title: Managing juvenile idiopathic arthritis-associated uveitis.
abstract: Bilateral chronic anterior uveitis is an extra-articular feature of juvenile idiopathic arthritis. Although figures vary, uveitis occurs in approximately 11%-13% of patients with this disease and is most commonly associated with the female gender, oligoarthritis, and presence of antinuclear antibodies. The disease has an insidious onset and is often asymptomatic. Managing patients with juvenile idiopathic arthritis-associated uveitis remains challenging as the disease may prove to be refractory to traditional treatment regimens. Stepwise immunomodulatory therapy is indicated, with new biologic drugs being used last in cases of refractory uveitis. Small scale studies and practice have provided the evidence to undertake randomized control trials to evaluate the efficacy, safety, and cost-effectiveness of anti-tumor necrosis factor-α therapies, such as infliximab and adalimumab. These have demonstrated promising results, with further data awaited from ongoing trials for adalimumab (as SYCAMORE and ADJUVITE trials). Lower grade evidence is supporting the use of newer biologics such as rituximab, daclizumab, tocilizumab, and abatacept in those cases refractory to anti-tumor necrosis factor-α therapy.
authors.affiliation: Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK.
authors.forename: Madeleine J
authors.initials: MJ
authors.lastname: Hawkins
authors.affiliation: Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK; Department of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Ocular Immunology, National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Dick
authors.affiliation: Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK; Department of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Ocular Immunology, National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
authors.forename: Richard J W
authors.initials: RJ
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Pediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK.
authors.forename: Athimalaipet V
authors.initials: AV
authors.lastname: Ramanan
authors.affiliation: Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK.
authors.forename: Ester
authors.initials: E
authors.lastname: Carreño
authors.affiliation: Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Guly
authors.affiliation: Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK. Electronic address: Adam.Ross@bristol.ac.uk.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D014606:Uveitis, Anterior / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents
keywords: biologics; childhood; juvenile idiopathic arthritis; management; uveitis