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Uveitis bei juveniler idiopathischer Arthritis

Betreuung von Patienten—Konsensusstatement der Arbeitsgemeinschaft Kinder- und Jugendrheumatologie (AGKJR) und der Uveitiszentren

Uveitis in juvenile idiopathic arthritis

Management of patients—Consensus statement of the Working Group for Children and Adolescents with Rheumatic Diseases in Germany and the German Uveitis Centers

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Zusammenfassung

Die Uveitis stellt bei Kindern und Jugendlichen mit juveniler idiopathischer Arthritis (JIA) ein zusätzliches Problem dar und kann unabhängig von den Arthritiden die Prognose der Krankheit erheblich beeinflussen. In Zusammenarbeit mit der Arbeitsgemeinschaft für Kinder- und Jugendrheumatologie (AGKJR)—unter Federführung der Arbeitsgruppe Kinder- und Jugendrheumatologie in Nordrhein-Westfalen—und den Uveitiszentren wurde ein Konzept zur Betreuung der Patienten mit JIA und Uveitis erarbeitet. Es umfasst ein augenärztliches Untersuchungskonzept, Empfehlungen zu den augenärztlichen Untersuchungsintervallen und ein Therapiekonzept. Grundlage waren eine Literatursuche und deren Bewertung nach evidenzbasierten Kriterien sowie die Diskussion der Behandler in den verschiedenen Arbeitsgruppen als Expertengremium. Ziel ist es, die klinische Betreuung der JIA-Patienten mit Uveitis zu optimieren und die Möglichkeit wissenschaftlicher Studien durch vereinheitlichte Strategien zu verbessern.

Abstract

Uveitis adds to the problems in children and adolescents with juvenile idiopathic arthritis (JIA), influencing the prognosis substantially and in ways that are quite independent of the arthritis itself. The Working Group for Children and Adolescents with Rheumatic Diseases in Germany (AGKJR)—and especially the branch group in North Rhine-Westphalia—and the German Uveitis Centers have initiated the formulation of an evidence-based strategy for the management of uveitis in JIA. This gives recommendations on the content and frequency of ophthalmological examinations and also a treatment concept. The aim is to improve the clinical management of these patients and to create a platform for further scientific approaches with uniform strategies.

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Literatur

  1. American Academy of Pediatrics (1993) Section of rheumatology and section of ophthalmology. Guidelines for ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics 92:295–296

    PubMed  Google Scholar 

  2. Baltatzis S, Tufail F, Yu EN et al. (2003) Mycophenolate mofetil as an immunomodulatory agent in the treatment of chronic ocular inflammatory disorders. Ophthalmology 110:1061–1065

    Article  PubMed  Google Scholar 

  3. Bloch-Michel E, Nussenblatt RB (1976) International uveitis study group recommentations for the evaluation of intraocular inflammatory disease. Am J Ophthalmol 103:234–235

    Google Scholar 

  4. Cassidy JT, Sullivan DB, Petty RE (1977) Clinical patterns of chronic iridocyclitis in children with juvenile rheumatoid arthritis. Arthritis Rheum 20:224–227

    CAS  PubMed  Google Scholar 

  5. Chalom EC, Goldsmith DP, Koehler MA (1997) Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. J Rheumatol 24:2031–2034

    CAS  PubMed  Google Scholar 

  6. Chylack LT, Bienfang DC, Bellows AR et al. (1975) Ocular manifestations of juvenile rheumatoid arthritis. Am J Ophthalmol 79:1026–1033

    PubMed  Google Scholar 

  7. Chylack LT Jr (1977) The ocular manifestations of juvenile rheumatoid arthritis. Arthritis Rheum 20:217–223

    PubMed  Google Scholar 

  8. Cross AG (1965) Uveitis in children. Trans Ophthalmol Soc UK 85:409–419

    CAS  PubMed  Google Scholar 

  9. Dana MR, Merayo-Lloves J, Schamberg DA et al. (1997) Visual outcomes prognosticators in juvenile rheumatoid arthritis-associated uveitis. Ophthalmology 104:236–244

    CAS  PubMed  Google Scholar 

  10. Foster CS, Barrett F (1993) Cataract development and cataract surgery in patients with juvenile rheumatoid arthritis-associated iridocyclitis. Ophthalmology 100:809–817

