medwireNews: Patients with juvenile idiopathic arthritis (JIA) are at high risk for uveitis in the first 24 months of discontinuing DMARD therapy, findings from the EULAR 2021 Virtual Congress indicate.
“Rheumatologists and ophthalmologists should be aware of the risk of uveitis after treatment discontinuation, which should lead to regular screenings,” said presenter Jens Klotsche (German Rheumatism Research Centre Berlin).
The risk for uveitis was assessed in 2041 patients from the BiKeR and JuMBO registries over an average 7.6 years of follow-up. Of these, 1280 had rheumatoid factor-negative polyarthritis and 761 had extended oligoarthritis.
The results showed that 12% of patients had uveitis as a comorbidity at the start of inclusion and 16% reported ever having uveitis, and there were 169 incident uveitis events reported in 125 patients during follow-up, including 27 incident cases of uveitis.
“Uveitis relapses are common, and new-onset uveitis events were observed even in the later course of the JIA disease course,” Klotsche commented.
Patients with uveitis had a lower age of JIA onset, on average, than those without, at 3.6 years versus 7.0 years, and were more likely to be antinuclear antibody positive (78 vs 53%) and to be taking adalimumab (31 vs 6%).
Methotrexate in particular (at a dose below 10 mg/kg per m2) was associated with a significant 40% increased risk for the onset of uveitis events, but there was no risk association with duration of methotrexate treatment or biologic DMARD treatment.
Uveitis events were also significantly more likely to occur in the first 24 months after patients discontinued treatment, with fewer events with longer time since stopping treatment. For methotrexate, the odds ratio for uveitis was 3.19 in the first 6 months, 2.06 for between 6 and 12 months, and 2.20 for between 12 and 24 months, compared with 36 months or more. For biologic DMARDs, the greatest risk was in the first 3 months, at an odds ratio of 5.40.
Klotsche noted that at the time of the uveitis event, 60% of patients had no joints with active arthritis, 37% were clinically inactive, and 53% reported no functional limitations.
He also pointed out some limitations to the study including the fact that there were no data available on the reasons for starting and withdrawing DMARD treatment, noting that uveitis could have been one. And uveitis cases could not be clinically characterized.
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