Juvenile idiopathic arthritis-associated uveitis

被引:40
|
作者
Sen, Ethan S. [1 ,2 ]
Ramanan, A., V [3 ]
机构
[1] Bristol Royal Hosp Children, Dept Paediat Rheumatol, Bristol, Avon, England
[2] Univ Bristol, Bristol Med Sch, Translat Hlth Sci, Bristol, Avon, England
[3] Bristol Royal Hosp Children, Dept Paediat Rheumatol, Upper Maudlin St, Bristol BS2 8BJ, Avon, England
来源
关键词
Juvenile idiopathic arthritis; Uveitis; Adalimumab; Tocilizumab; Biologics; TERM-FOLLOW-UP; AUTOIMMUNE CHRONIC UVEITIS; CHILDHOOD CHRONIC UVEITIS; CHRONIC ANTERIOR UVEITIS; RHEUMATOID-ARTHRITIS; RISK-FACTORS; MYCOPHENOLATE-MOFETIL; PEDIATRIC UVEITIS; SUBCUTANEOUS TOCILIZUMAB; INTRAVENOUS TOCILIZUMAB;
D O I
10.1016/j.berh.2018.01.002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Juvenile idiopathic arthritis (JIA) is the commonest rheumatic disease in children and JIA-associated uveitis its most frequent extra-articular manifestation. The uveitis is potentially sight-threatening and thus carries a considerable risk of morbidity with associated reduction in quality of life. The commonest form of uveitis seen in association with JIA is chronic anterior uveitis, which is almost always asymptomatic in the initial stages. Therefore, screening for JIA-associated uveitis in at-risk patients is essential. The aim of early detection and treatment is to minimise intraocular inflammation and to avoid complications that lead to visual loss, which can result from both disease activity and medications. The sight-threatening complications of JIA-associated uveitis include cataracts, glaucoma, band keratopathy, and macular oedema. There is increasing evidence for the early introduction of systemic immunosuppressive therapies to reduce topical and systemic use of glucocorticoids. A recently published randomised controlled trial of adalimumab in JIA-associated uveitis now provides convincing evidence for the use of this biologic in patients who fail to respond adequately to methotrexate. Tocilizumab and abatacept are being investigated as alternatives in children inadequately treated with anti-tumour necrosis factor drugs. (C) 2018 Elsevier Ltd. All rights reserved.
引用
收藏
页码:517 / 534
页数:18
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