Uveitis in Children

Chapter

Abstract

Uveitis is a disease involving inflammation of the uveal components of the eye, comprising the iris, choroid and retina. It can be idiopathic, infectious or non-infectious associated with inflammatory diseases including juvenile idiopathic arthritis (JIA). The commonest form seen in JIA is chronic anterior uveitis which is usually asymptomatic. Effective screening is therefore essential to identify early disease and reduce the risk of vision-threatening complications such as cataracts, glaucoma and maculopathy. Initial treatment of JIA-associated uveitis is with topical steroids but there is increasing evidence for earlier introduction of systemic immunosuppressive drugs, such as methotrexate, as steroid-sparing agents. Prospective controlled studies of biologic agents are underway or planned.

Keywords

Optical Coherence Tomography Juvenile Idiopathic Arthritis Kawasaki Disease Anterior Uveitis Juvenile Idiopathic Arthritis Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

References

  1. 1.
    Sen ES, Dick AD, Ramanan AV. Uveitis associated with juvenile idiopathic arthritis. Nat Rev Rheumatol. 2015;11(6):338–48.CrossRefPubMedGoogle Scholar
  2. 2.
    Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509–16.Google Scholar
  3. 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):1–2.Google Scholar
  4. 4.
    Hughes EH, Dick AD. The pathology and pathogenesis of retinal vasculitis. Neuropathol Appl Neurobiol. 2003;29(4):325–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Majumder PD, Biswas J. Pediatric uveitis: an update. Oman J Ophthalmol. 2013;6(3):140–50.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Tugal-Tutkun I. Pediatric uveitis. J Ophthalmic Vis Res. 2011;6(4):259–69.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Pan J, Kapur M, McCallum R. Noninfectious immune-mediated uveitis and ocular inflammation. Curr Allergy Asthma Rep. 2014;14(1):409.CrossRefPubMedGoogle Scholar
  8. 8.
    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(3):281–90.CrossRefPubMedGoogle Scholar
  9. 9.
    Paivonsalo-Hietanen T, Tuominen J, Saari KM. Uveitis in children: population-based study in Finland. Acta Ophthalmol Scand. 2000;78(1):84–8.CrossRefPubMedGoogle Scholar
  10. 10.
    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(5):676–80.CrossRefPubMedGoogle Scholar
  11. 11.
    Rathinam SR, Namperumalsamy P. Global variation and pattern changes in epidemiology of uveitis. Indian J Ophthalmol. 2007;55(3):173–83.CrossRefPubMedGoogle Scholar
  12. 12.
    Smith JA, Mackensen F, Sen HN, Leigh JF, Watkins AS, Pyatetsky D, et al. Epidemiology and course of disease in childhood uveitis. Ophthalmology. 2009;116(8):1544–51, 51.e1.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    de Boer J, Wulffraat N, Rothova A. Visual loss in uveitis of childhood. Br J Ophthalmol. 2003;87(7):879–84.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Angeles-Han ST, Pelajo CF, Vogler LB, Rouster-Stevens K, Kennedy C, Ponder L, et al. Risk markers of juvenile idiopathic arthritis-associated uveitis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol. 2013;40(12):2088–96.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Moradi A, Amin RM, Thorne JE. The role of gender in juvenile idiopathic arthritis-associated uveitis. J Ophthalmol. 2014;2014:461078.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Qian Y, Acharya NR. Juvenile idiopathic arthritis-associated uveitis. Curr Opin Ophthalmol. 2010;21(6):468–72.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    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(3):180–91.CrossRefPubMedGoogle Scholar
  18. 18.
    Saurenmann RK, Levin AV, Feldman BM, Laxer RM, Schneider R, Silverman ED. Risk factors for development of uveitis differ between girls and boys with juvenile idiopathic arthritis. Arthritis Rheum. 2010;62(6):1824–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Sabri K, Saurenmann RK, Silverman ED, Levin AV. Course, complications, and outcome of juvenile arthritis-related uveitis. J AAPOS. 2008;12(6):539–45.CrossRefPubMedGoogle Scholar
  20. 20.
