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Chinese Expert Consensus on Juvenile Idiopathic Arthritis-associated Uveitis (2023)
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摘要: 幼年特发性关节炎(juvenile idiopathic arthritis，JIA)是儿童时期常见的风湿免疫性疾病。幼年特发性关节炎相关葡萄膜炎(juvenile idiopathic arthritis-associated uveitis，JIA-U)是JIA重要的关节外并发症，主要表现为隐匿起病的虹膜和睫状体前部非肉芽肿性炎症(虹膜睫状体炎)，是造成儿童时期残疾和失明的重要原因之一。近年来，美国风湿病学会(American College of Rheumatology，ACR)及欧洲儿科风湿病学的单一枢纽和接入点(Single Hub and Access Point for Pediatric Rheumatology in Europe，SHARE)先后均发表了JIA-U的临床指南，但我国尚缺乏诊疗相关指导性文件。为进一步加强该病的临床认知和诊疗规范，中华医学会儿科学分会免疫学组、中国儿童风湿免疫病联盟、国家儿童健康与疾病临床研究中心风湿免疫联盟联合眼科专家共同制定了《幼年特发性关节炎相关葡萄膜炎诊疗中国专家共识(2023)》，在疾病筛查、诊断、治疗等方面达成初步共识，以供临床参考。Abstract: Juvenile idiopathic arthritis (JIA) is a common chronic rheumatologic disease in childhood. JIA-associated uveitis (JIA-U), an important extra-articular complication of JIA, is one of the major causes of childhood disability and blindness. It is predominantly anterior, nongranulomatous inflammation affecting the iris and ciliary body (iridocyclitis) of insidious onset. Recently, American College of Rheumatology (ACR) and the Single Hub and Access Point for Pediatric Rheumatology in Europe (SHARE) have published clinical guidelines for JIA-U. There is no guideline of diagnosis and treatment of JIA-U in China. To promote the standardization of clinical understanding and treatment, the Subspecialty Group of Immunology of the Society of Pediatrics of Chinese Medical Association, Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases, and National Clinical Research Center for Child Health and Disorders organized experts and scholars in related fields to discuss the issue and finally formed this consensus for clinicians' reference.
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Key words:
- juvenile idiopathic arthritis /
- uveitis /
- diagnosis /
- treatment /
- expert consensus
作者贡献：本专家共识由中华医学会儿科学分会免疫学组、中国儿童风湿免疫病联盟、国家儿童健康与疾病临床研究中心风湿免疫联盟发起，宋红梅、唐雪梅牵头成立指南制订工作组，杨曦起草本共识初稿并负责主要撰写工作，专家组成员共同进行讨论和投票, 杨培增、张美芬参与凝练本指南推荐意见。利益冲突：所有参与本共识制订的人员均声明不存在利益冲突核心专家组 (按姓氏首字母排序)：宋红梅(中国医学科学院北京协和医院儿科)，孙利(复旦大学附属儿科医院风湿科)，唐雪梅(重庆医科大学附属儿童医院风湿免疫科)，杨军(深圳市儿童医院风湿免疫科)，杨培增(重庆医科大学附属第一医院眼科)，张美芬(中国医学科学院北京协和医院眼科)工作组 (按姓氏首字母排序)：安云飞(重庆医科大学附属儿童医院风湿免疫科)，郝胜(上海市儿童医院肾脏风湿免疫科)，蒋新辉(贵阳市妇幼保健院儿童风湿免疫科)，李建国(首都儿科研究所附属儿童医院风湿免疫科)，李小青(西安市儿童医院风湿免疫科)，李晓忠(苏州大学附属儿童医院肾脏免疫科)，刘勍(重庆医科大学附属儿童医院眼科)，刘小惠(江西省儿童医院风湿免疫科)，卢美萍(浙江大学附属儿童医院风湿免疫科)，毛华伟(首都医科大学附属儿童医院免疫科)，唐琳(重庆医科大学附属第二医院风湿免疫科)，王亚军(云南省第一人民医院儿科)，吴小川(中南大学湘雅二医院儿科)，杨思睿(吉林大学第一医院儿童风湿免疫过敏科)，俞海国(南京医科大学附属儿童医院风湿免疫科)，张秋业(青岛大学附属儿童医院儿科)，张伟(成都市妇女儿童中心医院儿童风湿免疫科)，赵冬梅[乌鲁木齐市第一人民医院(儿童医院)风湿免疫科]，曾萍(广州市妇女儿童医疗中心风湿免疫科)，郑雯洁(温州医科大学附属第二医院儿童风湿科)，周纬(上海儿童医学中心肾脏风湿科)秘书组：杨曦(重庆医科大学附属儿童医院风湿免疫科)，马明圣(中国医学科学院北京协和医院儿科)，刘大玮(重庆医科大学附属儿童医院风湿免疫科)，王玉莲(重庆医科大学附属儿童医院风湿免疫科)执笔人：杨曦，唐雪梅，马明圣，宋红梅 -
2001年国际风湿病协会联盟
JIA分型2018年国际儿童风湿病试验组织
JIA分型全身型JIA 全身型JIA 少关节炎型JIA RF阳性JIA RF阳性多关节炎型JIA 附着点炎/脊柱关节炎相关性JIA RF阴性多关节炎型JIA 早发性ANA阳性JIA 银屑病性关节炎 其他类型JIA 附着点炎相关性关节炎 未分类JIA 未分化关节炎 JIA：幼年特发性关节炎；RF：类风湿因子; ANA: 抗核抗体 
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表 2 2001年牛津循证医学中心推荐强度和证据等级分类
推荐强度 证据等级 描述 A 1a 同质随机对照试验的系统评价 1b 单项随机对照试验 1c “全或无”证据(有治疗之前所有患者死亡，有治疗之后，有患者能存活；或者有治疗之前部分患者死亡，有治疗之后无患者死亡) B 2a 同质队列研究的系统评价 2b 单项队列研究(包括低质量的随机对照试验，如＜80%随访) 2c 结果研究，生态学研究 3a 同质病例对照研究的系统评价 3b 单项病例对照研究 C 4 病例报道(低质量队列研究) D 5 基于未经验证的专家意见或评论
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