Russian Pediatric OphthalmologyRussian Pediatric OphthalmologyРоссийская педиатрическая офтальмология1993-18592412-432XEco-Vector6251610.17816/rpo2020-15-1-36-44Clinical recommendationsКлинические рекомендацииResearch ArticleNovel algorithm for screening, treating, and monitoring uveitis in children with juvenile idiopathic arthritisСовременный алгоритм скрининга, лечения и мониторинга увеита у детей с ювенильным идиопатическим артритомhttps://orcid.org/0000-0003-3735-6249DenisovaEkaterina V.ДенисоваЕкатерина Валерьевна
Russian Federation

MD, PhD

канд. мед. наук, старший научный сотрудник отдела патологии глаз у детей ФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава России

deale_2006@inbox.ruNikishinaIrina P.НикишинаИрина Петровна
Russian Federation

MD, PhD

канд. мед. наук, заведующая лабораторией ревматических заболеваний детского возраста, ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»

deale_2006@inbox.ruKhrabrovaMaria A.ХраброваМария Алексеевна
Russian Federation

MD

клинический аспирант отдела патологии глаз у детей ФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава России

deale_2006@inbox.ruHelmholtz National Medical Research Center of Eye DiseasesФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава РоссииV.A. Nasonova Research Institute of RheumatologyФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», 115522, Москва1501202015136440203202102032021Copyright ©; 2020, Eco-VectorCopyright ©; 2020, ООО "Эко-Вектор"2020Eco-VectorООО "Эко-Вектор"https://ruspoj.com/1993-1859/article/view/62516

Uveitis is the most common extraarticular manifestation of juvenile idiopathic arthritis (JIA); if not diagnosed and treated in time, it can lead to severe complications and loss of vision. This report describes a novel algorithm for screening, treating, and monitoring uveitis in children with JIA. Ophthalmic screening of children with JIA is based on individual risk factors for uveitis. Treatment strategies include use of local glucocorticoids at the initial stage, followed by non-biological and then biological immunosuppressive drugs in severe or refractory cases. Therapy initiation and discontinuation schemes are detailed, and the need for further research is emphasized.

Увеит является наиболее частым внесуставным проявлением ювенильного идиопатического артрита (ЮИА) и при отсутствии своевременной диагностики или лечения может привести к тяжелым осложнениям и потере зрения. В данной статье представлен современный алгоритм скрининга, лечения и мониторинга увеита у детей с ЮИА. Офтальмологический скрининг детей с ЮИА основан на индивидуальных факторах риска развития увеита. Лечение увеита включает использование на начальном этапе местных глюкокортикоидов и в тяжелых / рефрактерных случаях небиологических и, затем, биологических иммуносупрессивных препаратов. Детализированы схемы назначения и отмены терапии. Подчеркнута необходимость дальнейших исследований по рассматриваемой проблеме.

uveitisjuvenile idiopathic arthritischildrenscreeningmonitoringglucocorticoidsmethotrexateadalimumabgolimumabinfliximabувеитювенильный идиопатический артритдетискринингмониторингглюкокортикоидыметотрексатадалимумабголимумабинфликсимабNikishina IP. Juvenile arthritis. In: Rheumatology: National guidelines. [Revmatologiya: Natsional’noe rukovodstvo]. Moscow: GEOTAR-Media; 2010. (in Russian)Никишина И.П. Ювенильный артрит. В кн.: Ревматология: Национальное руководство. М.: ГЭОТАР-Медиа; 2010.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. Doi: 10.1542/peds.2006-0421.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. Doi: 10.1542/peds.2006-0421.Heiligenhaus A, Niewerth M, Ganser G, et al. 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 (Oxford). 2007;46(6):1015-9. Doi: 10.1093/rheumatology/kem053.Heiligenhaus A., Niewerth M., Ganser G., Heinz C., Minden K. 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 (Oxford). 2007;46(6):1015-9. Doi: 10.1093/rheumatology/kem053.Heiligenhaus A, Michels H, Schumacher C, et al. Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol. Int. 2012;32(5):1121-33. Doi: 10.1007/s00296-011-2126-1.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. Doi: 10.1007/s00296-011-2126-1.Bou R, Adán A, Borrás F, et al. Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus. Rheumatol. Int. 2015;35(5):777-85. Doi: 10.1007/s00296-015-3231-3.Bou R., Adán A., Borrás F., Bravo B., Calvo I., Dе Inocencio J. et al. Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus. Rheumatol. Int. 2015;35(5):777-85. Doi: 10.1007/s00296-015-3231-3.Katargina LA, Brzheskiy VV, Guseva MR, et al. The federal clinical guidelines on “The diagnostics and treatment of uveitis associated with juvenile idiopathic arthritis”. Rossiiskaya pediatricheskaya oftal’mologiya. 2016;11(2):102-11. (in Russian) Doi: 10.18821/1993-1859-2016-11-2-102-111.Катаргина Л.А., Бржеский В.В., Гусева М.Р., Денисова Е.В., Дроздова Е.А., Жукова О.В. Диагностика и лечение увеитов, ассоциированных с ювенильным идиопатическим артритом. Федеральные клинические рекомендации. Российская педиатрическая офтальмология. 2016;11(2):102-11. Doi: 10.18821/1993-1859-2016-11-2-102-111.Constantin T, Foeldvari I, Anton J, et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann. Rheum. Dis. 2018;77(8):1107-17. Doi: 10.1136/annrheumdis-2018-213131.Constantin T., Foeldvari I., Anton J., de Boer J., Czitrom-Guillaume S., Edelsten C. et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann. Rheum. Dis. 2018;77(8):1107-17. Doi: 10.1136/annrheumdis-2018-213131.Heiligenhaus A, Minden K, Tappeiner C, et al. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin. Arthritis Rheum. 2019;49(1):43-55. Doi: 10.1016/j.semarthrit.2018.11.004.Heiligenhaus A., Minden K., Tappeiner C., Baus H., Bertram B., Deuter C. et al. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin. Arthritis Rheum. 2019;49(1):43-55. Doi: 10.1016/j.semarthrit.2018.11.004.Angeles-Han ST, Ringold S, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis-associated uveitis. Arthritis Rheumatol. 2019; 71(6):864-77. Doi: 10.1002/art.40885.Angeles-Han S.T., Ringold S., Beukelman T., Lovell D., Cuello C.A., Becker M.L. et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis-associated uveitis. Arthritis Rheumatol. 2019;71(6):864-77. Doi: 10.1002/art.40885.Angeles-Han ST, McCracken C, Yeh S, et al. HLA associations in a cohort of children with juvenile idiopathic arthritis with and without uveitis. Invest. Ophthalmol. Vis. Sci. 2015; 56(10):6043-8. Doi: 10.1167/iovs.15-17168.Angeles-Han S.T., McCracken C., Yeh S., Jang S.R., Jenkins K., Cope S. et al. HLA associations in a cohort of children with juvenile idiopathic arthritis with and without uveitis. Invest. Ophthalmol. Vis. Sci. 2015;56(10):6043-8. Doi: 10.1167/iovs.15-17168.Haas JP, Truckenbrodt H, Paul C, et al. Subtypes of HLA-DRB1*03, *08, *11, *12, *13 and *14 in early onset pauciarticular juvenile chronic arthritis (EOPA) with and without iridocyclitis. Clin. Exp. Rheumatol. 1994;12(Suppl 10):S7-14.Haas J.P., Truckenbrodt H., Paul C., Hoza J., Scholz S., Albert E.D. Subtypes of HLA-DRB1*03, *08, *11, *12, *13 and *14 in early onset pauciarticular juvenile chronic arthritis (EOPA) with and without iridocyclitis. Clin. Exp. Rheumatol. 