    Julián K, Terrada C, Quartier P, Lehoang P, Bodaghi B. Uveitis related to juvenile idiopathic arthritis: familial cases and possible genetic implication in the pathogenesis. Ocul Immunol Inflamm. 2010;18(3):172–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Vastert SJ, Bhat P, Goldstein DA. Pathophysiology of JIA-associated Uveitis. Ocul Immunol Inflamm. 2014;22:1–10.CrossRefGoogle Scholar
  22. 22.
    Giannini EH, Malagon CN, Van Kerckhove C, Taylor J, Lovell DJ, Levinson JE, et al. Longitudinal analysis of HLA associated risks for iridocyclitis in juvenile rheumatoid arthritis. J Rheumatol. 1991;18(9):1394–7.PubMedGoogle Scholar
  23. 23.
    Melin-Aldana H, Giannini EH, Taylor J, Lovell DJ, Levinson JE, Passo MH, et al. Human leukocyte antigen-DRB1*1104 in the chronic iridocyclitis of pauciarticular juvenile rheumatoid arthritis. J Pediatr. 1992;121(1):56–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Du L, Kijlstra A, Yang P. Immune response genes in uveitis. Ocul Immunol Inflamm. 2009;17(4):249–56.CrossRefPubMedGoogle Scholar
  25. 25.
    Lee RW, Dick AD. Current concepts and future directions in the pathogenesis and treatment of non-infectious intraocular inflammation. Eye (Lond). 2012;26(1):17–28.CrossRefGoogle Scholar
  26. 26.
    Kalinina Ayuso V, Makhotkina N, van Tent-Hoeve M, de Groot-Mijnes JDF, Wulffraat NM, Rothova A, et al. Pathogenesis of juvenile idiopathic arthritis associated uveitis: the known and unknown. Surv Ophthalmol. 2014;59(5):517–31.CrossRefPubMedGoogle Scholar
  27. 27.
    Caspi RR. A look at autoimmunity and inflammation in the eye. J Clin Invest. 2010;120(9):3073–83.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Levy RA, de Andrade FA, Foeldvari I. Cutting-edge issues in autoimmune uveitis. Clin Rev Allergy Immunol. 2011;41(2):214–23.CrossRefPubMedGoogle Scholar
  29. 29.
    Nussenblatt RB, Gery I. Experimental autoimmune uveitis and its relationship to clinical ocular inflammatory disease. J Autoimmun. 1996;9(5):575–85.CrossRefPubMedGoogle Scholar
  30. 30.
    Amadi-Obi A, Yu CR, Liu X, Mahdi RM, Clarke GL, Nussenblatt RB, et al. TH17 cells contribute to uveitis and scleritis and are expanded by IL-2 and inhibited by IL-27/STAT1. Nat Med. 2007;13(6):711–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Ruggieri S, Frassanito MA, Dammacco R, Guerriero S. Treg lymphocytes in autoimmune uveitis. Ocul Immunol Inflamm. 2012;20(4):255–61.CrossRefPubMedGoogle Scholar
  32. 32.
    Saurenmann RK, Levin AV, Feldman BM, Rose JB, Laxer RM, Schneider R, et al. Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum. 2007;56(2):647–57.CrossRefPubMedGoogle Scholar
  33. 33.
    Uchiyama RC, Osborn TG, Moore TL. Antibodies to iris and retina detected in sera from patients with juvenile rheumatoid arthritis with iridocyclitis by indirect immunofluorescence studies on human eye tissue. J Rheumatol. 1989;16(8):1074–8.PubMedGoogle Scholar
  34. 34.
    Sijssens KM, Rijkers GT, Rothova A, Stilma JS, Schellekens PA, de Boer JH. Cytokines, chemokines and soluble adhesion molecules in aqueous humor of children with uveitis. Exp Eye Res. 2007;85(4):443–9.CrossRefPubMedGoogle Scholar
  35. 35.
