title: Impact of Antiinflammatory Treatment on the Onset of Uveitis in Juvenile Idiopathic Arthritis: Longitudinal Analysis From a Nationwide Pediatric Rheumatology Database.
abstract: OBJECTIVE
  Based on a nationwide database, this study analyzed the influence of methotrexate (MTX), tumor necrosis factor (TNF) inhibitors, and a combination of the 2 medications on uveitis occurrence in juvenile idiopathic arthritis (JIA) patients.
  
  
  METHODS
  Data from the National Paediatric Rheumatological Database in Germany were used in this study. Between 2002 and 2013, data from JIA patients were annually documented at the participating pediatric rheumatologic sites. Patients with a JIA disease duration of <12 months at initial documentation and ≥2 years of followup were included in this study. The impact of antiinflammatory treatment on the occurrence of uveitis was evaluated by discrete-time survival analysis.
  
  
  RESULTS
  A total of 3,512 JIA patients (mean ± SD age 8.3 ± 4.8 years, 65.7% female, 53.2% antinuclear antibody positive, and mean ± SD age at arthritis onset 7.8 ± 4.8 years) fulfilled the inclusion criteria. Mean ± SD total followup time was 3.6 ± 2.4 years. Uveitis developed in a total of 180 patients (5.1%) within 1 year after arthritis onset. Uveitis onset after the first year was observed in another 251 patients (7.1%). Disease-modifying antirheumatic drug (DMARD) treatment in the year before uveitis onset significantly reduced the risk for uveitis as follows: MTX: hazard ratio (HR) 0.63, P = 0.022; TNF inhibitors: HR 0.56, P < 0.001; and a combination of the 2 medications: HR 0.10, P < 0.001. Patients treated with MTX within the first year of JIA had an even a lower uveitis risk (HR 0.29, P < 0.001).
  
  
  CONCLUSIONS
  The use of DMARDs in JIA patients significantly reduced the risk for uveitis onset. Early MTX use within the first year of disease and the combination of MTX with a TNF inhibitor had the highest protective effect.
authors.affiliation: German Rheumatism Research Centre Berlin, Leibniz Institute, Berlin, St. Franziskus Hospital, Muenster, Germany, and Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Tappeiner
authors.affiliation: German Rheumatism Research Centre Berlin, Leibniz Institute, Berlin, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Schenck
authors.affiliation: German Rheumatism Research Centre Berlin, Leibniz Institute, Berlin, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Niewerth
authors.affiliation: St. Franziskus Hospital, Muenster, and University Duisburg-Essen, Essen, Germany.
authors.forename: Arnd
authors.initials: A
authors.lastname: Heiligenhaus
authors.affiliation: German Rheumatism Research Centre Berlin, Leibniz Institute, and Charité University Medicine Berlin, Berlin, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Minden
authors.affiliation: German Rheumatism Research Centre Berlin, Leibniz Institute, and Charité University Medicine Berlin, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Klotsche
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D010372:Pediatrics; D065840:Protective Factors; D012219:Rheumatology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology; D014605:Uveitis / Q000175:diagnosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate