Uveitis associated with juvenile idiopathic arthritis
Zheng Yuezhong
Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin 300020, China
Juvenile idiopathic arthritis (JIA) that persists for at least 6 weeks is a group of the most common chronic arthritis conditions occurring in children under 16 years of age. Uveitis accompanies JIA in about 10% of patients. The characteristics of uveitis are usually asymptomatic with silent onset, light inflammation, more complications and severe visual damage. Traditional risk factors for uveitis development include children less than 7 years old at the time of arthritis onset, a positive antinuclear antibody (ANA) test result, female sex and oligoarthritis. The classic clinical pictures are bilateral chronic asymptomatic anterior uveitis and the major complications include band keratopathy, complicated cataract, posterior iris synechiae and secondary glaucoma. Treatment consists of topical corticosteroids, nonsteroidal anti-inflammatory drugs and mydriatics. In severe cases, treatment may include oral corticosteroids, immunosuppressive agents or biological therapies. Patients with complicated cataract need surgical management and aggressive perioperative control of intraocular inflammation for successful cataract surgery with lens implantation. In view of the asymptomatic nature of uveitis, careful screening of eyes in JIA patients and early diagnosis and treatment of uveitis are crucial to prevent complications and blindness.
Kesen MR, Setlur V, Goldstein DA. Juvenile idiopathic arthritis-related uveitis[J]. Int Ophthalmol Clin,2008,48(3):21-38.
[2]
Anesi SD, Foster CS. Importance of recognizing and preventing blindness from juvenile idiopathic arthritis-associated uveitis[J]. Arthritis Care Res,2012,64(5):653-657.
Carvounis PE, Herman DC, Cha S, et al. Incidence and outcomes of uveitis in juvenile rheumatoid arthritis[J]. Graefe′s Arch Clin Exp Ophthalmol,2006,244(3):281-290.
[5]
Sabri K, Saurenmann RK, Silverman ED, et al. Course, complications, and outcome of juvenile arthritis-related uveitis[J]. JAAPOS,2008,12(6):539-545.
[6]
Marvillet I, Terrada C, Quartier P, et al. Ocular threat in juvenile idiopathic arthritis[J]. Joint Bone Spine,2009,76(4):383-388.
[7]
Skarin A, Elborgh R, Edlund E, et al. Long-term follow-up of patients with uveitis associated with juvenile idiopathic arthritis[J]. Ocul Immunol Inflamm,2009,17(2):104-108.
Cimaz R, Moretti D, Pagnini I, et al. What do cytokine profiles tell us about subsets of juvenile idiopathic arthritis[J]. Curr Rheumatol Rep,2012,14(2):150-154.
Yanagimachi M, Miyamae T, Naruto T, et al. Association of HLA-A*02:06 and HLA-DRB1* 04:05 with clinical subtypes of juvenile idiopathic arthritis[J]. J Hum Genet,2011,56(3):196-199.
[14]
Parikh JG, Tawansy KA, Rao NA. Immunohistochemical study of chronic nongranulomatous anterior uveitis in juvenile idiopathic arthritis[J]. Ophthalmology,2008,115(10):1833-1836.
[15]
Angeles-Han S, Yeh S. Prevention and management of cataracts in children with juvenile idiopathic arthritis-associated uveitis[J]. Curr Rheumatol Rep,2012,14(2):142-149.
[16]
Woreta F, Thorne JE, Jabs DA, et al. Risk factors for ocular complications and poor visual acuity at presentation among patients with uveitis associated with juvenile idiopathic arthritis[J]. Am J Ophthalmol,2007,143(4):647-655.
[17]
Gregory AC, Kempen JH, Daniel E, et al. Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis[J]. Ophthalmology,2013,120(1):186-192.
[18]
Heinz C, Schumacher C, Roesel M, et al. Elevated intraocular pressure in uveitis associated with juvenile idiopathic arthritis-associated uveitis, often detected after achieving inactivity[J]. Br J Ophthalmol,2012,96(1):140-141.
[19]
Kotaniemi K, Sihto-Kauppi K. Occurrence and management of ocular hypertension and secondary glaucoma in juvenile idiopathic arthritis-associated uveitis[J]. Clin Ophthalmol,2007, 1(4):455-459.
[20]
Ducos de Lahitte G, Terrada C, Tran TH, et al. Maculopathy in uveitis of juvenile idiopathic arthritis[J]. Br J Ophthalmol, 2008,92(1):64-69.
[21]
Tappeiner C, Heinz C, Roesel M, et al. Elevated laser flare values correlate with complicated course of anterior uveitis in patients with juvenile idiopathic arthritis[J]. Acta Ophthalmol,2011,89(6):e521-527.
[22]
杨培增. 葡萄膜炎诊断与治疗[M]. 北京:人民卫生出版社,2009:566-580.
[23]
Heiligenhaus A, Michels H, Schumacher C, et al. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis[J]. Rheumatol Int,2012,32(5):1121-1133.
Goebel JC, Roesel M, Heinz C, et al. Azathioprine as a treatment option for uveitis in patients with juvenile idiopathic arthritis[J]. Br J Ophthalmol,2011,95(2):209-213.
[26]
Saeed MU, Raza SH, Goyal S, et al. Etanercept in methotrexate-resistant JIA-related uveitis[J]. Semin Ophthalmol, 2014,29(1):1-3.
[27]
Saboo US, Metzinger JL, Radwan A, et al. Risk factors associated with the relapse of uveitis in patients with juvenile idiopathic arthritis: a preliminary report[J]. JAAPOS,2013,17(5):460-464.
[28]
Kalinina Ayuso V, van de Winkel EL, Rothova A, et al. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis[J]. Am J Ophthalmol,2011,151(2):217-222.
[29]
Tappeiner C, Roesel M, Heinz C, et al. Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis[J]. Eye (Lond),2009, 23(5):1192-1198.
[30]
Zannin ME, Birolo C, Gerloni VM, et al. Safety and efficacy of infliximab and adalimumab for refractory uveitis in juvenile idiopathic arthritis[J]. J Rheumatol,2013,40(1):74-79.
[31]
William M, Faez S, Papaliodis GN, et al. Golimumab for the treatment of refractory juvenile idiopathic arthritis-associated uveitis[J]. J Ophthalmic Inflamm Infect,2012,2(4):231-233.
[32]
Tappeiner C, Heinz C, Ganser G, et al. Is tocilizumab an effective option for treatment of refractory uveitis associated with juvenile idiopathic arthritis[J]. J Rheumatol,2012,39(6):1294-1296.
[33]
Heiligenhaus A, Miserocchi E, Heinz C, et al. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody[J]. Rheumatology,2011,50(8): 1390-1394.
[34]
Kenawy N, Cleary G, Mewar D, et al. Abatacept: a potential therapy in refractory cases of juvenile idiopathic arthritis-associated uveitis[J]. Graefes Arch Clin Exp Ophthalmol,2011, 249(2):297-300.
[35]
Cordero-Coma M, Garzo I, Calleja S, et al. Preoperative cataract surgery use of an intravitreal dexamethasone implant(Ozurdex) in a patient with juvenile idiopathic arthritis and chronic anterior uveitis[J]. JAAPOS,2013,17(6):632-634.
[36]
Zannin ME, Buscain I, Vittadello F, et al. Timing of uveitis onset in oligoarticular juvenile idiopathic arthritis is the main predictor of severe course uveitis[J]. Acta Ophthalmol,2012,90(1):91-95.