    British Society for Paediatric and Adolescent Rheumatology, Royal College of Ophthalmology. Guidelines for Screening for Uveitis in Juvenile Idiopathic Arthritis. 2006. Available at: www.bspar.org.uk/DocStore/FileLibrary/PDFs/BSPAR%20Guidelines%20for%20Eye%20Screening%202006.pdf
  36. 36.
    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. 2007;46(6):1015–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Cassidy J, Kivlin J, Lindsley C, Nocton J, Section on Rheumatology, Section on Ophthalmology. Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics. 2006;117(5):1843–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Davies K, Cleary G, Foster H, Hutchinson E, Baildam E, British Society of Paediatric and Adolescent Rheumatology. BSPAR Standards of Care for children and young people with juvenile idiopathic arthritis. Rheumatology. 2010;49(7):1406–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Angeles-Han ST, Yeh S, Vogler LB. Updates on the risk markers and outcomes of severe juvenile idiopathic arthritis-associated uveitis. Int J Clin Rheumtol 2013;8(1):109–121.Google Scholar
  40. 40.
    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(6):757–62.CrossRefPubMedGoogle Scholar
  41. 41.
    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(1):51–6.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Kotaniemi K, Sihto-Kauppi K, Salomaa P, Säilä H, Ristolainen L, Kauppi M. The frequency and outcome of uveitis in patients with newly diagnosed juvenile idiopathic arthritis in two 4-year cohorts from 1990-1993 and 2000-2003. Clin Exp Rheumatol. 2014;32(1):143–7.PubMedGoogle Scholar
  43. 43.
    Skarin A, Elborgh R, Edlund E, Bengtsson-Stigmar E. Long-term follow-up of patients with uveitis associated with juvenile idiopathic arthritis: a cohort study. Ocul Immunol Inflamm. 2009;17(2):104–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Kotaniemi K, Arkela-Kautiainen M, Haapasaari J, Leirisalo-Repo M. Uveitis in young adults with juvenile idiopathic arthritis: a clinical evaluation of 123 patients. Ann Rheum Dis. 2005;64(6):871–4.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390–2.PubMedGoogle Scholar
  46. 46.
    Heiligenhaus A, Foeldvari I, Edelsten C, Smith JR, Saurenmann RK, Bodaghi B, et al. Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis: a consensus effort from the multinational interdisciplinary working group for uveitis in childhood. Arthritis Care Res. 2012;64(9):1365–72.CrossRefGoogle Scholar
  47. 47.
    Tappeiner C, Heinz C, Roesel M, Heiligenhaus A. Elevated laser flare values correlate with complicated course of anterior uveitis in patients with juvenile idiopathic arthritis. Acta Ophthalmol. 2011;89(6):e521–7.CrossRefPubMedGoogle Scholar
  48. 48.
    Holland GN. A reconsideration of anterior chamber flare and its clinical relevance for children with chronic anterior uveitis (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2007;105:344–64.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Ducos de Lahitte G, Terrada C, Tran TH, Cassoux N, LeHoang P, Kodjikian L, et al. Maculopathy in uveitis of juvenile idiopathic arthritis: an optical coherence tomography study. Br J Ophthalmol. 2008;92(1):64–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Heinz C, Schumacher C, Roesel M, Heiligenhaus A. Elevated intraocular pressure in uveitis associated with juvenile idiopathic arthritis-associated uveitis, often detected after achieving inactivity. Br J Ophthalmol. 2012;96(1):140–1.CrossRefPubMedGoogle Scholar
  51. 51.
    Nordal EB, Songstad NT, Berntson L, Moen T, Straume B, Rygg M. Biomarkers of chronic uveitis in juvenile idiopathic arthritis: predictive value of antihistone antibodies and antinuclear antibodies. J Rheumatol. 2009;36(8):1737–43.CrossRefPubMedGoogle Scholar
  52. 52.
