NEW YORK (Reuters Health) – All patients diagnosed with juvenile idiopathic arthritis (JIA) should be screened for uveitis with a current audited protocol, according to consensus-based recommendations from a European expert committee.
The group is part of a European initiative called SHARE (Single Hub and Access point for pediatric Rheumatology in Europe) launched in 2012 to optimize and disseminate diagnosis and management regimens for children and young adults with rheumatic diseases.
In a report online March 28 in Annals of the Rheumatic Diseases, Dr. Athimalaipet Ramanan of the University of Bristol, U.K., and colleagues note that JIA is the most common rheumatic disease in children, and uveitis is possibly its most devastating extra-articular manifestation.
“Evidence-based guidelines are sparse and management is mostly based on physicians’ experience,” they write. “Consequently, treatment practices differ widely within and between nations.”
The committee formulated recommendations for the diagnosis, treatment and management of JIA-related uveitis based on a systematic literature review and consensus procedure. The experts accepted 22 recommendations with more than 80% agreement, including three on diagnosis, five on disease-activity management, 12 on treatment and two on future recommendations.
Topics included screening for JIA-associated uveitis, monitoring during follow-up, stopping treatment of uveitis, measuring disease activity and suggestions for treatment with disease-modifying antirheumatic drugs and biologics.
The expert group recommended methotrexate as the first choice for systemic immunosuppression, with the use of anti-TNF treatment strategies (adalimumab>infliximab>golimumab) for patients with uveitis refractory to DMARD therapy.
“Uveitis is an important cause of visual impairment. It is important to diagnose and treat it early,” Dr. Ramanan told Reuters Health by email. “Systemic therapies, such as methotrexate and adalimumab, are key in the control of uveitis in those with moderate to severe disease.”
The authors note, “The risk of visual symptoms and potential for relapse in patients initially responding to treatment highlights the necessity for maintained regular close ophthalmological screening. Frequency of ophthalmological follow-up should be based on ocular disease severity and decided upon in conjunction with an expert ophthalmologist.”
They also highlight the need for more well-controlled clinical trials in children with JIA-related uveitis with the goal being to ensure that best evidence is used to support treatment.
“In a disease setting where the evidence base is limited by small numbers of patients, and which is developing rapidly, these expert recommendations should help specialists with the evidence-based advice to provide optimal care for their patients,” the committee writes.
Dr. Andrew White, a pediatric rheumatologist at St. Louis Children’s Hospital in St. Louis, Missouri, who was not involved in the new work, told Reuters Health by email, “This systematic review of the published evidence regarding diagnostic and treatment recommendations for patients with uveitis associated with juvenile idiopathic arthritis makes important points that will change the management of this disease.”
The literature search was funded by an unrestricted grant from AbbVie, which markets adalimumab as Humira. Dr. Ramanan and several co-authors report financial ties to the company.
Content written by Rita Buckly, April 16, 2018
Content shared from Medscape Ophthalmology