title: Uveitis in juvenile idiopathic arthritis.
abstract: BACKGROUND
  Juvenile idiopathic arthritis (JIA) is the most common systemic disease causing uveitis in childhood, with a prevalence of 10 per 100 000 persons. JIA often takes a severe inflammatory course, and its complications often endanger vision.
  
  
  METHODS
  This review is based on pertinent articles retrieved by a selective literature search up to 18 August 2014 and on the current interdisciplinary S2k guideline on the diagnostic evaluation and anti-inflammatory treatment of juvenile idiopathic uveitis.
  
  
  RESULTS
  Uveitis arises in roughly 1 in 10 patients with JIA. Regular eye check-ups should be performed starting as soon as JIA is diagnosed. 75-80% of patients are girls; antinuclear antibodies are found in 70-90%. The risk to vision is higher if JIA begins in the preschool years. As for treatment, only a single, small-scale randomized controlled trial (RCT) and a small number of prospective trials have been published to date. Topical corticosteroids should be given as the initial treatment. Systemic immunosuppression is needed if irritation persists despite topical corticosteroids, if new complications arise, or if the topical steroids have to be given in excessively high doses or have unacceptable side effects. If the therapeutic effect remains inadequate, conventional and biological immune modulators can be given as add-on (escalation) therapy. Treatment lowers the risk of uveitis and its complications and thereby improves the prognosis for good visual function.
  
  
  CONCLUSIONS
  Severely affected patients should be treated in competence centers to optimize their long-term outcome. Multidisciplinary, individualized treatment is needed because of the chronic course of active inflammation and the ensuing high risk of complications that can endanger vision. Future improvements in therapy will be aided by prospective, population-based registries and by basic research on biomarkers for the prediction of disease onset, prognosis, tissue damage, and therapeutic response.
authors.affiliation: Department of Opthalmology, St. Franziskus Hospital, Uveitis Center, University of Duisburg-Essen.
authors.forename: Arnd
authors.initials: A
authors.lastname: Heiligenhaus
authors.affiliation: German Rheumatism Research Centre Berlin (DRFZ), University Medicine, Berlin.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Minden
authors.affiliation: Department of Pediatric Rheumatology and Immunology, University Children's Hospital Münster.
authors.forename: Dirk
authors.initials: D
authors.lastname: Föll
authors.affiliation: Department of Ophthalmology, Charité - Universitätsmedizin Berlin.
authors.forename: Uwe
authors.initials: U
authors.lastname: Pleyer
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome; D014605:Uveitis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents