The recently published recommendations on managing juvenile idiopathic arthritis (JIA)-associated uveitis from the SHARE initiative emphasize the importance of effective collaboration between rheumatologists and ophthalmologists to ensure children are screened and treated appropriately. To accompany our news story on the guidelines and interview with the lead author, medwireNews speaks to consultant ophthalmologist Carlos Pavesio (Moorfields Eye Hospital, London, UK) about why these recommendations are important.
Carlos Pavesio
“Things have changed a great deal from a disastrous past when most children [with uveitis] would lose vision with glaucoma and have irreversible damage to the eye because we were unable to treat them properly,” says Pavesio.
“We have now added so many options to the treatment which are effective, but that is not good enough if the patients are not diagnosed early enough,” he adds, stressing that early diagnosis is key to ensuring a good outcome for these patients.
The importance of the recommendations
Because the SHARE initiative guidelines advocate that all patients suspected of having JIA should be screened for uveitis, Pavesio believes that those who require treatment from an ophthalmologist will be identified more easily in future.
“That means that we are more likely not to miss anyone who may have eye problems,” he says.
Pavesio also thinks that the guidelines will have an important impact in terms of treating JIA-associated uveitis. They “give us a very clear message of how disease management should run,” which is particularly important for healthcare providers who are inexperienced in managing patients with JIA-associated uveitis, he remarks.
How rheumatologists and ophthalmologists can work together
Pavesio highlights that there are many opportunities for rheumatologists and ophthalmologists to collaborate during the screening, diagnosis, and treatment of children with JIA.
“Once JIA is suspected or diagnosed, the ophthalmologist is already on board,” he says, noting that establishing whether eye disease is present is essential to determine whether patients require treatment for uveitis or whether they only require monitoring.
“The ophthalmologist, in conjunction with rheumatologists, should establish a schedule of visits [to determine] when the patient needs to be reviewed again,” he recommends.
And collaboration remains essential when patients require treatment because “sometimes medications which are very good for the joints may not have the same efficacy for the eyes,” says Pavesio.
We can learn a lot from ophthalmologists about the nature, cause, and the complications associated with these conditions
“It's important that the two [specialists] are in discussion so that I can flag to the rheumatologist that even though the joints are wonderful, there is still ongoing inflammation in the eye, which is not responding as we expected, so we may have to make some changes to the treatment.”
The challenges of collaboration
While rheumatologists and ophthalmologists working in partnership is key to delivering optimal patient care, there are some challenges associated with collaboration, particularly when the specialists work in different locations.
When this is the case, “communication is harder because you depend on receiving a letter or receiving a phone call, and then you may not be able to convey your impression as well as you would if we worked together seeing the patient at the same time,” says Pavesio.
He points out that communication is particularly challenging between specialists who do not know each other, noting that some rheumatologists “tend to just focus on the joint problems, and leave the eye problem,” even though “the role they play in helping us with adjustment of treatment or changing strategy is really important.”
He says that having joint rheumatology–ophthalmology clinics “would be ideal,” to avoid the issue of messages being lost in translation, but concedes that this is not always a possibility in reality.
Implementing the SHARE recommendations in clinical practice
To help healthcare providers overcome these challenges, Pavesio believes that “it is important for rheumatologists to be involved in ophthalmic meetings,” and vice versa, in order to facilitate communication and better understanding between the two specialties. Moreover, he adds that digital technology can allow people to participate in such meetings from any location, giving the example of webcasts that allow people to listen to presentations and discussions, and ask questions, from home.
Although Pavesio acknowledges that “there will be hurdles” in implementing the SHARE guidelines, he thinks that proper dissemination of the recommendations will ensure that they are followed correctly by specialists caring for patients who have, or are at risk for, JIA-associated uveitis.
“Via clear information sessions, education, and meetings, [effective collaboration] will become part of their work day-to-day and will be implemented,” he says.
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