Kamilė Grigaitė¹, Edvardas Jukna²

¹Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania

²Joniskis Hospital, emergency department, Joniskis, Lithuania

Abstract

Juvenile idiopathic arthritis (JIA) is one of the most common rheumatic diseases with onset before the age of 16 years and a prevalence of 1 in 1,000 children and Juvenile idiopathic arthritis – associated uveitis (JIAU) is its most frequent extra-articular manifestation. Patients with JIAU are at high risk of developing visually impaired complications such as cataracts, glaucoma, band keratopathy, chronic cystoid macular oedema and posterior synechiae. Since JIAU is often initially asymptomatic, it tends to stay undiagnosed for extended periods of time, potentially leading to permanent vision impairment, which makes early recognition of children at risk of uveitis and providing proper treatment highly important.

Aim: to analyse the most recent scientific literature of risk factors, screening, monitoring and treatment of juvenile idiopathic arthritis-associated uveitis.

Material and methods: recently published studies were reviewed to evaluate the latest findings in Juvenile idiopathic arthritis-associated uveitis risk factors, screening, monitoring and treatment. Databases from the subscription list of Lithuanian University of Health Sciences were selected: Medline (PubMed), SpringerLink and ScienceDirect. Certain keywords were used for the search of the most relevant articles.

Conclusion: Non-granulomatous inflammation of the anterior chamber of the eye is a frequent extra-articular manifestation of Juvenile idiopathic arthritis, which requires a regular ophthalmic examination because of a high risk of sight threatening complications or blindness. The main risk factors are age of onset, gender, category of JIA, anti-nuclear antibody and a genetic predisposition. Topical glucocorticoids are the first-line therapy for ocular inflammation and methotrexate is the first option of immunomodulatory therapy choice if glucocorticoids fail the management of uveitis. Biologic therapy is consedered in cases when methotrexate treatment provides insufficient control of JIA-associated uveitis or is not tolerated well. Recent studies recommend to choose TNFi adalimumab as the first option in biology therapy and if the control of JIAU is not reached, then patients should try to use other monoclonal antibody from the same group, for example, infliximab. Abatacept, golimumab and rituximab are possible alternatives, however, further studies of the effectiveness and safety of these biologic agents are needed.

Keywords: juvenile, idiopathic, arthritis, uveitis, treatment.