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Cesare Pirondini, Chiara Mapelli, Alfonso Spinello, Edoardo Villani, Elisabetta Vismara, Paolo Vercellesi, Antonella Petaccia, Fabrizia Corona, Roberto Ratiglia; Therapeutic Experience With Infliximab In Patient With Juvenile Idiopathic Arthritis Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4258.
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To describe our experience using infliximab for the treatment of juvenile idiopathic arthritis (JIA) associated uveitis.
We performed a retrospective chart review of 79 consecutive JIA patients observed between January 2005 and November 2010 at the Ophthalmology Department of Ospedale Maggiore in Milan and we analyzed the notes of those treated with infliximab for refractory uveitis. All patients underwent routinely complete ophthalmologic exam including best corrected visual acuity (BCVA), slit-lamp biomicroscopy, IOP measurement, dilated fundus examination, Optical Coherence Tomography. All patients underwent also a regular complete rheumatological evaluation at our Rheumatology Pediatric Departement.Outcome measures included incidence of uveitis recurrences, BCVA, macular thickness, tapering/discontinuation of systemic or topical treatment and infliximab side effects.
Uveitis occurred in 21/79 (26%) JIA patients (3 males, 18 females); among these, 5 children (1 male, 4 females) were started on infliximab (5mg/kg i.v. at week 0, 2, 4, followed by 6/8 weekly infusion according to clinical response) for refractory uveitis.Mean duration of ocular disease at the beginning of therapy was 101 months (49-130) and mean follow-up on infliximab was 15 months (12-19).Recurrences of uveitis decreased in 3patients (4 eyes) while minimal or no response was observed in 2 children. Visual acuity remained stable in all cases.Two patients presented macular edema (ME) when switched to infliximab and showed a remarkable reduction of the macular thickness after treatment; 1eye developed ME 1 year after treatment beginning.Systemic (steroids and methotrexate) treatment was tapered in 3 patients during the follow up period, topical steroids were tapered in 2 patients (3 eyes) and discontinued in 1.Two patients discontinued infliximab for treatment failure represented by persistent inflammatory status and/or development of macular edema.No systemic side effects related to inflixmab were observed.
Infliximab appears to be safe in children, and may represents a useful option for the treatment of refractory JIA associated uveitis.
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