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Treating juvenile idiopathic arthritis (JIA)-related uveitis beyond TNF-α inhibition: a narrative review

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Abstract

Chronic anterior uveitis is the most frequent among extra-articular manifestations of juvenile idiopathic arthritis (JIA) and a relevant cause of ocular morbidity in children. Asymmetric arthritis, early onset disease, female sex, and anti-nuclear antibody (ANA) positivity are counted among risk factors for developing this complication. It usually has insidious onset and asymptomatic chronic-relapsing course, but the persistence of low-grade chronic inflammation can lead to irreversible structural ocular damage and to vision-threatening complications. For such reasons, achieving a complete absence of inflammation through early targeted and aggressive treatments is a primary therapeutic goal in these patients. This review is aimed at summarizing scientific evidence about biologic rescue therapy of JIA-related uveitis in patients who fail to achieve clinical remission, in spite of being treated with conventional disease-modifying anti-rheumatic drugs (cDMARDs) and at least one biologic tumor necrosis factor (TNF)-α inhibitor. Interleukin (IL)-6 inhibition appears a promising and safe option for refractory JIA-related uveitis. Abatacept and rituximab proved to be beneficial as well, but their efficacy together with some safety concerns needs to be more extensively evaluated.

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Authors and Affiliations

  1. Clinical Pediatrics, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy

    Carla Gaggiano & Salvatore Grosso

  2. Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy

    Donato Rigante

  3. Periodic Fever Research Center, Università Cattolica Sacro Cuore, Rome, Italy

    Donato Rigante

  4. Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy

    Gian Marco Tosi & Claudia Fabiani

  5. Research Center of Systemic Autoinflammatory Diseases, Behçet’s Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy

    Antonio Vitale, Bruno Frediani & Luca Cantarini

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  1. Carla Gaggiano
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Gaggiano, C., Rigante, D., Tosi, G.M. et al. Treating juvenile idiopathic arthritis (JIA)-related uveitis beyond TNF-α inhibition: a narrative review. Clin Rheumatol 39, 327–337 (2020). https://doi.org/10.1007/s10067-019-04763-3

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