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Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis
  1. Pirjo Tynjälä (pirjo.tynjala{at}hus.fi)
  1. Helsinki University Central Hospital, the Hospital for Children and Adolescents, Finland
    1. Päivi Lindahl (paivi.lindahl{at}hus.fi)
    1. Helsinki University Central Hospital, Department of Ophthalmology, Finland
      1. Visa Honkanen (visa.honkanen{at}hus.fi)
      1. Helsinki University Central Hospital, the Hospital for Children and Adolescents, Finland
        1. Pekka Lahdenne (pekka.lahdenne{at}hus.fi)
        1. Helsinki University Central Hospital, the Hospital for Children and Adolescents, Finland
          1. Kaisu Kotaniemi (kaisu.kotaniemi{at}reuma.fi)
          1. Rheumatism Foundation Hospital, Heinola, Finland

            Abstract

            Objective: Evaluation of the anti-tumor necrosis factor (TNF) therapy on juvenile idiopathic arthritis (JIA)-associated uveitis.

            Methods: Twenty-four patients with uveitis were on etanercept and twenty-one on infliximab. The end- point ophthalmologic evaluation was at 24 months or at the termination of the first biological agent. The ocular inflammatory activity was graded based on the number of anterior chamber cells.

            Results: Of the 45 patients, uveitis improved in 14 (31%), no change was observed in 14 (31%), and in 17 (38%) the activity of uveitis increased. Inflammatory activity improved more frequently (p=0.047) in the patients on infliximab than on etanercept. The number of uveitis flares/year was higher (p=0.015) in the patients on etanercept (mean 1.4, range 0-3.2) compared to infliximab (mean 0.7, range 0-2.0). Uveitis developed for the first time while on anti-TNF therapy in five patients – four on etanercept (2.2 /100 patient-years) and one on infliximab (1.1 /100 patient-years).

            Conclusions: During anti-TNF therapy, the ophthalmologic condition improved in one-third of the patients with uveitis. In chronic anterior uveitis, associated with refractory JIA, infliximab may be more effective than etanercept.

            • biological agents
            • juvenile idiopathic arhtritis
            • outcome assessment
            • uveitis

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