    CAS  PubMed  Google Scholar 

  11. Foster CS, Havrlikova K, Baltatzis S et al. (2000) Secondary glaucoma in patients with juvenile rheumatoid arthritis-associated iridocyclitis. Acta Ophthalmol Scand 78:576–579

    Article  CAS  PubMed  Google Scholar 

  12. Foster CS (2003) Diagnosis and treatment of juvenile idiopathic arthritis-associated uveitis. Curr Opin Ophthalmol 14:395–398

    Article  PubMed  Google Scholar 

  13. Giannini EH, Brewer EJ, Kuzmina N et al. (1992) Methotrexate in resistant juvenile rheumatoid arthritis: results of the U.S.A.-U.S.S.R. double blind, placebo-controlled trial. N Engl J Med 326:1043–1049

    CAS  PubMed  Google Scholar 

  14. Giordano M (1983) Dauerprophylaxe der rezidivierenden „spondylitischen Iridozyklitis“ durch Antimalarika und nichtsteroidale Antiphlogistika. Z Rheumatol 41:105–106

    Google Scholar 

  15. Goel KM, Shanks RQA (1974) Follow-up of 100 cases of juvenile rheumatoid arthritis. Ann Rheum Dis 33:25–31

    CAS  PubMed  Google Scholar 

  16. Godfrey WA, Epstein WV, O’Connor GR et al. (1974) The use of chlorambucil in intractable idiopathic uveitis. Am J Ophthalmol 78:415–428

    CAS  PubMed  Google Scholar 

  17. Hemady RK, Baer JC, Foster CS (1992) Immunosuppressive drugs in the management of progressive, corticosteroid-resistant uveitis associated with juvenile rheumatoid arthritis. Int Ophthalmol Clin 32:241–252

    CAS  PubMed  Google Scholar 

  18. Henderly DE, Genstler AJ, Smith RE et al. (1987) Changing patterns of uveitis. Am J Ophthalmol 103:131–136

    CAS  PubMed  Google Scholar 

  19. Kanski JJ (1977) Anterior uveitis in juvenile rheumatoid arthritis. Arch Ophthalmol 95:1794–1797

    Google Scholar 

  20. Kanski JJ (1981) Care of children with anterior uveitis. Trans Ophthalmol Soc UK 101:387–390

    PubMed  Google Scholar 

  21. Kanski JJ, Shun-Shin GA (1984) Systemic uveitis syndromes in childhood: an analysis of 340 cases. Ophthalmology 91:1247–1252

    CAS  PubMed  Google Scholar 

  22. Kanski JJ (1988) Uveitis in juvenile chronic arthritis: incidence, clinical features and prognosis. Eye 2:641–645

    PubMed  Google Scholar 

  23. Kanski JJ (1989) Screening for uveitis in juvenile chronic arthritis. Br J Ophthalmol 73:225–228

    CAS  PubMed  Google Scholar 

  24. Kanski JJ (1990) Juvenile arthritis and uveitis. Surv Ophthalmol 34:253–267

    Article  CAS  PubMed  Google Scholar 

  25. Kanski JJ (1992) Lensectomy for complicated cataract in juvenile chronic iridocyclitis. Br J Ophthalmol 76:72–75

    CAS  PubMed  Google Scholar 

  26. Key SN, Kimura SJ (1975) Iridocyclitis associated with juvenile rheumatoid arthritis. Am J Ophthalmol 80:425–429

    PubMed  Google Scholar 

  27. Kilmartin DJ, Forrester JV, Dick AD (1998) Cyclosporin A therapy in refractory non-infectious childhood uveitis. Br J Ophthalmol 82:737–742

    CAS  PubMed  Google Scholar 

  28. Kimura SJ, Hogan MJ, Thygeson P (1954) Uveitis in children. Arch Ophthalmol 51:80–88

    CAS  Google Scholar 

  29. Kimura SJ, Hogan MJ (1964) Uveitis in children: analysis of 264 cases. Trans Am Ophthalmol Soc 62:173–192

    CAS  PubMed  Google Scholar 

  30. Kotaniemi K (1998) Late onset uveitis in juvenile-type chronic polyarthritis controlled with prednisolone, cyclosporin A and methotrexat. Clin Exp Rheumatol 16:469–471

