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
...iagnosis...
...ble 1. Terms, definitions, and medicat...
...1. A, Ophthalmic screening examinations; B, Opht...
...le 2. Critical and important outcome...
Treatment
...eatment
...gure 2. Recommendations for topical gluco...
.... Recommendations for ophthalmic screen...
...for ophthalmic screeningIn children and...
Recommendations for ophthalmic...
...scontinuing topical glucocorticoids, o...
...ble therapy, ophthalmic monitoring no les...
...ing or discontinuing systemic therapy, op...
...dations for glucocorticoid us...
...nd adolescents with JIA and active CAU:...
...g prednisolone acetate 1% topical drops is co...
...creasing topical glucocorticoids for short-term co...
...dren and adolescents with JIA and CAU still req...
...ot on systemic therapy, adding systemic therap...
...ring 1–2 drops/day of prednisolone...
...adolescents with JIA who develop new C...
...commendations for DMARDs and biologi...
...stemic treatment for uveitis: Using subcutan...
...ng a TNFi: Starting a monoclonal anti...
...ve CAU and sight-threatening complications: Start...
...quate response to one monoclonal TNFi at sta...
...st monoclonal antibody TNFi at above-stand...
...trexate and 2 monoclonal antibody TNFi at abov...
...ommendations for education about and tr...
...recommend education regarding the wa...
...-controlled with systemic immunosuppressive th...
...dations for tapering therapy for uveiti...
...adolescents with JIA and CAU that is con...
In children and adolescents with JIA and uveitis...
...ommendation had very low quality level of ev...