[Uveitis associated with juvenile idiopathic arthritis : Optimization of immunomodulatory therapy]

Ophthalmologe. 2016 May;113(5):391-7. doi: 10.1007/s00347-016-0262-4.
[Article in German]

Abstract

Background: Uveitis associated with juvenile idiopathic arthritis (JIA-associated uveitis) is a vision-threatening disorder with a high complication rate. Besides early diagnosis within screening programs an adequate therapy is essential for improvement of the long-term prognosis. Corticosteroid therapy is often insufficient. In addition to conventional immunosuppression, immunomodulatory drugs, so-called biologicals, are novel highly effective treatment modalities.

Objective: A systematic search of the literature was carried out for biologicals currently used in the treatment of JIA-associated uveitis.

Material and methods: Review of current publications, summary of treatment guidelines and discussion of treatment options for therapy refractive patients.

Results: In accordance with the current recommendations tumor necrosis factor (TNF) inhibitors are administered if uveitis inactivity cannot be achieved with topical corticosteroids and in the next stage with immunosuppressants (methotrexate preferred). According to the currently available data adalimumab is then preferred. When the effectiveness of TNF inhibitors ceases during long-term administration and/or recurrences, other biological response modifiers are attractive treatment options (e. g. lymphocyte inhibitors or specific receptor antagonists).

Conclusion: The TNF inhibitors are of major importance for the treatment of JIA-associated uveitis. Prospective studies and registries would be desirable in order to be able to compare the value of TNF inhibitors and other biologicals and for optimization of treatment recommendations.

Keywords: Biologicals; Complications; Immunosuppressants; TNF inhibitors; Visual acuity.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Anti-Inflammatory Agents / administration & dosage
  • Antibodies, Monoclonal / administration & dosage*
  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / drug therapy*
  • Autoimmune Diseases / immunology
  • Evidence-Based Medicine
  • Humans
  • Immunologic Factors / administration & dosage*
  • Immunomodulation
  • Immunosuppressive Agents / administration & dosage
  • Molecular Targeted Therapy / methods
  • Treatment Outcome
  • Uveitis / diagnosis
  • Uveitis / drug therapy*
  • Uveitis / immunology

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Immunologic Factors
  • Immunosuppressive Agents