title: Overview and recent developments in the medical management of paediatric uveitis.
abstract: BACKGROUND
  Although rarer than its adult counterpart, non-infectious uveitis remains a significant cause of ocular morbidity in children. Owing to the chronicity of the disorder and when refractory to first-line treatment, namely corticosteroids, systemic immunosuppressive treatment may be required to control the disease.
  
  
  METHODS
  Following a literature search using the keywords 'paediatric uveitis', 'juvenile idiopathic arthritis-associated uveitis', 'immunosuppression' and 'treatment', we reviewed the range and effectiveness of treatments employed in the management of non-infectious, paediatric uveitis.
  
  
  CONCLUSIONS
  Corticosteroids (topical, periocular, intraocular or systemic) remain the initial drug of choice in ameliorating the signs and symptoms of non-infectious paediatric uveitis. Failure to control the disease and/or failure to reduce the oral dose of prednisolone at least 0.15 mg/kg within 4 weeks often requires additional immunosuppressant therapy. Methotrexate and azathioprine have shown to be effective in the management of juvenile idiopathic arthritis (JIA)-associated uveitis with the former considered the first-line corticosteroid-sparing agent. Biologic therapies are increasingly used earlier in the disease with investigators in the UK currently recruiting patients for the SYCAMORE trial evaluating the efficacy of methotrexate and adalimumab vs methotrexate alone for the treatment for JIA-associated uveitis. Until further randomised controlled trials are conducted, the use of other biologic agents should only be used with an appreciation that there are potentially unknown side-effects and that there is not a full knowledge of their efficacy.
authors.affiliation: York Teaching Hospital, Academic Unit of Ophthalmology, NHS Foundation Trust, Wigginton Rd, York, North Yorkshire, YO31 8HE, UK.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Pilly
authors.forename: Greg
authors.initials: G
authors.lastname: Heath
authors.forename: Patrizia
authors.initials: P
authors.lastname: Tschuor
authors.forename: Susan
authors.initials: S
authors.lastname: Lightman
authors.forename: Richard P
authors.initials: RP
authors.lastname: Gale
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014605:Uveitis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha