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Uveitis in Children: Diagnosis and Management

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Abstract

Uveitis is a term used to describe inflammation of uvea, which is the middle layer of eye. It is an important cause of blindness in children in both developed and developing countries. Delayed diagnosis, inadequate treatment and risk of amblyopia are some of the factors that are unique to childhood uveitis and are responsible for significant morbidity seen with this disease.

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References

  1. Carvounis PE, Herman DC, Cha S, Burke JP. Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature. Graefes Arch Clin Exp Ophthalmol. 2006;244:281–90.

    Article  PubMed  Google Scholar 

  2. Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol. 2005;140:509–16.

  3. Deschenes J, Murray PI, Rao NA. Nussenblatt RB; International Uveitis Study Group. International uveitis study group (IUSG): clinical classification of uveitis. Ocul Immunol Inflamm. 2008;16:1–2.

  4. Edelsten C, Reddy MA, Stanford MR, Graham EM. Visual loss associated with pediatric uveitis in English primary and referral centers. Am J Ophthalmol. 2003;135:676–80.

    Article  PubMed  Google Scholar 

  5. Smith JA, Mackensen F, Sen HN, et al. Epidemiology and course of disease in childhood uveitis. Ophthalmology. 2009;116:1544–51.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Aggarwal A, Misra RN. Juvenile rheumatoid arthritis in India-rarity of antinuclear autoantibody and uveitis. Indian J Pediatr. 1996;63:301–4.

    Article  CAS  PubMed  Google Scholar 

  7. Aggarwal A, Misra R. Juvenile chronic arthritis in india: is it different from that seen in western countries? Rheumatol Int. 1994;14:53–6.

    Article  CAS  PubMed  Google Scholar 

  8. Narayana KM, Bora A, Biswas J. Patterns of uveitis in children presenting at a tertiary eye care Centre in south India. Indian J Ophthalmol. 2003;51:129–32.

    PubMed  Google Scholar 

  9. Sudharshan S, Biswas J, Ganesh SK. Analysis of juvenile idiopathic arthritis associated uveitis in India over the last 16 years. Indian J Ophthalmol. 2007;55:199–202.

    Article  CAS  PubMed  Google Scholar 

  10. Mathur G, Biswas J. Systemic manifestations of anterior uveitis in a tertiary care ophthalmic Centre in south India. Int Ophthalmol. 2012;32:417–21.

    Article  PubMed  Google Scholar 

  11. Angeles-Han ST, Pelajo CF, Vogler LB, et al. Risk markers of juvenile idiopathic arthritis-associated uveitis in the childhood arthritis and rheumatology research alliance (CARRA) registry. J Rheumatol. 2013;40:2088–96.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Moradi A, Amin RM, Thorne JE. The role of gender in juvenile idiopathic arthritis-associated uveitis. J Ophthalmol. 2014;2014:461078.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Saurenmann RK, Levin AV, Feldman BM, et al. Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum. 2007;56:647–57.

    Article  CAS  PubMed  Google Scholar 

  14. Qian Y, Acharya NR. Juvenile idiopathic arthritis-associated uveitis. Curr Opin Ophthalmol. 2010;21:468–72.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Heiligenhaus A, Heinz C, Edelsten C, Kotaniemi K, Minden K. Review for disease of the year: epidemiology of juvenile idiopathic arthritis and its associated uveitis: the probable risk factors. Ocul Immunol Inflamm. 2013;21:180–91.

    Article  PubMed  Google Scholar 

  16. Heiligenhaus A, Niewerth M, Ganser G, Heinz C, Minden K; German uveitis in childhood study group. Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology (Oxford). 2007;46:1015–9.

    Article  CAS  Google Scholar 

  17. Wouters CH, Maes A, Foley KP, Bertin J, Rose CD. Blau syndrome, the prototypic auto-inflammatory granulomatous disease. Pediatr Rheumatol Online J. 2014;12:33.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Cunningham Jr ET, Rathinam SR, Tugal-Tutkun I, Muccioli C, Zierhut M. Vogt-koyanagi-Harada disease. Ocul Immunol Inflamm. 2014;22:249–52.

    Article  PubMed  Google Scholar 

  19. Korsten P, Müller GA. Interstitial nephritis in rheumatic diseases. Z Rheumatol. 2015;74:290–9.

    Article  CAS  PubMed  Google Scholar 

  20. Vodopivec I, Lobo AM, Prasad S. Ocular inflammation in neurorheumatic disease. Semin Neurol. 2014;34:444–57.

    Article  PubMed  Google Scholar 

  21. Heiligenhaus A. Michels H, Schumacher C, et al. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int. 2012;32: 1121–33.

    Article  CAS  PubMed  Google Scholar 

  22. Bou R, Iglesias E, Antón J. Treatment of uveitis associated with juvenile idiopathic arthritis. Curr Rheumatol Rep. 2014;16:437.

