New developments in the management of juvenile idiopathic arthritis-related uveitis

Author： Zannin Maria Elisabetta Zulian Francesco

ISSN： 1746-0816

Source： Future Rheumatology, Vol.3, Iss.6, 2008-12, pp. : 587-598

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Abstract

Chronic anterior uveitis is the most important extra-articular complication of juvenile idiopathic arthritis. It is more frequent in the early-onset forms, with a higher prevalence in the oligoarticular subtype, and bilateral in most cases. The risk for visual impairment is still relevant due to sight-threatening complications, such as band keratopathy, cataract, glaucoma and cystoid macular edema. To date, treatment is not standardized and involves a complex decision-making process. Among several steroid-sparing immunosuppressive options, low-dose methotrexate is still the most diffuse treatment. Mycophenolate mofetil is another potential choice, although it is less effective in chronic anterior uveitis than in posterior or intermediate uveitis. TNF-αα antagonists, the new generation of agents increasingly frequently used in autoimmune and rheumatic conditions, have demonstrated effectiveness in open-label studies, although no large, randomized, controlled trials have been reported so far. Although infliximab, an anti-TNF monoclonal antibody, seems to be superior to etanercept, an anti-TNF receptor antagonist, in controlling intra-ocular inflammation, serious side effects and loss of efficacy after the first year of treatment are reported. Adalimumab has evidenced efficacy similar to infliximab, but a better tolerance. In this review, the current practice in the medical management of juvenile idiopathic arthritis-related uveitis and the potential new agents are discussed.