[EBM analysis: classic DMARDs (disease-modifying antirheumatic drugs) and immunosuppressants in arthritis and uveitis].
The best experience in the use of DMARDs/immunosuppressive drugs for treatment of juvenile idiopathic arthritis (JIA) and JIA-associated uveitis has been obtained with MTX. Controlled studies on the treatment of uveitis in JIA, however, are still lacking; this is also true for other DMARDs/immunosuppressive drugs. Thus, the grading of the evidence level for these substances only reaches evidence level III (expert opinion, clinical experience or descriptive studies). For the treatment of uveitis in JIA the utility of MTX in comparison to the new biological substance classes (e. g., tumor necrosis factor-alpha, blockers, interleukin-1 receptor antagonist) will have to be examined. Experience with Mycophenolate mofetil (MMF) in JIA uveitis is limited to single cases. According to data from a retrospective analysis cyclosporin A (CsA) appears to have a limited efficacy in JIA uveitis. The results with azathioprine are not consistent. Controlled studies which led to the approval of drugs for JIA are also mandatory for uveitis to offer the most effective and safe therapy for children.
Niehues
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T
Zentrum für Kinder- und Jugendmedizin, Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Pädiatrische Immunologie und Rheumatologie, Jeffrey Modell Immundefektzentrum Universitätsklinikum Düsseldorf. niehues@uni-duesseldorf.de
Winterhalter
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S
Zierhut
M
M
Michels
H
H
Becker
M D
MD
Heiligenhaus
A
A
D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001168:Arthritis / Q000188:drug therapy*; D002648:Child; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014605:Uveitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000628:therapy*
D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents