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SAT0518 Treatment Pathway of Patients with Juvenile Idiopathic Arthritis (JIA)-Associated Uveitis Requiring Systemic Immunosuppression
  1. S.P.S. Li1,
  2. S. Compeyrot-Lacassagne2,
  3. C. Edelsten2
  1. 1Paediatrics, Paediatric Hospital, Hong Kong, Hong Kong
  2. 2Rheumatology, Great Ormond Street Hospital, London, United Kingdom

Abstract

Background JIA-associated uveitis is an insidious and often asymptomatic complication of JIA. Up to 30% of patients with JIA will develop uveitis depending of their disease's subgroup, the extended oligoarticular JIA being the most often affected group. There is also evidence of an association with positive ANA. More than 50% of patients with JIA-associated uveitis will develop complications including cataract and glaucoma. Although the risk of blindness is low, the risk of functional impairment is much higher. Increasing uveitis activity was associated with increased risk of vision loss. Use of immunosuppressive drugs was associated with reduced risk of vision loss. Control of inflammation and use of immunosuppression may be critical aspects in improving outcome although little evidence is yet available.

Objectives

  1. To identify the proportion of patients with JIA-associated uveitis who discontinued Methotrexate (MTX) due to remission

  2. To identify the proportion of patients with JIA-associated uveitis who require an anti-TNF biologic agent for the management of uveitis

Methods We conducted a retrospective review of the clinical notes of patients diagnosed with JIA-associated uveitis between 1993 and 2009. We excluded the patients who did not require systemic treatment and those with incomplete record. We identified a total of 81 patients.

Results MTX was stopped due to remission in 18 patients (22.2%) but 3 patients were started on an anti-TNF. Therefore, only 15 patients (18.5%) could stop MTX due to remission without using systemic medication. MTX was stopped in 13 patients (16.0%) due to side effect or non-compliance. In that group, six patients were switched to other immunosuppressive drugs including anti-TNF in four patients.

MTX was continued in the remaining 50 patients (61.7%). Biologics and Cyclosporin A were added as in 11 and 4 patients respectively for further disease control. For those on additional Cyclosporin A, 3/4 patients were switched to an anti-TNF later. In the group of patients remaining on MTX, 14/50 patients (28%) required the addition of an anti-TNF for the control of their uveitis. Some of the patients in the MTX group have been on this medication for over 10 years.

In summary, 21/81 patients (25.9%) have been on an anti-TNF agent and 14/21 patients have been receiving a biologic along with MTX.

At the last follow up, 57/81 patients (70.7%) required long term systemic immunosuppression mostly MTX (87.7%). 21 (36.8%) out of the 57 patients were started on anti-TNF either with MTX or alone.

Conclusions Over 2/3 of the patients have to remain on long-term systemic immunosuppression (mostly MTX) for the management of their uveitis. About 1/3 of them require long-term anti-TNF therapy either alone or along with MTX. Although this has led to a better visual functional outcome, it is associated with potential side-effects which need monitoring and an increased cost of management.

Disclosure of Interest None declared

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