Management for JIA-associated uveitis
Management for JIA-associated uveitis must be tailored to an individual patient depending on disease severity, duration of disease, disease activity, complications, response to prior treatments and other comorbidities.
Topical ocular corticosteroids (prednisolone acetate 1% or dexamethasone 0.1%) are often used as first-line treatment for JIA-associated uveitis. In chronic disease, when uveitis is not active, prednisolone acetate 1% drops may be used as often as 2 times daily to suppress disease. Higher long-term doses of corticosteroids should be avoided as there are risks of developing vision-threatening complications, such as cataract and glaucoma.
Systemic immunomodulatory therapy is indicated for patients with JIA-associated uveitis who have a higher reliance on ocular corticosteroids (ie needing more than 2 drops of topical corticosteroid daily) or active disease with complications (including band keratopathy, cataract, glaucoma and cystoid macular oedema). Methotrexate is recommended as the first-line conventional synthetic disease-modifying antirheumatic drug (csDMARD) for JIA-associated uveitis. Mycophenolate may be considered in the event of intolerance or contraindication to methotrexate.
Adalimumab is the first-line biological disease-modifying antirheumatic drug (bDMARD) for JIA-associated uveitis as it has been shown to be safe and effective in randomised controlled trials. Other bDMARDs including infliximab and tocilizumab may be used in refractory cases. Etanercept is not effective for treating uveitis and should not be used for this purpose.Renton, 2022
Some patients may require supportive treatments to manage the complications of JIA-associated uveitis; treatments include topical beta blockers for glaucoma or mydriatics for synechiae.
Duration of therapy for JIA-associated uveitis is controversial; stopping systemic immunomodulatory therapy may be considered if the uveitis and underlying condition, if the patient has one, have been quiescent for 2 years.