    CAS  PubMed  Google Scholar 

  31. Kotaniemi K, Kaipiainen-Seppanen O, Savolainen A et al. (1999) A population-based study on uveitis in juvenile rheumatoid arthritis. Clin Exp Rheumatol 17:119–122

    CAS  PubMed  Google Scholar 

  32. Kotaniemi K, Kautiainen H, Karma A et al. (2001) Occurrence of uveitis in recently diagnosed juvenile chronic arthritis. A prospective study. Ophthalmology 108:2071–2075

    Article  CAS  PubMed  Google Scholar 

  33. Kotaniemi K, Aho K, Kotaniemi A (2001) Uveitis as a cause of visual loss in arthritis and comparable conditions. J Rheumatol 28:309–312

    CAS  PubMed  Google Scholar 

  34. Lazar M, Weiner MJ, Leopold IH (1969) Treatment of uveitis with methotrexate. Am J Ophthalmol 67:383–387

    CAS  PubMed  Google Scholar 

  35. Mehra R, Moore TL, Catalano D et al. (1981) Chlorambucil in the treatment of iridocyclitis in juvenile rheumatoid arthritis. J Rheumatol 8:141–144

    CAS  PubMed  Google Scholar 

  36. Niehues T, Horneff G, Michels H et al. (2003) Evidenzbasierter Einsatz von Methotrexat bei Kindern mit rheumatischen Erkrankungen. Monatsschr Kinderheilkd 151:881–890

    Article  Google Scholar 

  37. Olson NY, Lindsey CB, Godfrey WA (1988) Nonsteroidal anti-inflammatory drug therapy in chronic childhood iridocyclitis. Am J Dis Child 142:1289–1292

    CAS  PubMed  Google Scholar 

  38. Paivonsalo-Hietanen T, Tuominen J, Saari KM (2000) Uveitis in children: population-based study in Finland. Acta Ophthalmol Scand 78:84–88

    Article  CAS  PubMed  Google Scholar 

  39. Paroli MP, Speranza S, Marino M et al. (2003) Prognosis of juvenile rheumatoid arthritis-associated uveitis. Eur J Ophthalmol 13:616–621

    CAS  PubMed  Google Scholar 

  40. Ramadan A, Nussenblatt R (1997) Cytotoxic agents in ocular inflammation. Ophthalmol Clin North Am 10:377–387

    Google Scholar 

  41. Reiff A, Takei S, Sadeghi S (2001) Etanercept therapy in children with treatment-resistant uveitis. Arthritis Rheum 44:1411–1415

    Article  CAS  PubMed  Google Scholar 

  42. Rosenberg AM, Oen KG (1986) The relationship between ocular and articular disease activity in children with juvenile rheumatoid arthritis and associated uveitis. Arthritis Rheum 29:797–800

    CAS  PubMed  Google Scholar 

  43. Samson CM, Waheed N, Baltatzis S et al. (2001) Methotrexate therapy for chronic noninfectious uveitis. Analysis of a case series of 160 patients. Ophthalmology 108:1134–1139

    Article  CAS  PubMed  Google Scholar 

  44. Sand BB, Krogh E (1991) Topical indomethacin, a prostaglandin inhibitor, in acute anterior uveitis. A controlled clinical trial of non-steroid versus steroid anti-inflammatory treatment. Acta Ophthalmol 69:145–148

    CAS  Google Scholar 

  45. Savolainen HA, Kautianen H, Isomaki H et al. (1997) Azathioprin in patients with juvenile chronic arthritis: a longterm followup study. J Rheumatol 24:2444–2450

    CAS  PubMed  Google Scholar 

  46. Sherry DD, Mellins ED, Wedgewood RJ (1991) Decreasing severity of chronic uveitis in children with pauciarticular arthritis. Am J Dis Child 145:1026–1028

    CAS  PubMed  Google Scholar 

  47. Shetty AK, Zganjar BE, Ellis GS Jr (1999) Low-dose methotrexate in the treatment of severe juvenile rheumatoid arthritis and sarcoid iritis. J Pediatr Ophthalmol Strabismus 36:125–128

    CAS  PubMed  Google Scholar 

  48. Smith JR, Levinson RD, Holland GN (2001) Differential efficacy of tumor necrosis factor inhibition in the management of inflammatory eye disease and associated rheumatic disease. Arthritis Rheum 45:252–257

