Treatment of eye disease in patients with juvenile idiopathic arthritis – a guideline.

This study reviewed the treatment of uveitis (a form of eye wall inflammation) in patients with juvenile idiopathic arthritis (JIA). 

Juvenile idiopathic arthritis (JIA) is a condition caused by inflammation. It affects children and leads to painful swelling in the joints. Children with JIA may also develop uveitis. Uveitis is inflammation in the eye. There are two forms of uveitis. Chronic anterior uveitis (CAU) occurs in 10-20% of JIA patients. If untreated, CAU can lead to vision loss. In some cases, there may be no symptoms. However, CUA can be detected through vision screening. 

Current guidelines on CUA were released in 2006. An update on the treatment of CUA in JIA was performed recently. This was conducted by the American College of Rheumatology (ACR) and Arthritis Foundation (AF). 

A panel of experts analyzed 1,537 studies on uveitis in JIA. Recommendations were made based on this analysis. Recommendations were categorized as strong (SR) or conditional (CR). SRs were based on a significant benefit to all patients. CRs were based on a significant benefit for most patients. 

SRs: Local (topical) glucocorticoid drugs should be reduced after 1 month of treatment for uveitis. Systemic (tablets/injections) therapy should be reduced after 2 months of treatment. These options are recommended instead of less frequent monitoring. Patients should be educated on the symptoms and risks of acute anterior uveitis (AAU).

CRs: Screening for uveitis should be performed every 3 months. Topical glucocorticoids should be used before systemic therapy. Systemic therapy should start with methotrexate (MTX). If a tumor necrosis factor inhibitor (TNFi) is needed, etanercept (Enbrel) should be used. If severe CAU is diagnosed both MTX and a TNFi should be used. 

This study reviewed the guidelines for screening and treatment of uveitis in patients with JIA.

If you have any concerns regarding JIA and uveitis please consult with your doctor.