    Pelegrín L, Casaroli-Marano R, Antón J, García de Vicuña MC, Molina-Prat N, Ignacio Aróstegui J, et al. Predictive value of selected biomarkers, polymorphisms, and clinical features for oligoarticular juvenile idiopathic arthritis-associated uveitis. Ocul Immunol Inflamm. 2014;22(3):208–12.CrossRefPubMedGoogle Scholar
  53. 53.
    Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U, Niehues T, et al. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int. 2012;32(5):1121–33.CrossRefPubMedGoogle Scholar
  54. 54.
    Bou R, Iglesias E, Antón J. Treatment of uveitis associated with juvenile idiopathic arthritis. Curr Rheumatol Rep. 2014;16(8):437.CrossRefPubMedGoogle Scholar
  55. 55.
    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(10):674–83.CrossRefPubMedGoogle Scholar
  56. 56.
    Foster CS, Alter G, DeBarge LR, Raizman MB, Crabb JL, Santos CI, et al. Efficacy and safety of rimexolone 1% ophthalmic suspension vs 1% prednisolone acetate in the treatment of uveitis. Am J Ophthalmol. 1996;122(2):171–82.CrossRefPubMedGoogle Scholar
  57. 57.
    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(7):1436–41.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Ramanan AV, Dick AD. Blinded by lack of evidence. Rheumatology. 2013;52(5):765–6.CrossRefPubMedGoogle Scholar
  59. 59.
    Chan ES, Cronstein BN. Methotrexate – how does it really work? Nat Rev Rheumatol. 2010;6(3):175–8.CrossRefPubMedGoogle Scholar
  60. 60.
    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. 2013;52(5):825–31.CrossRefPubMedGoogle Scholar
  61. 61.
    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(2):209–13.CrossRefPubMedGoogle Scholar
  62. 62.
    Doycheva D, Deuter C, Stuebiger N, Biester S, Zierhut M. Mycophenolate mofetil in the treatment of uveitis in children. Br J Ophthalmol. 2007;91(2):180–4.CrossRefPubMedGoogle Scholar
  63. 63.
    Chang PY, Giuliari GP, Shaikh M, Thakuria P, Makhoul D, Foster CS. Mycophenolate mofetil monotherapy in the management of paediatric uveitis. Eye (Lond). 2011;25(4):427–35.CrossRefGoogle Scholar
  64. 64.
    Sobrin L, Christen W, Foster CS. Mycophenolate mofetil after methotrexate failure or intolerance in the treatment of scleritis and uveitis. Ophthalmology. 2008;115(8):1416–21, 21.e1.CrossRefPubMedGoogle Scholar
  65. 65.
    Tappeiner C, Roesel M, Heinz C, Michels H, Ganser G, Heiligenhaus A. Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis. Eye (Lond). 2009;23(5):1192–8.CrossRefGoogle Scholar
  66. 66.
    Kilmartin DJ, Forrester JV, Dick AD. Cyclosporin A therapy in refractory non-infectious childhood uveitis. Br J Ophthalmol. 1998;82(7):737–42.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Hogan AC, McAvoy CE, Dick AD, Lee RW. Long-term efficacy and tolerance of tacrolimus for the treatment of uveitis. Ophthalmology. 2007;114(5):1000–6.CrossRefPubMedGoogle Scholar
  68. 68.
    Foeldvari I, Wierk A. Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis. J Rheumatol. 2005;32(2):362–5.PubMedGoogle Scholar
  69. 69.
    Sijssens KM, Rothova A, Van De Vijver DA, Stilma JS, De Boer JH. Risk factors for the development of cataract requiring surgery in uveitis associated with juvenile idiopathic arthritis. Am J Ophthalmol. 2007;144(4):574–9.CrossRefPubMedGoogle Scholar
  70. 70.
