Purchase this article with an account.
Shivani Kasbekar, Gavin Cleary, Arvind Chandna; Treatment Response to Methotrexate in Children with Chronic Uveitis Associated with Juvenile Idiopathic Arthritis (JIA) and other Non-infectious Uveitis Entities. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5500.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate and compare outcomes of patients receiving methotrexate (MTX) therapy for chronic uveitis associated with juvenile idiopathic arthritis (JIA) with other chronic non-infectious uveitis entities (non-JIA). This has not been previously reported and only a few pediatric studies with small numbers of non-JIA cases exist in the literature. Indeed, efficacy data on MTX itself in children with chronic uveitis is limited with no available clinical trial data.
Retrospective case note review of 17 consecutive cases with chronic uveitis treated with methotrexate between 2005-2010 was undertaken at a single tertiary referral unit. Recorded data included: anatomic location of uveitis, autoantibody and HLA status, visual acuity, uveitis complications, MTX dose/route and change of therapy. Anterior chamber activity and treatment response were recorded according to standardized criteria (Standardization of Uveitis Nomenclature). Assessment of corticosteroid therapy received was graded using a severity scale we devised (grade1- 5; based on frequency of guttae prednisolone acetate 1%) dose of oral and frequency of periocular steroid. This was recorded for each visit. Statistical analysis was undertaken using nonparametric tests (SPSS, IBM, 10.0)
Five boys and twelve girls were identified; mean age=8.1; mean duration follow up=25.8 months. Of 11 patients with JIA receiving methotrexate: 2 received periocular steroids; 2 received oral steroids; 3 patients achieved remission (p=0.174, median=0 months among JIA patients). Of 6 patients with non-JIA uveitis receiving MTX: 1 received periocular steroids; 5 received oral steroids; no remissions occurred. Non-JIA patients required 10mg or more oral steroid for a greater proportion of total follow up time; median 44.4% and 0% respectively (p=0.002). No statistically significant difference was found between patient groups in the proportion of time grade 2 or less/grade 4 or more topical corticosteroids were prescribed (p>0.2). All JIA patients compared to 1 of 6 non-JIA patients were antinuclear antibody positive.
Our data demonstrates poorer treatment responses in patients with non-JIA chronic non-infectious uveitis compared with those with JIA associated uveitis. To the best of our knowledge this is the first report comparing treatment responses between these subgroups. Corticosteroid intake is a major confounding factor, which, unique to other reports of non-JIA uveitis has been accounted for in our study. Future clinical trails should include quantitative assessment of corticosteroid intake and compare subgroups of diagnostic entities.
This PDF is available to Subscribers Only