1994;12(Suppl 10):S7-14.Zeggini E, Packham J, Donn R, et al. Association of HLA-DRB1*13 with susceptibility to uveitis in juvenile idiopathic arthritis in two independent data sets. Rheumatology. 2006;45:972-4. Doi: 10.1093/rheumatology/kel049.Zeggini E., Packham J., Donn R., Wordsworth P., Hall A., Thomson W. et al. Association of HLA-DRB1*13 with susceptibility to uveitis in juvenile idiopathic arthritis in two independent data sets. Rheumatology. 2006;45:972-4. Doi: 10.1093/rheumatology/kel049.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. Doi: 10.1016/j.ajo.2005.03.057.Jabs D.A., Nussenblatt R.B., Rosenbaum J.T.; 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. Doi: 10.1016/j.ajo.2005.03.057.Nussenblatt RB, Palestine AG, Chan CC, Roberge F. Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology. 1985;92(4):467-71. Doi: 10.1016/s0161-6420(85)34001-0.Nussenblatt R.B., Palestine A.G., Chan C.C., Roberge F. Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology. 1985;92(4):467-71. Doi: 10.1016/s0161-6420(85)34001-0.Foeldvari I, Klotsche J, Simonini G, et al. Proposal for a definition for response to treatment, inactive disease and damage for JIA associated uveitis based on the validation of a uveitis related JIA outcome measures from the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC). Pediatr. Rheumatol. Online J. 2019;17(1):66. Doi: 10.1186/s12969-019-0345-2.Foeldvari I., Klotsche J., Simonini G., Edelsten C., Angeles-Han S.T., Bangsgaard R. et al. Proposal for a definition for response to treatment, inactive disease and damage for JIA associated uveitis based on the validation of a uveitis related JIA outcome measures from the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC). Pediatr. Rheumatol. Online J. 2019;17(1):66. Doi: 10.1186/s12969-019-0345-2.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. Doi: 10.1016/j.ophtha.2009.12.003.Thorne J.E., Woreta F.A., Dunn J.P., Jabs D.A. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology. 2010;117(7):1436-41. Doi: 10.1016/j.ophtha.2009.12.003.Paroli MP, Speranza S, Marino M, et al. Prognosis of juvenile rheumatoid arthritis associated uveitis. Eur. J. Ophthalmol. 2003;13(7):616-21. Doi: 10.1177/112067210301300704.Paroli M.P., Speranza S., Marino M., Pirraglia M.P., Pivetti-Pezzi P. Prognosis of juvenile rheumatoid arthritis associated uveitis. Eur. J. Ophthalmol. 2003;13(7):616-21. Doi: 10.1177/112067210301300704.Yu EN, Meniconi ME, Tufail F, et al. Outcomes of treatment with immunomodulatory therapy in patients with corticosteroid-resistant juvenile idiopathic arthritis-associated chronic iridocyclitis. Ocul. Immunol. Inflamm. 2005;13(5):353-60. Doi: 10.1080/09273940590951061.Yu E.N., Meniconi M.E., Tufail F., Baltatzis S., Foster C.S. Outcomes of treatment with immunomodulatory therapy in patients with corticosteroid-resistant juvenile idiopathic arthritis-associated chronic iridocyclitis. Ocul. Immunol. Inflamm. 2005;13(5):353-60. Doi: 10.1080/09273940590951061.Sijssens KM, Rothova A, Van De Vijver DA, et al. Risk factors for the development of cataract requiring surgery in uveitis associated with juvenile idiopathic arthritis. Am. J. Ophthalmol. 2007;144(4):574-9. Doi: 10.1016/j.ajo.2007.06.030.Sijssens K.M., Rothova A., Van De Vijver D.A., Stilma J.S., De Boer J. H. Risk factors for the development of cataract requiring surgery in uveitis associated with juvenile idiopathic arthritis. Am. J. Ophthalmol. 2007;144(4):574-9. Doi: 10.1016/j.ajo.2007.06.030.Saboo US, Metzinger JL, Radwan A, et al. Risk factors associated with the relapse of uveitis in patients with juvenile idiopathic arthritis: a preliminary report. J. AAPOS. 2013;17(5):460-4. Doi: 10.1016/j.jaapos.2013.06.004.Saboo U.S., Metzinger J.L., Radwan A., Arcinue C., Parikh R., Mohamed A. et al. Risk factors associated with the relapse of uveitis in patients with juvenile idiopathic arthritis: a preliminary report. J. AAPOS. 2013;17(5):460-4. Doi: 10.1016/j.jaapos.2013.06.004.Kotaniemi K, Sihto-Kauppi K, Salomaa P, et al. 