Volume 14 Issue 2
Mar.  2023
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The Subspecialty Group of Immunology, the Society of Pediatrics, Chinese Medical Association, Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases, Alliance of Rheumatic and Immunologic Diseases, National Clinical Research Center for Child Health and Disorders. Chinese Expert Consensus on Juvenile Idiopathic Arthritis-associated Uveitis (2023)[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(2): 247-256. doi: 10.12290/xhyxzz.2023-0090
Citation: The Subspecialty Group of Immunology, the Society of Pediatrics, Chinese Medical Association, Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases, Alliance of Rheumatic and Immunologic Diseases, National Clinical Research Center for Child Health and Disorders. Chinese Expert Consensus on Juvenile Idiopathic Arthritis-associated Uveitis (2023)[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(2): 247-256. doi: 10.12290/xhyxzz.2023-0090

Chinese Expert Consensus on Juvenile Idiopathic Arthritis-associated Uveitis (2023)

doi: 10.12290/xhyxzz.2023-0090
Funds:

National Key Research and Development Program of China 2021YFC2702003

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    Corresponding authors: TANG Xuemei1, E-mail: tangxuemei2008@163.com
    SONG Hongmei2, E-mail: songhm1021@126.com
    1. Department of Immunology and Rheumatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
    2. Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • Received Date: 2023-02-19
  • Accepted Date: 2023-03-15
  • Available Online: 2023-03-19
  • Publish Date: 2023-03-30
  • 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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  • [1] Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001[J]. J Rheumatol, 2001, 31: 390-392.
    [2] Martini A, Ravelli A, Avcin T, et al. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus[J]. J Rheumatol, 2019, 46: 190-197. doi:  10.3899/jrheum.180168
    [3] Bou R, Adán A, Borrás F, et al. Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus[J]. Rheumatol Int, 2015, 35: 777-785. doi:  10.1007/s00296-015-3231-3
    [4] Heiligenhaus A, Niewerth M, Ganser G, et al. Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines[J]. Rheumatology (Oxford), 2007, 46: 1015-1019. doi:  10.1093/rheumatology/kem053
    [5] Constantin T, Foeldvari I, Anton J, et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative[J]. Ann Rheum Dis, 2018, 77: 1107-1117.
    [6] Angeles-Han ST, Ringold S, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis[J]. Arthritis Care Res (Hoboken), 2019, 71: 703-716. doi:  10.1002/acr.23871
    [7] Sim KT, Venning HE, Barrett S, Gregson RM, et al. Extended oligoarthritis and other risk factors for developing JIA-associated uveitis under ILAR classification and its implication for current screening guideline[J]. Ocul Immunol Inflamm, 2006, 14: 353-357. doi:  10.1080/09273940600977233
    [8] Saurenmann RK, Levin AV, Feldman BM, et al. Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: A long-term followup study[J]. Arthritis Rheum, 2007, 56: 647-657. doi:  10.1002/art.22381
    [9] Nordal E, Rypdal V, Christoffersen T, et al. Incidence and predictors of Uveitis in juvenile idiopathic arthritis in a Nordic long-term cohort study[J]. Pediatr Rheumatol, 2017, 15: 1-8. doi:  10.1186/s12969-016-0134-0
    [10] Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis[J]. Arthritis Care Res, 2019, 71: 717-734. doi:  10.1002/acr.23870
    [11] Curtis JR, Johnson SR, Anthony DD, et al. American College of Rheumatology Guidance for COVID‐19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 2[J]. Arthritis Rheumatol, 2021, 73: 1-16.
    [12] Lee JJY, Duffy CM, Guzman J, et al. Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort[J]. Arthritis Care Res, 2019, 71: 1436-1443. doi:  10.1002/acr.23783
    [13] Guillaume S, Prieur AM, Coste J, Job-Deslandre C. Long-term outcome and prognosis in oligoarticular-onset juvenile idiopathic arthritis[J]. Arthritis Rheum, 2000, 43: 1858-1865. doi:  10.1002/1529-0131(200008)43:8<1858::AID-ANR23>3.0.CO;2-A
    [14] Sabri K, Saurenmann RK, Silverman ED, et al. Course, complications, and outcome of juvenile arthritis-related uveitis[J]. J AAPOS, 2008, 12: 539-545. doi:  10.1016/j.jaapos.2008.03.007
    [15] Cassidy J, Kivlin J, Lindsley C, et al. Ophthalmologic examinations in children with juvenile rheumatoid arthritis[J]. Pediatrics, 2006, 117: 1843-1845. doi:  10.1542/peds.2006-0421
    [16] Hoeve M, Ayuso VK, Schalij-Delfos NE, et al. The clinical course of juvenile idiopathic arthritis-associated uveitis in childhood and puberty[J]. Br J Ophthalmol, 2012, 96: 852-856. doi:  10.1136/bjophthalmol-2011-301023
    [17] Angeles-Han ST, McCracken C, Yeh S, et al. Characteris-tics of a cohort of children with Juvenile Idiopathic Arthritis and JIA-associated Uveitis[J]. Pediatr Rheumatol, 2015, 13: 15-17. doi:  10.1186/s12969-015-0011-2
    [18] Vastert SJ, Bhat P, Goldstein DA. Pathophysiology of JIA-associated Uveitis[J]. Ocul Immunol Inflamm, 2014, 22: 414-423. doi:  10.3109/09273948.2014.926937
    [19] Du L, Kijlstra A, Yang P. Immune response genes in uveitis[J]. Ocul Immunol Inflamm, 2009, 17: 249-256. doi:  10.1080/09273940902999356
    [20] Tappeiner C, Klotsche J, Sengler C, et al. Risk Factors and Biomarkers for the Occurrence of Uveitis in Juvenile Idiopathic Arthritis: Data From the Inception Cohort of Newly Diagnosed Patients With Juvenile Idiopathic Arthritis Study[J]. Arthritis Rheumatol, 2018, 70: 1685-1694. doi:  10.1002/art.40544
    [21] Vitale AT, Graham E, De Boer JH. Juvenile idiopathic arthritis-associated uveitis: Clinical features and complica-tions, risk factors for severe course, and visual outcome[J]. Ocul Immunol Inflamm, 2013, 21: 478-485. doi:  10.3109/09273948.2013.815785
    [22] Heiligenhaus A, Foeldvari I, Edelsten C, et al. Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis: A consensus effort from the multinational interdisciplinary working group for uveitis in childhood[J]. Arthritis Care Res, 2012, 64: 1365-1372. doi:  10.1002/acr.21674
    [23] Jabs DA, Nussenblatt RB, Rosenbaum JT, et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop[J]. Am J Ophthalmol, 2005, 140: 509-516. doi:  10.1016/j.ajo.2005.03.057
    [24] Clarke SLN, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis[J]. Pediatr Rheumatol, 2016, 14: 1-11. doi:  10.1186/s12969-015-0062-4
    [25] Thorne JE, Woreta F, Kedhar SR, et al. Juvenile Idiopathic Arthritis-Associated Uveitis: Incidence of Ocular Complications and Visual Acuity Loss[J]. Am J Ophthalmol, 2007, 143: 840-846. doi:  10.1016/j.ajo.2007.01.033
    [26] Zannin ME, Martini G, Buscain I, et al. Sudden visual loss in a child with juvenile idiopathic arthritis-related uveitis[J]. Br J Ophthalmol, 2009, 93: 282-283. doi:  10.1136/bjo.2008.137794
    [27] Heinz C, Schumacher C, Roesel M, et al. Elevated intraocular pressure in uveitis associated with juvenile idiopathic arthritis-associated uveitis, often detected after achieving inactivity[J]. Br J Ophthalmol, 2012, 96: 140-141. doi:  10.1136/bjophthalmol-2011-300731
    [28] Grassi A, Corona F, Casellato A, et al. Prevalence and outcome of juvenile idiopathic arthritis- associated uveitis and relation to articular disease[J]. J Rheumatol, 2007, 34: 1139-1145.
    [29] Lerman MA, Lewen MD, Kempen JH, et al. Uveitis reactivation in children treated with tumor necrosis factor α inhibitors[J]. Am J Oph-thalmol, 2015, 160: 193-200. doi:  10.1016/j.ajo.2015.04.016
    [30] Kotaniemi K, Sihto-Kauppi K, Salomaa P, et al. The frequency and outcome of uveitis in patients with newly diagnosed juvenile idiopathic arthritis in two 4-year cohorts from 1990-1993 and 2000—2003[J]. Clin Exp Rheumatol, 2014, 32: 143-147.
