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C. Edelsten, D.S. Daud, M.G. Cunniffe; Factors Influencing Course of Uveitis in Children Taking Methotrexate . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2388.
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Purpose: To determine factors influencing the course of uveitis after the administration of weekly methotrexate[MTX] in children. Methods: The notes of 54 paediatric uveitis patients were retrospectively reviewed. Uveitis was either associated with JIA or had idiopathic uveitis of a similar type. Remission was defined as 6mnths of inactive uveitis without topical steroid and disease control was defined as 6mnths relapse–free on no more than 1 drop of topical steroid. These endpoints were examined on and off systemic MTX by survival analysis. Results: 84 eyes were involved with uveitis starting at 56m [15–120m] and MTX given 2.6years after onset. Mean follow up was 40m [9–95]. At one year 49% achieved control and 5% remission on MTX;no patient had MTX withdrawn.At 5 years, 81% achieved control and 48% remission on MTX but only 20% achieved control and 6% remission off MTX.The only risk factor affecting rates of remission or control was disease severity at diagnosis. No patients [0/27] entered remission on MTX compared to 23/55 of those with mild onset [p=0.001]. Idiopathic uveitis was less likely to remit compared to JIA–uveitis [incidence rate 0.002 vs 0.010,p=0.03]. Age, gender, timing of MTX, ANA status were not significant. Conclusions: In this large cohort, the majority of responders achieved control within 9 months of starting MTX, but only a minority actually remit within 5 years.Disease control is not confined to any subgroups of patients. Few enter full remission off MTX.Alternative immunusupression is justified in those at high risk of ocular complications within a year and patients need to be informed of comtemporary long–term outcomes.
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