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M. Zierhut, D. Doycheva, E. Altpeter, S. Biester, N. Stuebiger, C. Deuter; Role of Systemic Corticosteroids in JIA-Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2688.
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In contrast to rheumatologists, ophthalmologists still recommend for JIA-associated uveitis to switch to immunosuppression when previous therapy with systemic corticosteroids has failed. This study evaluates the efficacy of systemic steroid treatment alone by assessing the frequency of those children with JIA-associated or ANA-positive anterior uveitis who needed immunosuppressive treatment after ineffective therapy with systemic corticosteroids.
Retrospective review of all children with JIA-associated or ANA-positive anterior uveitis in whom the intraocular inflammation was the indication to start with systemic corticosteroids. Exclusion of all children in whom the arthritis lead to initiation of systemic treatment as well as children with JIA-associated or ANA-positive anterior uveitis who were already on systemic therapy when first presented.
Out of 295 children with uveitis, 17 children fulfilled the criteria. Twelve children suffered from JIA-associated and 5 children from ANA-positive (no signs of arthritis at begin of uveitis) anterior uveitis. Systemic corticosteroids were administered at an initial dose of 1-2 mg/kg per day followed by a weekly tapering. Fifteen children (88.2 %) had to be switched to immunosuppression (12 to methotrexate, 2 to cyclosporine, 1 to azathioprine) because of relapses during tapering of corticosteroids. In 1 child immunosuppression was indicated but has not begun (compliance). Each of these 16 children received a mean of 1.7 (1-3) courses of systemic corticosteroids, altogether 27 courses. Relapses of the uveitis occurred after a median duration of 2 months (mean 4.8 months, 1-19 months) of corticosteroid therapy. Mean duration of the systemic corticosteroids before initiation of immunosuppression was 8.1 months (2-37 months). Only 1 child did not need immunosuppressive drugs because remission of the uveitis was achieved with systemic corticosteroids alone.
In our cohort 16 out of 17 children (94.1 %) with JIA-associated or ANA-positive anterior uveitis had to be switched to immunosuppression due to inefficacy or inacceptable side effects of systemic corticosteroids after a mean of 8.1 months. We therefore recommend for these children to start directly with an immunosuppressive drug like methotrexate if systemic treatment is indicated.
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