    [31] Heiligenhaus A, Michels H, Schumacher C, et al. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis[J]. Rheumatol Int, 2012, 32: 1121-1133. doi:  10.1007/s00296-011-2126-1
    [32] Foster CS, Alter G, DeBarge LR, et al. Efficacy and safety of rimexolone 1% ophthalmic suspension vs 1% prednisolone acetate in the treatment of uveitis[J]. Am J Ophthalmol, 1996, 122: 171-182. doi:  10.1016/S0002-9394(14)72008-2
    [33] Heiligenhaus A, Minden K, Tappeiner C, et al. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis[J]. Semin Arthritis Rheum, 2019, 49: 43-55. doi:  10.1016/j.semarthrit.2018.11.004
    [34] Simonini G, Cantarini L, Bresci C, et al. Current thera-peutic approaches to autoimmune chronic uveitis in children[J]. Autoimmun Rev, 2010, 9: 674-683. doi:  10.1016/j.autrev.2010.05.017
    [35] Edelsten C, Reddy MA, Stanford MR, et al. Visual loss associated with pediatric uveitis in English primary and referral centers[J]. Am J Ophthalmol, 2003, 135: 676-680. doi:  10.1016/S0002-9394(02)02148-7
    [36] Olson NY, Lindsley CB, Godfrey WA. Nonsteroidal Anti-inflammatory Drug Therapy in Chronic Childhood Iridocyclitis[J]. Am J Dis Child, 1988, 142: 1289-1292.
    [37] Sijssens KM, rothova A, Van de Vijver dA, et al. risk factors for the development of cataract requiring surgery in uveitis associated with juvenile idiopathic arthritis[J]. Am J Ophthalmol, 2007, 144: 574-579. doi:  10.1016/j.ajo.2007.06.030
    [38] Thorne JE, Woreta FA, dunn JP, et al. risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids[J]. Ophthalmology, 2010, 117: 1436-1441. doi:  10.1016/j.ophtha.2009.12.003
    [39] Kalinina Ayuso V, Van De Winkel EL, Rothova A, et al. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis[J]. Am J Ophthalmol, 2011, 151: 217-222. doi:  10.1016/j.ajo.2010.08.021
    [40] Simonini G, Paudyal P, Jones GT, et al. Current evidence of methotrexate efficacy in childhood chronic uveitis: A systematic review and meta-analysis approach[J]. Rheumatol (United Kingdom), 2013, 52: 825-831.
    [41] Tappeiner C, Roesel M, Heinz C, et al. Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis[J]. Eye, 2009, 23: 1192-1198. doi:  10.1038/eye.2008.174
    [42] Angeles-Han ST, Lo MS, Henderson LA, et al. Childhood arthritis and rheumatology research alliance consensus treatment plans for juvenile idiopathic arthritis-Associated and idiopathic chronic anterior uveitis[J]. Arthritis Care Res, 2019, 71: 482-491. doi:  10.1002/acr.23610
    [43] Little JA, Sen ES, Strike H, et al. The safety and efficacy of noncorticosteroid triple immunosuppressive therapy in the treatment of refractory chronic noninfectious uveitis in childhood[J]. J Rheumatol, 2014, 41: 136-139. doi:  10.3899/jrheum.130594
    [44] Rosenbaum JT, George RK, Gordon C. The treatment of refractory uveitis with intravenous immunoglobulin[J]. Am J Ophthalmol, 1999, 127: 545-549. doi:  10.1016/S0002-9394(99)00029-X
    [45] Ayuso VK, ten Cate HAT, van der Does P, et al. Male Gender and Poor Visual Outcome in Uveitis Associated With Juvenile Idiopathic Arthritis[J]. Am J Ophthalmol, 2010, 149: 987-993. doi:  10.1016/j.ajo.2010.01.014
    [46] Zannin ME, Buscain I, Vittadello F, et al. Timing of uveitis onset in oligoarticular juvenile idiopathic arthritis (JIA) is the main predictor of severe course uveitis[J]. Acta Ophthalmol, 2012, 90: 91-95. doi:  10.1111/j.1755-3768.2009.01815.x
    [47] Sen ES, Morgan MJ, MacLeod R, et al. Cross sectional, qualitative thematic analysis of patient perspectives of disease impact in juvenile idiopathic arthritis-associated uveitis[J]. Pediatr Rheumatol, 2017, 15: 1-8. doi:  10.1186/s12969-016-0134-0
    [48] Heiligenhaus A, Klotsche J, Tappeiner C, et al. Predictive factors and biomarkers for the 2-year outcome of uveitis in juvenile idiopathic arthritis: Data from the Inception Cohort of Newly diagnosed patients with Juvenile Idiopathic Arthritis (ICON-JIA) study[J]. Rheumatol (United Kingdom), 2019, 58: 975-986.
