What are treatment options for uveitis secondary to juvenile idiopathic arthritis (JIA)?

Updated: Jul 25, 2019
  • Author: David D Sherry, MD; Chief Editor: Lawrence K Jung, MD  more...
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Answer

Treatment with topical corticosteroid medication and with mydriatic agents (to prevent closed-angle glaucoma) often can prevent progression of disease to development of calcium deposition in the lens (band keratopathy) and adhesions of the iris to the lens (posterior synechiae), in which an irregular pupillary margin develops. Such complications may herald a chronic active disease in which vision is threatened.

Immunosuppressive agents, such as methotrexate or cyclosporine, may help control chronic uveitis. Infliximab can be effective in some patients who are resistant to immunosuppressive agents.

A multicenter, double-blind, randomized, placebo-controlled trial by Ramanan et al reported that adalimumab plus methotrexate therapy controlled inflammation and was associated with a lower rate of treatment failure than placebo among children and adolescents with active JIA-associated uveitis. The study observed 16 treatment failures out of 60 patients (27%) in the adalimumab group compared to 18 treatment failures in 30 patients (60%) in the placebo group (hazard ratio, 0.25; 95% confidence interval [CI], 0.12 to 0.49; P<0.0001). The study also reported a higher rate of adverse events (eg, oropharyngeal pain, cough, arthralgia) in the adalimumab group (10.07 events per patient-year vs. 6.51 events per patient-year) as well as a higher rate of serious adverse events (eg, infections or infestations [0.29 events per patient-year vs. 0.19 events per patient-year]). [44]


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