title: Medication use in juvenile uveitis patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.
abstract: BACKGROUND
  There is not yet a commonly accepted, standardized approach in the treatment of juvenile idiopathic uveitis when initial steroid therapy is insufficient. We sought to assess current practice patterns within a large cohort of children with juvenile uveitis.
  
  
  METHODS
  This is a cross-sectional cohort study of patients with uveitis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRAnet) registry. Clinical information including, demographic information, presenting features, disease complications, and medications were collected. Chi-square and Fisher's exact tests were used to assess for associations between medications and clinical characteristics.
  
  
  RESULTS
  Ninety-two children with idiopathic and 656 with juvenile idiopathic arthritis (JIA)-associated uveitis were identified. Indication (arthritis or uveitis) for medication use was not available for JIA patients; therefore, detailed analysis was limited to children with idiopathic uveitis. In this group, 94 % had received systemic steroids. Methotrexate (MTX) was used in 76 % of patients, with oral and subcutaneous forms given at similar rates. In multivariable analysis, non-Caucasians were more likely to be treated initially with subcutaneous MTX (P = 0.003). Of the 53 % of patients treated with a biologic DMARD, all received a tumor necrosis factor (TNF) inhibitor. TNF inhibitor use was associated with a higher frequency of cataracts (52 % vs 21 %; P = 0.001) and antinuclear antibody positivity (49 % vs 29 %; P = 0.04), although overall complication rates were not higher in these patients.
  
  
  CONCLUSIONS
  Among idiopathic uveitis patients enrolled in the CARRAnet registry, MTX was the most commonly used DMARD, with subcutaneous and oral forms equally favored. Patients who received a TNF inhibitor were more likely to be ANA positive and have cataracts.
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, MA and Department of Pediatrics, Harvard Medical School, 1 Blackfan Circle, Karp Building, 10th Floor, Boston, MA, 02115, USA. Lauren.Henderson@childrens.harvard.edu.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Henderson
authors.affiliation: Departments of Anesthesia and Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. david.zurakowski@childrens.harvard.edu.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Pediatrics and Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA. sangele@emory.edu.
authors.forename: Sheila T
authors.initials: ST
authors.lastname: Angeles-Han
authors.affiliation: Department of Pediatric Rheumatology, Randall Children's Hospital at Legacy Emanuel, Portland, OR, USA. Alasky@lhs.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lasky
authors.affiliation: Division of Rheumatology, Department of Pediatrics, Duke Children's, Durham, NC, USA. egla.rabinovich@duke.edu.
authors.forename: C Egla
authors.initials: CE
authors.lastname: Rabinovich
authors.affiliation: Division of Immunology, Boston Children's Hospital, Boston, MA and Department of Pediatrics, Harvard Medical School, 1 Blackfan Circle, Karp Building, 10th Floor, Boston, MA, 02115, USA. Mindy.Lo@childrens.harvard.edu.
authors.forename: Mindy S
authors.initials: MS
authors.lastname: Lo
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000150:complications* / Q000188:drug therapy; D035843:Biomedical Research; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012219:Rheumatology / Q000379:methods*; D014605:Uveitis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D018501:Antirheumatic Agents; D000069285:Infliximab; D000068879:Adalimumab; D008727:Methotrexate