesa...
Treatment
...Treatmen...
...gure 2. Recommendations for topical glu...
...Table 3. Recommendati...
...mendations for ophthalmic screeningIn child...
...dations for ophthalmic monitoring...
Tapering or discontinuing topical...
...y, ophthalmic monitoring no less frequen...
...discontinuing systemic therapy, ophthalmic monito...
...Reco...
In children and adolescents with JIA and ac...
...prednisolone acetate 1% topical drops is conditio...
...r increasing topical glucocorticoids...
In children and adolescents with JIA and CA...
...systemic therapy, adding systemic ther...
...quiring 1–2 drops/day of prednisolo...
...hildren and adolescents with JIA who deve...
Recommendations for DMARDs and bi...
...systemic treatment for uveitis: Using subcutaneo...
...a TNFi: Starting a monoclonal antibody TNFi is...
...evere active CAU and sight-threatening co...
...nse to one monoclonal TNFi at standard JIA...
...first monoclonal antibody TNFi at ab...
Failed methotrexate and 2 monoclonal antibody TNFi...
...for education about and treatment of AAU...
...mend education regarding the warning signs o...
...ontrolled with systemic immunosupp...
...and adolescents with JIA and CAU that is controll...
...and adolescents with JIA and uveitis tha...
...ach recommendation had very low quality level of...