Relapse of Juvenile Idiopathic Arthritis-Associated Uveitis after Discontinuation of Immunomodulatory Therapy

Abstract

Purpose: To assess treatment outcomes in juvenile idiopathic arthritis (JIA)-associated uveitis and relapse rates upon discontinuation of immunomodulatory therapy (IMT). Methods: Medical records of patients with JIA-associated uveitis seen at the University of Illinois at Chicago and the F.I. Proctor Foundation uveitis clinics from September 14, 1988 to January 5, 2011 were reviewed. The main outcome was time to relapse after attempting to discontinue IMT.Results: Of 66 patients with JIA-associated uveitis, 51 (77%) received IMT as either sole or combination therapy. Of a total of 51, 41 (80%) patients achieved corticosteroid-sparing control. Attempts were made to discontinue treatment in 19/51 (37%) patients. Of a total of 19 patients, 13 (68%) attempting to discontinue IMT relapsed, with a median time to relapse of 288 days from the time of attempted taper/discontinuation (IQR: 108-338).Conclusions: Corticosteroid-sparing control of inflammation was achieved in the majority of patients; however, attempts to stop IMT were often unsuccessful. Close follow-up of patients after discontinuation of therapy is warranted.

Keywords: immunomodulatory therapy; juvenile idiopathic arthritis-associated uveitis; tumor necrosis factor-alpha inhibitors.

Figure 1:. Treatment Overview

^aImmunomodulatory therapy ^bOther reasons for stopping include: adverse events (n=6), lack of systemic efficacy (n=2), pregnancy (n=1), cost (n=1), and unknown (n=1).

Figure 2:

Time to relapse after attempting to taper/discontinue TNF-α inhibitors

Figure 3:

A comparison of time to relapse after tapering/stopping TNF-α inhibitors for presumed remission versus other reasons