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Review
. 2019 Aug;49(1):43-55.
doi: 10.1016/j.semarthrit.2018.11.004. Epub 2018 Dec 4.

Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

A Heiligenhaus  1 , K Minden  2 , C Tappeiner  3 , H Baus  4 , B Bertram  5 , C Deuter  3 , I Foeldvari  2 , D Föll  2 , M Frosch  2 , G Ganser  2 , M Gaubitz  6 , A Günther  2 , C Heinz  3 , G Horneff  2 , C Huemer  2 , I Kopp  7 , C Lommatzsch  3 , T Lutz  2 , H Michels  2 , T Neß  3 , U Neudorf  2 , U Pleyer  3 , M Schneider  6 , H Schulze-Koops  6 , S Thurau  3 , M Zierhut  3 , H W Lehmann  2
Affiliations
Free article
Review

Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

A Heiligenhaus et al. Semin Arthritis Rheum. 2019 Aug.
Free article

Abstract

Background: Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized.

Methods: Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure).

Results: Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of ≥ 2 years of uveitis inactivity.

Conclusions: An interdisciplinary, evidence-based treatment guideline for JIAU is presented.

Keywords: Adolescents; Children; Consensus; Evidence-based medicine; Juvenile idiopathic arthritis; Rheumatic disease; Treatment; Uveitis.

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