    [49] Simonini G, Druce K, Cimaz R, et al. Current evidence of anti-tumor necrosis factor α treatment efficacy in childhood chronic uveitis: A systematic review and meta-analysis approach of individual drugs[J]. Arthritis Care Res, 2014, 66: 1073-1084. doi:  10.1002/acr.22214
    [50] Ramanan AV, Dick AD, Jones AP, et al. Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis[J]. N Engl J Med, 2017, 376: 1637-1646. doi:  10.1056/NEJMoa1614160
    [51] Quartier P, Baptiste A, Despert V, et al. ADJUVITE: A double-blind, randomised, placebo-controlled trial of adalimumab in early onset, chronic, juvenile idiopathic arthritis-associated anterior uveitis[J]. Ann Rheum Dis, 2018, 77: 1003-1011. doi:  10.1136/annrheumdis-2017-212089
    [52] Palmou-Fontana N, Calvo-Río V, Martín-Varillas JL, et al. Golimumab in refractory uveitis associated to juvenile idiopathic arthritis: multicentre study of 7 cases and literature review[J]. Clin Exp Rheumatol, 2018, 36: 652-657.
    [53] Lanz S, Seidel G, Skrabl-Baumgartner A. Golimumab in juvenile idiopathic arthritis-associated uveitis unresponsive to Adalimumab[J]. Pediatr Rheumatol, 2021, 19: 1-6. doi:  10.1186/s12969-020-00490-1
    [54] Smith JA, Thompson DJS, Whitcup SM, et al. A randomized, placebo-controlled, double-masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis[J]. Arthritis Care Res, 2005, 53: 18-23. doi:  10.1002/art.20904
    [55] Tynjälä P, Lindahl P, Honkanen V, et al. Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis[J]. Ann Rheum Dis, 2007, 66: 548-550.
    [56] Schmeling H, Horneff G. Etanercept and uveitis in patients with juvenile idiopathic arthritis[J]. Rheumatology, 2005, 44: 1008-1011. doi:  10.1093/rheumatology/keh658
    [57] Lim LL, Fraunfelder FW, Rosenbaum JT. Do tumor necrosis factor inhibitors cause uveitis? A registry-based study[J]. Arthritis Rheum, 2007, 56: 3248- 3252. doi:  10.1002/art.22918
    [58] Skrabl-Baumgartner A, Seidel G, Langner-Wegscheider B, et al. Drug monitoring in long-term treatment with adalimumab for juvenile idiopathic arthritis-associated uveitis[J]. Arch Dis Child, 2019, 104: 246-250. doi:  10.1136/archdischild-2018-315060
    [59] Kahn P, Weiss M, Imundo LF, et al. Favorable Response to High-Dose Infliximab for Refractory Childhood Uveitis[J]. Ophthalmology, 2006, 113: 860-864. e2. doi:  10.1016/j.ophtha.2006.01.005
    [60] Correll CK, Bullock DR, Cafferty R, et al. Safety and clinical response of weekly adalimumab in the treatment of juvenile idiopathic arthritis, pediatric chronic uveitis and other childhood rheumatic diseases[J]. Arthritis Rheumatol, 2016, 68: 501-504.
    [61] Tappeiner C, Heinz C, Ganser G, et al. Is tocilizumab an effective option for treatment of refractory uveitis associated with juvenile idiopathic arthritis?[J]. J Rheumatol, 2012, 39: 1294-1295.
    [62] Tappeiner C, Mesquida M, Adán A, et al. Evidence for tocilizumab as a treatment option in refractory uveitis associa-ted with juvenile idiopathic arthritis[J]. J Rheumatol, 2016, 43: 2183-2188. doi:  10.3899/jrheum.160231
    [63] Burmester GR, Rubbert-Roth A, Cantagrel A, et al. A randomised, double-blind, parallel-group study of the safety and efficacy of subcutaneous tocilizumab versus intravenous tocilizumab in combination with traditional disease-modifying antirheumatic drugs in patients with moderate to severe rheumatoid art[J]. Ann Rheum Dis, 2014, 73: 69-74. doi:  10.1136/annrheumdis-2013-203523
    [64] Quesada-Masachs E, Caballero CM. Subcutaneous tocilizumab may be less effective than intravenous tocilizumab in the treatment of juvenile idiopathic arthritis-Associated uveitis[J]. J Rheumatol, 2017, 44: 260-261. doi:  10.3899/jrheum.160908
    [65] Adán A, Moll-Udina A, Ramirez J, et al. Subcutaneous Tocilizumab for Cystoid Macular Edema Secondary to Juvenile Idiopathic Arthritis (JIA)-associated Uveitis: A Case Report[J]. Ocul Immunol Inflamm, 2021, 29: 6-8. doi:  10.1080/09273948.2019.1644350
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