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Ann-Marie Lobo, Sepideh Faez, Mindy Lo, George N Papaliodis, Danielle M Ledoux; Ocular complications in juvenile idiopathic arthritis associated uveitis patients on TNF inhibitor therapy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5319.
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Juvenile idiopathic arthritis (JIA) associated uveitis is the most common cause of childhood uveitis and is associated with significant ocular morbidity. Advances in therapy, including tumor necrosis factor (TNF) alpha inhibitors, have improved visual outcomes and control of ocular inflammation in severe JIA uveitis. This study examines ocular complications and rate of development of complications in patients treated with standard immunosuppressive therapy and TNF inhibitor therapy.
A retrospective chart review of all patients diagnosed with JIA uveitis in the Uveitis Service at Massachusetts Eye and Ear Infirmary and the pediatric ophthalmology service at Children’s Hospital Boston between 2006 and 2012 was performed. Data from baseline visit, visits at 6 months, 1, 2 and 3 years were obtained for each patient. For patients on TNF inhibitor therapy, baseline visit was defined as the visit prior to starting TNF inhibitor therapy or initial visit (for patients already on TNF inhibitor therapy).Visual acuity, medications, ocular complications, inflammation grade, and flares since last visit were recorded. Inclusion criteria were: diagnosis of JIA prior to age 16 with documented uveitis and follow up period greater than 6 months.
46 patients (83 eyes) with JIA uveitis met the inclusion criteria. 23 patients were on TNF inhibitor therapy and 23 were on other systemic anti-inflammatory therapy. 74% of patients were female and 75% were ANA positive. Median age at uveitis presentation was 3 years in the TNF group and 4 in the non-TNF group. At baseline visit, there was no significant difference in complication rates between the TNF and non-TNF groups (p=0.53, CI 0.45-4.67). The rate of development of any complication was significantly higher in the TNF group at 0.12/person-year than the non-TNF group at 0.03/person year (p=0.04). The rate of development of cataract was significantly higher in the TNF group at 0.06/eye-year than the non-TNF group at 0.01/eye-year (p=0.04).
JIA uveitis patients with recalcitrant uveitis are often treated with TNF inhibitors. Although these medications control inflammation, patients on TNF inhibitors are still at higher risk for developing ocular complications. Disease duration and severity of inflammation may contribute to higher complication rates in these patients.
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