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E. Miserocchi, G. Modorati, I. Pontikaki, V. Gerloni, P. Rama; TNF Blockers in Patients With Juvenile Idiopathic Arthritis Associated Uveitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2693.
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to report the efficacy of TNF blockers in treating patients with JIA associated uveitis.
charts of 38 patients affected by JIA and uveitis of a tertiary care center of pediatric rheumatology were retrospectively evaluated. Patients refractory to standard second-line immunosuppressive agents were treated with TNF blockers (Etanercept, Infliximab and Adalimumab) from 1999 to 2008. Indications to TNF blockers treatment were active arthritis and/or active uveitis. Anti TNF treatment was added to the current drug treatment. Main outcome measures were control of intraocular inflammation, occurrence of treatment-related side-effects. Infliximab (6 mg/kg) was given intravenously, at weeks 0, 2 and then every 4 weeks. Etanercept (0.8 mg/kg/week) was given subcutaneously. Adalimumab was given at the dose of 40 mg every other week subcutaneously.
38 patients (30 F, 8M) with a mean age of 14.2 years (range 1.9-34.9) were treated. 14 patients were treated for uncontrolled active uveitis, 13 for refractory polyarthritis, 11 for active uveitis and arthritis. Uveitis was bilateral in 33 patients (84%). The median duration of uveitis before initiation of anti TNF treatment was 8.5 years. A total of 70 treatments was performed: 18 Infliximab, 17 Etanercept, 3 Adalimumab. The mean duration of treatment was 47 months (range 2-98). 27/38 patients (71%) achieved ocular inflammation control with the initial addition of anti TNF therapy to their immunomodulatory therapy. 12/38 patients (31%) required discontinuation of treatment because severe side-effects: 8 pts on infliximab for infusion reaction, 1 pt on etanercept for Chrohn’s disease onset, 3 pts on adalimumab for psychological disturbances.
anti TNF treatment seems to be effective in controlling JIA associated uveitis refractory to standard immunosuppressive treatment. Careful monitoring by and expert pediatric rheumatologist is warranted in order to prevent serious systemic and psychological disorders.
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