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
...agnosis...
...s, definitions, and medication interventionsHa...
...phthalmic screening examinations; B, Ophthalm...
...tical and important outcomesaHavin...
Treatment
Treatmen...
...ommendations for topical glucocort...
...ble 3. Recommendations for ophthalmic screeni...
...mendations for ophthalmic screeningI...
...ons for ophthalmic monitorin...
...or discontinuing topical glucocorticoids, o...
...apy, ophthalmic monitoring no less frequen...
...ontinuing systemic therapy, ophthalm...
...endations for glucocorticoid us...
In children and adolescents with JIA...
...prednisolone acetate 1% topical drops is...
...ding or increasing topical glucocorticoids for s...
...ildren and adolescents with JIA and CAU still req...
...emic therapy, adding systemic ther...
...uiring 1–2 drops/day of prednisolone acetate 1%...
...adolescents with JIA who develop...
...dations for DMARDs and biologics
...ystemic treatment for uveitis: Usin...
...i: Starting a monoclonal antibody TN...
...active CAU and sight-threatening complications: St...
...uate response to one monoclonal TNF...
...monoclonal antibody TNFi at above-standard do...
...d methotrexate and 2 monoclonal antibody TNFi at a...
...mmendations for education about and tr...
...rongly recommend education regarding...
...l-controlled with systemic immunosup...
...for tapering therapy for uveitis...
...hildren and adolescents with JIA and CAU...
...adolescents with JIA and uveitis that is...
...ommendation had very low quality level of evi...