    Kalinina Ayuso V, van de Winkel EL, Rothova A, de Boer JH. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis. Am J Ophthalmol. 2011;151(2):217–22.CrossRefPubMedGoogle Scholar
  71. 71.
    Sharma SM, Dick AD, Ramanan AV. Non-infectious pediatric uveitis: an update on immunomodulatory management. Paediatr Drugs. 2009;11(4):229–41.CrossRefPubMedGoogle Scholar
  72. 72.
    Angeles-Han S, Yeh S. Prevention and management of cataracts in children with juvenile idiopathic arthritis-associated uveitis. Curr Rheumatol Rep. 2012;14(2):142–9.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Quiñones K, Cervantes-Castañeda RA, Hynes AY, Daoud YJ, Foster CS. Outcomes of cataract surgery in children with chronic uveitis. J Cataract Refract Surg. 2009;35(4):725–31.CrossRefPubMedGoogle Scholar
  74. 74.
    Grajewski RS, Zurek-Imhoff B, Roesel M, Heinz C, Heiligenhaus A. Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis. Acta Ophthalmol. 2012;90(7):657–62.CrossRefPubMedGoogle Scholar
  75. 75.
    Zaborowski AG, Quinn AG, Dick AD. Cataract surgery in pediatric uveitis. J Pediatr Ophthalmol Strabismus. 2008;45(5):270–8.CrossRefPubMedGoogle Scholar
  76. 76.
    Sijssens KM, Los LI, Rothova A, Schellekens PA, van de Does P, Stilma JS, et al. Long-term ocular complications in aphakic versus pseudophakic eyes of children with juvenile idiopathic arthritis-associated uveitis. Br J Ophthalmol. 2010;94(9):1145–9.CrossRefPubMedGoogle Scholar
  77. 77.
    Magli A, Forte R, Rombetto L, Alessio M. Cataract management in juvenile idiopathic arthritis: simultaneous versus secondary intraocular lens implantation. Ocul Immunol Inflamm. 2014;22(2):133–7.CrossRefPubMedGoogle Scholar
  78. 78.
    Freedman SF, Rodriguez-Rosa RE, Rojas MC, Enyedi LB. Goniotomy for glaucoma secondary to chronic childhood uveitis. Am J Ophthalmol. 2002;133(5):617–21.CrossRefPubMedGoogle Scholar
  79. 79.
    Kafkala C, Hynes A, Choi J, Topalkara A, Foster CS. Ahmed valve implantation for uncontrolled pediatric uveitic glaucoma. J AAPOS. 2005;9(4):336–40.CrossRefPubMedGoogle Scholar
  80. 80.
    Bohnsack BL, Freedman SF. Surgical outcomes in childhood uveitic glaucoma. Am J Ophthalmol. 2013;155(1):134–42.CrossRefPubMedGoogle Scholar
  81. 81.
    Smith JA, Thompson DJ, Whitcup SM, Suhler E, Clarke G, Smith S, 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(1):18–23.CrossRefPubMedGoogle Scholar
  82. 82.
    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. 2014;66(7):1073–84.CrossRefGoogle Scholar
  83. 83.
    Ramanan AV, Dick AD, Benton D, Compeyrot-Lacassagne S, Dawoud D, Hardwick B, et al. A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). Trials. 2014;15:14.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    William M, Faez S, Papaliodis GN, Lobo AM. Golimumab for the treatment of refractory juvenile idiopathic arthritis-associated uveitis. J Ophthalmic Inflamm Infect. 2012;2(4):231–3.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Suhler EB. An open-label trial to assess the efficacy and safety of Tocilizumab in the management of juvenile idiopathic arthritis associated vision-threatening uveitis that is refractory to other modes of systemic immunosuppression. ClinicalTrials.gov [Internet]. Bethesda: National Library of Medicine (US); 2014.Google Scholar
  86. 86.
    Tappeiner C, Heinz C, Ganser G, Heiligenhaus A. Is tocilizumab an effective option for treatment of refractory uveitis associated with juvenile idiopathic arthritis? J Rheumatol. 2012;39(6):1294–5.CrossRefPubMedGoogle Scholar
  87. 87.
