New Guidelines May Help Prevent Vision Damage Among Children with JIA
Published April 2019 | Arthritis Care and Research
Some children with juvenile idiopathic arthritis (JIA) develop more than severe joint damage. About 10% to 20% also develop chronic anterior uveitis (CAU), a potentially vision-stealing form of eye inflammation.
While all JIA specialists are aware of this sometimes hard-to-detect complication, treatment approaches vary. That variation, amid limited data, prompted the American College of Rheumatology and the Arthritis Foundation to convene an expert panel to develop the first national CAU guidelines.
Two Cincinnati Children’s experts played key roles in the work: Sheila Angeles-Han, MD, MSc, served as first author, and Daniel Lovell, MD, MPH, served as a senior co-author.
After reviewing more than 1,500 papers on the subject, panel leaders determined that the pooled data was strong enough to guide certain recommendations. For other recommendations, a consensus of expert opinion was used with input from patients and families. In all, the panel laid out 19 recommendations.
“A child with JIA needs to be monitored by a pediatric ophthalmologist at the recommended screening schedule, especially since children with uveitis usually do not have any eye symptoms,” Lovell says. “Sight-threatening complications can occur if uveitis is undetected, untreated, or not adequately treated.”
Among the recommendations:
- In children with JIA and controlled uveitis on stable therapy, ophthalmic monitoring no less frequently than every three months is strongly recommended.
- In children with JIA and CAU still requiring one to two drops per day of prednisolone acetate 1% for at least three months and on systemic therapy for uveitis control, changing or escalating systemic therapy is conditionally recommended.
- In children with JIA with severe active CAU and sight-threating complications, starting methotrexate and a monoclonal antibody TNFi immediately is conditionally recommended over methotrexate as a monotherapy.