    Article  CAS  PubMed  Google Scholar 

  49. Spalter HF (1975) The visual prognosis in juvenile rheumatoid arthritis. Trans Am Ophthalmol Soc 73:554–570

    CAS  PubMed  Google Scholar 

  50. Speckmaier M, Findeisen J, Woo P (1989) Low-dose methotrexate in systemic onset juvenile chronic arthritis. Clin Exp Rheumatol 7:647–650

    CAS  PubMed  Google Scholar 

  51. Tugal-Tutkun I, Havrlikova K, Power WJ et al. (1996) Changing patterns in uveitis of childhood. Ophthalmology 103:375–383

    CAS  PubMed  Google Scholar 

  52. Vesterdal E, Sury B (1950) Iridocyclitis and bandshaped corneal opacity in juvenile rheumatoid arthritis. Acta Ophthalmol (Copenh) 28:321–327

    CAS  Google Scholar 

  53. Wallace CA, Bleyer WA, Sherry DD (1989) Toxicity and serum levels of methotrexate in children with juvenile rheumatoid arthritis. Arthritis Rheum 32:677–681

    CAS  PubMed  Google Scholar 

  54. Walton RC, Nussenblatt RB, Whitcup SM (1998) Cyclosporine therapy for severe sight-threatening uveitis in children and adolescents. Ophthalmology 105:2028–2034

    Article  CAS  PubMed  Google Scholar 

  55. Wakefield D, McCluskey P, Penny R (1986) Intravenous pulse methylprednisolone therapy in severe inflammatory eye disease. Arch Ophthalmol 104:847–851

    Google Scholar 

  56. Weiss AH, Wallace CA, Sherry DD (1998) Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis. J Pediatr 133:266–268

    CAS  PubMed  Google Scholar 

  57. Winkler A, Schmeling H, Horneff G (2003) Etanercepttherapie und Uveitis bei der juvenilen idiopathischen Arthritis. Aktuelle Rheumatol 28:277

    Google Scholar 

  58. Wolf MD, Lichter PR, Ragsdale CG (1987) Prognostic factors in the uveitis of juvenile rheumatoid arthritis. Ophthalmology 94:1242–1248

    CAS  PubMed  Google Scholar 

  59. Wong VG (1966) Methotrexate treatment of uveal disease. Am J Med Sci 251:239–241

    CAS  PubMed  Google Scholar 

  60. Young BJ, Cunningham WF, Akingkein T (1982) Double-masked, controlled clinical trial of 5% tolmetin versus 0.5% prednisolone versus 0.9% saline in acute endogenous nongranulomatous anterior uveitis. Br J Ophthalmol 26:389–391

    Google Scholar 

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Authors and Affiliations

  1. Universitätskinderklinik Essen

    U. Neudorf

  2. Augenabteilung am St. Franziskus Hospital, Münster

    A. Heiligenhaus

  3. Universitätskinderklinik, Hufelandstraße 55, 45122, Essen

    U. Neudorf

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  1. U. Neudorf
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  2. A. Heiligenhaus
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Correspondence to U. Neudorf.

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Für die Arthritis und Uveitis im Kindesalter Studiengruppe

Arbeitsgemeinschaft Kinder- und Jugendrheumatologie (AGKJR) G. Dannecker, G. Ganser

Arbeitsgemeinschaft Kinder- und Jugendrheumatologie Nordrhein-Westfalen G. Bürk, S. Fahl, D. Föll, M. Frosch, G. Ganser, S. Kastner, I. Kleine, E. Lainka, E. Lilienthal, K. Mönkemöller, J. Ndagijimana, U. Neudorf, T. Niehues, N. Wagner, R. Wieland

Uveitiszentren M. Becker (Heidelberg), A. Heiligenhaus (Münster), T. Hudde (Essen), U. Pleyer (Berlin), K.-P. Steuhl (Essen), S. Thurau (München), M. Zierhut (Tübingen)

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Neudorf, U., Heiligenhaus, A. Uveitis bei juveniler idiopathischer Arthritis. Monatsschr Kinderheilkd 152, 1240–1249 (2004). https://doi.org/10.1007/s00112-004-1002-4

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