Abstract
Juvenile idiopathic arthritis (JIA) is one of the most common rheumatic diseases in childhood with a prevalence of 4 in 1,000 children. Anterior uveitis is a well-known threatening comorbid condition of JIA and affects around 10 % of the patients depending on JIA subtype. A large proportion of children with JIA develop uveitis in the first year of disease and 73 to 90 % after 4 years. Uveitis can progress into adulthood and usually occurs as ‘white uveitis’, while in the JIA related to the enthesitis subtype that is symptomatic. Current studies reinforced the previous observations that early age of JIA onset, oligoarticular subtype and ANA reactivity are the main risk factors for the development of uveitis. Factors associated to worse prognosis are as follows: findings of 1+ or more vitreous cells at presentation and initial visual acuity of 20/200 or worse. The Standardization of Uveitis Nomenclature (SUN) Group took the first step to define outcome measures for uveitis, but it was established for adults. The Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC) proposed outcome measures for JIA-associated uveitis incorporating the SUN criteria in 2011. The current suggested management recommends to start early a steroid-sparing effective immunomodulatory systemic treatment. Methylprednisolone intravenous pulse therapy, rituximab, tocilizumab and abatacept are promising agents. Because JIA-associated uveitis is a potentially threatening comorbidity, it is important to recognize and treat it early to prevent any visual damage that could impair visual acuity.
Similar content being viewed by others
References
Gowdie PJ, Tse SM (2012) Juvenile idiopathic arthritis. Pediatr Clin N Am 59(2):301–327
Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31(2):390–392
Heiligenhaus A, Niewerth M, Ganser G, Heinz C, Minden K (2007) Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology (Oxford) 46(6):1015–1019
Vidqvist KL, Malin M, Varjolahti-Lehtinen T, Korpela MM (2013) Disease activity of idiopathic juvenile arthritis continues through adolescence despite the use of biologic therapies. Rheumatology (Oxford) 52(11):1999–2003
Hoeve M, Kalinina Ayuso V, Schalij-Delfos NE, Los LI, Rothova A, de Boer JH (2012) The clinical course of juvenile idiopathic arthritis-associated uveitis in childhood and puberty. Br J Ophthalmol 96(6):852–856
Reininga JK, Los LI, Wulffraat NM, Armbrust W (2008) The evaluation of uveitis in juvenile idiopathic arthritis (JIA) patients: are current ophthalmologic screening guidelines adequate? Clin Exp Rheumatol 26(2):367–372
Heiligenhaus A, Heinz C, Edelsten C, Kotaniemi K, Minden K (2013) Review for disease of the year: epidemiology of juvenile idiopathic arthritis and its associated uveitis: the probable risk factors. Ocul Immunol Inflamm 21(3):180–191
Angeles-Han ST, Pelajo CF, Vogler LB, Rouster-Stevens K, Kennedy C, Ponder L et al (2013) Risk markers of juvenile idiopathic arthritis-associated uveitis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol 40(12):2088–2096
Cole TS, Frankovich J, Iyer S, Lependu P, Bauer-Mehren A, Shah NH (2013) Profiling risk factors for chronic uveitis in juvenile idiopathic arthritis: a new model for EHR-based research. Pediatr Rheumatol Online J 11(1):45
Saurenmann RK, Levin AV, Feldman BM, Rose JB, Laxer RM, Schneider R et al (2007) Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum 56(2):647–657
Anesi SD, Foster CS (2012) Importance of recognizing and preventing blindness from juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res (Hoboken) 64(5):653–657
Artornsombudh P, Pistilli M, Foster CS, Pujari SS, Gangaputra SS, Jabs DA et al (2014) Factors predictive of remission of new-onset anterior uveitis. Ophthalmology 121(3):778–784
Gregory AC 2nd, Kempen JH, Daniel E, Kacmaz RO, Foster CS, Jabs DA et al (2013) Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study. Ophthalmology 120(1):186–192
Wallace CA, Ruperto N, Giannini E (2004) Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol 31(11):2290–2294
Jabs DA, Nussenblatt RB, Rosenbaum JT (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 140(3):509–516
Heiligenhaus A, Foeldvari I, Edelsten C, Smith JR, Saurenmann RK, Bodaghi B et al (2012) Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis: a consensus effort from the multinational interdisciplinary working group for uveitis in childhood. Arthritis Care Res (Hoboken) 64(9):1365–1372
Kalinina Ayuso V, de Boer JH, Byers HL, Coulton GR, Dekkers J, de Visser L et al (2013) Intraocular biomarker identification in uveitis associated with juvenile idiopathic arthritis. Invest Ophthalmol Vis Sci 54(5):3709–3720
Chasnyk V, Nekhai S, Hynes A, Ammosova T, Obukhov Y, Gaidar E et al (2013) Proteomic profile of the tears—can it help to diagnose juvenile idiopathic arthritis associated uveitis prior to the clinical sign of joint inflammation. Arthritis and Rheumatism. 65(10 (Supplement)):abstract #1891
Tempest-Roe S, Joshi L, Dick AD, Taylor SR (2013) Local therapies for inflammatory eye disease in translation: past, present and future. BMC Ophthalmol 13(1):39
