Therapeutic approaches for ophthalmic problems in juvenile rheumatoid arthritis.
Juvenile rheumatoid arthritis is a disease of children which is chronic and painful, with the potential to produce permanent disability and blindness in a significant portion of cases. The treatment we provide these children may also disable them. Managing this disease process and caring for these patients is a challenging task in which therapeutic efficacy must be continually balanced against treatment morbidity. With respect to ocular disease, we must particularly recognize the difficulties parents have in treating a characteristically asymptomatic process with interventions that can produce unpleasant symptomatology. The importance of discussion of therapeutic decisions with parent and child cannot be overemphasized. Children with JRA should be carefully classified and those at greatest risk for development of ocular disease should receive frequent ophthalmologic screening exams. Early intervention and aggressive medical management of intraocular inflammation will minimize morbidity and permanent visual compromise. Patients should also be closely monitored for ocular side effects of therapies directed against articular disease. Procedures employed for treatment of cataract, glaucoma, corneal, and vitreal opacities must take into account the risk and complications of surgical intervention in the JRA patient prone to perioperative inflammation.
O'Brien
J M
JM
Harvard Medical School, Boston, Massachusetts.
Albert
D M
DM
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000150:complications*; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007905:Lens Diseases / Q000209:etiology / Q000601:surgery; D009184:Mydriatics / Q000627:therapeutic use; D014606:Uveitis, Anterior / Q000188:drug therapy* / Q000209:etiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009184:Mydriatics