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.Kotaniemi K., Sihto-Kauppi K., Salomaa P., Säilä H., Ristolainen L., Kauppiet 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.Tappeiner C, Klotsche J, Schenck S, et al. Temporal change in prevalence and complications of uveitis associated with juvenile idiopathic arthritis:data from a cross-sectional analysis of a prospective nationwide study. Clin. Exp. Rheumatol. 2015;33(6):936-44.Tappeiner C., Klotsche J., Schenck S., Niewerth M., Minden K., Heiligenhaus A. Temporal change in prevalence and complications of uveitis associated with juvenile idiopathic arthritis:data from a cross-sectional analysis of a prospective nationwide study. Clin. Exp. Rheumatol. 2015;33(6):936-44.Kostik MM, Gaidar EV, Hynnes AY, et al. Methotrexate treatment may prevent uveitis onset in patients with juvenile idiopathic arthritis: experiences and subgroup analysis in a cohort with frequent methotrexate use. Clin. Exp. Rheumatol. 2016;34(4):714-8.Kostik M.M., Gaidar E.V., Hynnes A.Y., Dubko M.F., Masalova V.V., Snegireva L.S. et al. Methotrexate treatment may prevent uveitis onset in patients with juvenile idiopathic arthritis: experiences and subgroup analysis in a cohort with frequent methotrexate use. Clin. Exp. Rheumatol. 2016;34(4):714-8.Tappeiner C, Schenck S, Niewerth M, et al. Impact of antiinflammatory treatment on the onset of uveitis in juvenile idiopathic arthritis: longitudinal analysis from a nationwide pediatric rheumatology database. Arthritis Care Res. 2016;68(1):46-54. Doi: 10.1002/acr.22649.Tappeiner C., Schenck S., Niewerth M., Heiligenhaus A., Minden K., Klotsche J. Impact of antiinflammatory treatment on the onset of uveitis in juvenile idiopathic arthritis: longitudinal analysis from a nationwide pediatric rheumatology database. Arthritis Care Res. 2016;68(1):46-54. Doi: 10.1002/acr.22649.Ramanan AV, Dick AD, Jones AP, et al. Adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis. N. Engl. J. Med. 2017;376(17):1637-46. Doi: 10.1056/NEJMoa1614160.Ramanan A.V., Dick A.D., Jones A.P., McKay A., Williamson P.R., Compeyrot-Lacassagne S. et al. Adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis. N. Engl. J. Med. 2017;376(17):1637–46. Doi: 10.1056/NEJMoa1614160.Quartier P, Baptiste A, Despert V, et al. ADJUVITE Study Group. ADJUVITE: a double-blind, randomised, placebo-controlled trial of adalimumab in early onset, chronic, juvenile idiopathic arthritis-associated anterior uveitis. Ann. Rheum. Dis. 2018;77(7):1003-11. Doi: 10.1136/annrheumdis-2017-212089.Quartier P., Baptiste A., Despert V., Allain-Launay E., Koné-Paut I., Belot A. et al. ADJUVITE Study Group. ADJUVITE: a double-blind, randomised, placebo-controlled trial of adalimumab in early onset, chronic, juvenile idiopathic arthritis-associated anterior uveitis. Ann. Rheum. Dis. 2018;77(7):1003-11. Doi: 10.1136/annrheumdis-2017-212089.Correll CK, Bullock DR, Cafferty RM, Vehe RK. Safety of weekly adalimumab in the treatment of juvenile idiopathic arthritis and pediatric chronic uveitis. Clin. Rheumatol. 2018; 37(2):549-53. Doi: 10.1007/s10067-017-3890-4.Correll C.K., Bullock D.R., Cafferty R.M., Vehe R.K. Safety of weekly adalimumab in the treatment of juvenile idiopathic arthritis and pediatric chronic uveitis. Clin. Rheumatol. 2018; 37(2):549-53. Doi: 10.1007/s10067-017-3890-4.Kahn P, Weiss M, Imundo LF, Levy DM. Favorable response to high-dose infliximab for refractory childhood uveitis. Ophthalmology. 2006;113(5):860-4. Doi: 10.1016/j.ophtha.2006.01.005.Kahn P., Weiss M., Imundo L.F., Levy D.M. Favorable response to high-dose infliximab for refractory childhood uveitis. Ophthalmology. 2006;113(5):860-4. Doi: 10.1016/j.ophtha.2006.01.005.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. Doi: 10.1016/j.ajo.2010.08.021.Kalinina Ayuso V., van de Winkel E.L., Rothova A., de Boer J.H. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis. Am. J. Ophthalmol 2011;151(2):217-22. Doi: 10.1016/j.ajo.2010.08.021.Shakoor A, Esterberg E, Acharya NR. Recurrence of uveitis after discontinuation of infliximab. Ocul. Immunol. Inflamm 2014;22(2):96-101. Doi: 10.3109/09273948.2013.812222.Shakoor A., Esterberg E., Acharya N.R. Recurrence of uveitis after discontinuation of infliximab. Ocul. Immunol. Inflamm 2014;22(2):96-101. Doi: 10.3109/09273948.2013.812222.