    Article  PubMed  Google Scholar 

  23. Simonini G, Cantarini L, Bresci C, Lorusso M, Galeazzi M, Cimaz R. Current therapeutic approaches to autoimmune chronic uveitis in children. Autoimmun Rev. 2010;9:674–83.

    Article  CAS  PubMed  Google Scholar 

  24. Thorne JE, Woreta FA, Dunn JP, Jabs DA. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology. 2010;117:1436–41.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Simonini G, Paudyal P, Jones GT, Cimaz R, Macfarlane GJ. Current evidence of methotrexate efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach. Rheumatology (Oxford). 2013;52:825–31.

    Article  CAS  Google Scholar 

  26. Goebel JC, Roesel M, Heinz C, Michels H, Ganser G, Heiligenhaus A. Azathioprine as a treatment option for uveitis in patients with juvenile idiopathic arthritis. Br J Ophthalmol. 2011;95:209–13.

    Article  CAS  PubMed  Google Scholar 

  27. Doycheva D, Deuter C, Stuebiger N, Biester S, Zierhut M. Mycophenolatemofetil in the treatment of uveitis in children. Br J Ophthalmol. 2007;91:180–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Kilmartin DJ, Forrester JV, Dick AD. Cyclosporin a therapy in refractory non-infectious childhood uveitis. Br J Ophthalmol. 1998;82:737–42.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Hogan AC, McAvoy CE, Dick AD, Lee RW. Long-term efficacy and tolerance of tacrolimus for the treatment of uveitis. Ophthalmology. 2007;114:1000–6.

    Article  PubMed  Google Scholar 

  30. Sharma SM, Dick AD, Ramanan AV. Non-infectious pediatric uveitis: an update on immunomodulatory management. Paediatr Drugs. 2009;11:229–41.

    Article  PubMed  Google Scholar 

  31. Simonini G, Druce K, Cimaz R, Macfarlane GJ, Jones GT. Current evidence of anti-tumor necrosis factor α treatment efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach of individual drugs. Arthritis Care Res (Hoboken). 2014;66:1073–84.

    Article  CAS  Google Scholar 

  32. Smith JA, Thompson DJ, Whitcup SM, et al. A randomized, placebo-controlled, double-masked clinical trial of etanercept for the treatment of uveitis associated with juvenile idiopathic arthritis. Arthritis Rheum. 2005;53:18–23.

  33. Saurenmann RK, Levin AV, Feldman BM, Laxer RM, Schneider R, Silverman ED. Risk of new-onset uveitis in patients with juvenile idiopathic arthritis treated with anti-TNF alpha agents. J Pediatr. 2006;149:833–6.

    Article  CAS  PubMed  Google Scholar 

  34. Kotaniemi K, Sihto-Kauppi K, Salomaa P, et al. The frequency and outcome of uveitis in patients with newly diagnosed juvenile idiopathic arthritis in two 4-year cohorts from 1990 to 1993 and 2000–2003. Clin Exp Rheumatol. 2014;32:143–7.

    PubMed  Google Scholar 

  35. Skarin A, Elborgh R, Edlund E, Rengtsson-Stigmar E. Long-term follow-up of patients with uveitis associated with juvenile idiopathic arthritis: a cohort study. Ocul Immunol Inflamm. 2009;17:104–8.

    Article  PubMed  Google Scholar 

  36. Angeles-Han ST, Yeh S, Vogler LB. Updates on the risk markers and outcomes of severe juvenile idiopathic arthritis-associated uveitis. Int J Clin Rheumatol. 2013;8. doi:10.2217/ijr.12.83.

  37. Chia A, Lee V, Graham EM, Edelsten C. Factors related to severe uveitis at diagnosis in children with juvenile idiopathic arthritis in a screening program. Am J Ophthalmol. 2003;135:757–62.

    Article  PubMed  Google Scholar 

  38. Edelsten C, Lee V, Bentley CR, Kanski JJ, Graham EM. An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. Br J Ophthalmol. 2002;86:51–6.

    Article  PubMed Central  PubMed  Google Scholar 

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Contributions

AG drafted the manuscipt. AVR revised several drafts and contributed to content. AVR will act as guarantor for this paper.

Conflict of Interest

AVR has received honoraria/speaker’s fees from Abbvie, Pfizer, SOBI, Novartis and Roche and is the Co-Chief Investigator of Sycamore trial.

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None.

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Authors and Affiliations

  1. Division of Allergy Immunology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Anju Gupta

  2. Department of Pediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK

    A. V. Ramanan

  3. Royal National Hospital for Rheumatic Diseases, Bath, UK

    A. V. Ramanan

Authors
  1. Anju Gupta
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  2. A. V. Ramanan
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Correspondence to A. V. Ramanan.

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Gupta, A., Ramanan, A.V. Uveitis in Children: Diagnosis and Management. Indian J Pediatr 83, 71–77 (2016). https://doi.org/10.1007/s12098-015-1889-x

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  • DOI: https://doi.org/10.1007/s12098-015-1889-x

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