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
...gnosis...
.... Terms, definitions, and medication...
Figure 1. A, Ophthalmic screening examina...
...ble 2. Critical and important outcomesaHavin...
Treatment
Treatment
...commendations for topical glucocorticoids...
...commendations for ophthalmic screening, ophtha...
...ns for ophthalmic screeningIn children and adole...
...ions for ophthalmic monitoring...
...ng or discontinuing topical glucocor...
...ble therapy, ophthalmic monitoring n...
...or discontinuing systemic therapy,...
...dations for glucocorticoid use...
In children and adolescents with JIA and activ...
...one acetate 1% topical drops is con...
...ing or increasing topical glucocorti...
...children and adolescents with JIA and CAU stil...
...f not on systemic therapy, adding systemi...
...till requiring 1–2 drops/day of...
...n children and adolescents with JIA who develo...
...dations for DMARDs and biolog...
...ic treatment for uveitis: Using subcutaneou...
...rting a TNFi: Starting a monoclonal an...
...U and sight-threatening complications: Starti...
...nse to one monoclonal TNFi at standar...
...first monoclonal antibody TNFi at abo...
...rexate and 2 monoclonal antibody TNFi a...
...ons for education about and treatment of A...
...rongly recommend education regarding...
...trolled with systemic immunosuppressiv...
...endations for tapering therapy fo...
In children and adolescents with JI...
...adolescents with JIA and uveitis that is well con...
...ch recommendation had very low quality...