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Anton Kolomeyer, Yufei Tu, Natasha Nayak, Elisabetta Miserocchi, David Chu; Treatment of Chronic, Persistent, Non-infectious, Non-granulomatous Uveitis in Patients with Juvenile Idiopathic Arthritis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5194. doi: https://doi.org/.
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To describe treatment of chronic, persistent, non-infectious, non-granulomatous uveitis in patients with Juvenile Idiopathic Arthritis (JIA).
Eighty-two patients (147 eyes) with JIA treated for ≥2 months were included. Main outcome measures were clinical findings, visual acuity (VA), surgeries, rate of inflammation control and medication discontinuation, and side effects.
Sixty-four (78%) patients were female. Mean ± SD age was 16.9 ± 8.7 years (range, 5-44 years). Mean ± SD follow-up time was 8.7 ± 7.8 years (range, 2 months-32.0 years). Sixty-five (79%) patients had bilateral uveitis, and 61 (74%) anterior uveitis. Findings at baseline included posterior synechiae (50%), band keratopathy (44%), cataract (28%), anterior chamber cells (21%), and glaucoma (16%). Rate of ocular inflammation at baseline was significantly higher than follow-up time points. Mean VA and eyes with VA ≤20/200 did not significantly change throughout follow-up period. Three (2%) eyes achieved no light perception vision, with one becoming phthisical. Thirty (37%) patients (38 [26%] eyes) underwent 69 procedures, with 19 (50%) eyes requiring multiple surgeries (range, 2-4). At last examination, 41 (50%) patients had achieved inflammation control. Patients on Adalimumab, Infliximab, and Methotrexate were significantly more likely and those on Cyclosporine and steroids were significantly less likely to achieve inflammation control. Seven (8.5%) patients stopped treatment due to side effects after a mean ± SD 17.9 ± 18.9 months (range, 2-65 months). Two (2.4%) others had side effects not requiting treatment stoppage.
Despite the myriad medications available, inflammation control in JIA patients is particularly difficult to achieve. The rate of medication side effects is remarkably low. It remains unclear which treatment modality is best to use for what JIA subtype. Prospective, randomized, double blind clinical trials in this regard are warranted.
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