Palejwala NV, Yeh S, Angeles-Han ST (2013) Current perspectives on ophthalmic manifestations of childhood rheumatic diseases. Curr Rheumatol Rep 15(7):341
Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U, Niehues T et al (2012) Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int 32(5):1121–1133
Tappeiner C, Roesel M, Heinz C, Michels H, Ganser G, Heiligenhaus A (2008) Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis. Eye 23:1192–1198
Simonini G, Paudyal P, Jones GT, Cimaz R, Macfarlane GJ (2013) Current evidence of methotrexate efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach. Rheumatology (Oxford) 52(5):825–831
Sen ES, Sharma S, Hinchcliffe A, Dick AD, Ramanan AV (2012) Use of adalimumab in refractory non-infectious childhood chronic uveitis: efficacy in ocular disease—a case cohort interventional study. Rheumatology (Oxford) 51(12):2199–2203
Bravo-Ljubetic L, Peralta-Calvo J, Noval S, Pastora-Salvador N, Abelairas-Gomez J (2013) Adalimumab therapy for refractory childhood uveitis. J AAPOS 17(5):456–459
Magli A, Forte R, Navarro P, Russo G, Orlando F, Latanza L et al (2013) Adalimumab for juvenile idiopathic arthritis-associated uveitis. Graefes Arch Clin Exp Ophthalmol 251(6):1601–1606
Little JA, Sen ES, Strike H, Hinchcliffe A, Guly CM, Lee RW et al (2014) The safety and efficacy of noncorticosteroid triple immunosuppressive therapy in the treatment of refractory chronic noninfectious uveitis in childhood. J Rheumatol 41(1):136–139
Simonini G, Taddio A, Cattalini M, Caputo R, de Libero C, Parentin F et al (2013) Superior efficacy of adalimumab in treating childhood refractory chronic uveitis when used as first biologic modifier drug: adalimumab as starting anti-TNF-alpha therapy in childhood chronic uveitis. Pediatr Rheumatol Online J 11(1):16
Simonini G, Taddio A, Cattalini M, Caputo R, De Libero C, Naviglio S et al (2011) Prevention of flare recurrences in childhood-refractory chronic uveitis: an open-label comparative study of adalimumab versus infliximab. Arthritis Care Res (Hoboken) 63(4):612–618
Zannin ME, Birolo C, Gerloni VM, Miserocchi E, Pontikaki I, Paroli MP et al (2013) Safety and efficacy of infliximab and adalimumab for refractory uveitis in juvenile idiopathic arthritis: 1-year followup data from the Italian Registry. J Rheumatol 40(1):74–79
Ramanan AV, Dick AD, Benton D, Compeyrot-Lacassagne S, Dawoud D, Hardwick B et al (2014) A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). Trials 15:14
Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K (2011) Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology (Oxford) 50(8):1390–1394
Tappeiner C, Heinz C, Ganser G, Heiligenhaus A (2012) Is tocilizumab an effective option for treatment of refractory uveitis associated with juvenile idiopathic arthritis? J Rheumatol 39(6):1294–1295
Mesquida M, Leszczynska A, Llorenc V, Adan A (2014) Interleukin-6 blockade in ocular inflammatory diseases. Clin Exp Immunol 176(3):301–309
Tsang AC, Roth J, Gottlieb C (2013) Tocilizumab for severe chronic anterior uveitis associated with juvenile idiopathic arthritis in a pediatric patient. Ocul Immunol Inflamm 22(2):155–157
Zulian F, Balzarin M, Falcini F, Martini G, Alessio M, Cimaz R et al (2010) Abatacept for severe anti-tumor necrosis factor alpha refractory juvenile idiopathic arthritis-related uveitis. Arthritis Care Res (Hoboken) 62(6):821–825
Elhai M, Deslandre CJ, Kahan A (2011) Abatacept for refractory juvenile idiopathic arthritis-associated uveitis: two new cases. Comment on the article by Zulian et al. Arthritis Care Res (Hoboken) 63(2):307–308, author reply 8
Kenawy N, Cleary G, Mewar D, Beare N, Chandna A, Pearce I (2011) Abatacept: a potential therapy in refractory cases of juvenile idiopathic arthritis-associated uveitis. Graefes Arch Clin Exp Ophthalmol 249(2):297–300
Angeles-Han S, Flynn T, Lehman T (2008) Abatacept for refractory juvenile idiopathic arthritis-associated uveitis—a case report. J Rheumatol 35(9):1897–1898
Dick AD, Tugal-Tutkun I, Foster S, Zierhut M, Melissa Liew SH, Bezlyak V et al (2013) Secukinumab in the treatment of noninfectious uveitis: results of three randomized, controlled clinical trials. Ophthalmology 120(4):777–787
Wakefield D, McCluskey P, Penny R (1986) Intravenous pulse methylprednisolone therapy in severe inflammatory eye disease. Arch Ophthalmol 104(6):847–851
Saboo US, Metzinger JL, Radwan A, Arcinue C, Parikh R, Mohamed A et al (2013) Risk factors associated with the relapse of uveitis in patients with juvenile idiopathic arthritis: a preliminary report. J AAPOS 17(5):460–464
Kalinina Ayuso V, van de Winkel EL, Rothova A, de Boer JH (2010) Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis. Am J Ophthalmol 151(2):217–222
Acknowledgments
To Christianne Diniz for her careful and critical review of the paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Foeldvari, I. Ocular Involvement in Juvenile Idiopathic Arthritis: Classification and Treatment. Clinic Rev Allerg Immunol 49, 271–277 (2015). https://doi.org/10.1007/s12016-014-8436-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12016-014-8436-9