Abstract
Purpose: :
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.
Methods: :
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)
Results: :
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.
Conclusions: :
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.
Keywords: uveitis-clinical/animal model • clinical (human) or epidemiologic studies: outcomes/complications • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials