Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis

Eye (Lond). 2009 May;23(5):1192-8. doi: 10.1038/eye.2008.174. Epub 2008 Jun 13.


Aims: Juvenile idiopathic arthritis (JIA) is often associated with severe chronic anterior uveitis (CAU), and immunosuppressive therapy may be required. In this study, the value of cyclosporine A (CsA) as monotherapy or as combination therapy for treating uveitis was studied in a large cohort of JIA children.

Methods: Multicentre retrospective study including 82 JIA children (girls n=60) suffering from unilateral or bilateral (n=55) CAU. The indication for CsA was active uveitis, although patients were on topical or systemic corticosteroids, MTX, or other immunosuppressive drugs.

Results: Inactivity of uveitis during the entire treatment period (mean 3.9 years) was obtained with CsA monotherapy in 6 of 25 (24%) patients, but more often when CsA was combined with the immunosuppressives (35/72 patients; 48.6%, P=0.037), or MTX (18/37 patients, 48.6%, P=0.065), which had already been given. With CsA (mean dosage 2.9 mg/kg), systemic immunosuppressive drugs and steroids could be reduced by >or=50% (n=19) or topical steroids reduced to <or=2 drops/eye/day (n=40) in selected patients. Pre-existing cystoid macular oedema did not resolve under CsA treatment in any of the patients. In nine patients (11%), CsA was discontinued because of systemic hypertension (n=1), elevated creatinine levels (n=3), or other adverse effects (n=5).

Conclusions: These observations suggest that CsA has limited value as a second-line immunosuppressive drug for the treatment of JIA-associated CAU. The efficacy was better as the combination therapy in patients not responding to other immunosuppressives (eg, MTX) than the systemic monotherapy.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use
  • Arthritis, Juvenile / complications*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cyclosporine / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Methotrexate / therapeutic use
  • Retrospective Studies
  • Uveitis / drug therapy*
  • Uveitis / etiology


  • Adrenal Cortex Hormones
  • Immunosuppressive Agents
  • Cyclosporine
  • Methotrexate