    Tsang AC, Roth J, Gottlieb C. Tocilizumab for severe chronic anterior uveitis associated with juvenile idiopathic arthritis in a pediatric patient. Ocul Immunol Inflamm. 2014;22(2):155–7.CrossRefPubMedGoogle Scholar
  88. 88.
    Suhler EB. An Openlabel, Phase II trial of Abatacept (Orencia) in the treatment of refractory non-infectious uveitis.: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2014.Google Scholar
  89. 89.
    Zulian F, Balzarin M, Falcini F, Martini G, Alessio M, Cimaz R, et al. Abatacept for severe anti-tumor necrosis factor alpha refractory juvenile idiopathic arthritis-related uveitis. Arthritis Care Res. 2010;62(6):821–5.CrossRefGoogle Scholar
  90. 90.
    Kenawy N, Cleary G, Mewar D, Beare N, Chandna A, Pearce I. Abatacept: a potential therapy in refractory cases of juvenile idiopathic arthritis-associated uveitis. Graefes Arch Clin Exp Ophthalmol. 2011;249(2):297–300.CrossRefPubMedGoogle Scholar
  91. 91.
    Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology. 2011;50(8):1390–4.CrossRefPubMedGoogle Scholar
  92. 92.
    Miserocchi E, Pontikaki I, Modorati G, Bandello F, Meroni PL, Gerloni V. Rituximab for uveitis. Ophthalmology. 2011;118(1):223–4.CrossRefPubMedGoogle Scholar
  93. 93.
    Sen ES, Ramanan AV. New age of biological therapies in paediatric rheumatology. Arch Dis Child. 2014;99(7):679–85.CrossRefPubMedGoogle Scholar
  94. 94.
    Tynjälä P, Lindahl P, Honkanen V, Lahdenne P, Kotaniemi K. Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis. Ann Rheum Dis. 2007;66(4):548–50.CrossRefPubMedGoogle Scholar
  95. 95.
    Schmeling H, Horneff G. Etanercept and uveitis in patients with juvenile idiopathic arthritis. Rheumatology. 2005;44(8):1008–11.CrossRefPubMedGoogle Scholar
  96. 96.
    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-TNFalpha agents. J Pediatr. 2006;149(6):833–6.CrossRefPubMedGoogle Scholar
  97. 97.
    Lim LL, Fraunfelder FW, Rosenbaum JT. Do tumor necrosis factor inhibitors cause uveitis? A registry-based study. Arthritis Rheum. 2007;56(10):3248–52.CrossRefPubMedGoogle Scholar
  98. 98.
    Simonini G, Taddio A, Cattalini M, Caputo R, De Libero C, Naviglio S, et al. Prevention of flare recurrences in childhood-refractory chronic uveitis: an open-label comparative study of adalimumab versus infliximab. Arthritis Care Res. 2011;63(4):612–8.CrossRefGoogle Scholar
  99. 99.
    Dhingra N, Morgan J, Dick AD. Switching biologic agents for uveitis. Eye (Lond). 2009;23(9):1868–70.CrossRefGoogle Scholar
  100. 100.
    Lee RW, Nicholson LB, Sen HN, Chan CC, Wei L, Nussenblatt RB, et al. Autoimmune and autoinflammatory mechanisms in uveitis. Semin Immunopathol. 2014;36(5):581–94.CrossRefPubMedPubMedCentralGoogle Scholar
  101. 101.
    Quartier P. Evaluation of the efficacy of adalimumab for the treatment of uveitis in juvenile idiopathic arthritis: randomized double-blind placebo-controlled trial. ClinicalTrials.gov [Internet]. Bethesda: National Library of Medicine (US); 2014.Google Scholar

Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  1. 1.Pediatric RheumatologyBristol Royal Hospital for ChildrenBristolUK

Personalised recommendations