Background Uveitis is the inflammation of the uvea by definition, but for a rather long time the term “uveitis” was used to identify inflammation in any part of the eye (retinitis, chorioretinitis, scleritis, episcleritis). According to some authors one of the most common causes of uveitis in childhood is Juvenile Idiopathic Arthritis (JIA). Patients with JIA associated uveitis are usually asymptomatic at early stages. In 20–30% of cases uveitis may occur a few years before joint manifestation. As the result of those two factors we often see the delay in the treatment or not adequate treatment. Early and aggressive treatment of JIA associated uveitis can help better control inflammation and can help to eliminate inflammation before development of irreversible ophthalmic pathology.
Objectives The goal of the study was to evaluate the efficacy of two anti-TNF-alpha biological agents: Adalimumab (ADA, humanized monoclonal anti-TNF-alpha antibody) and Infliximab (INF, chimeric monoclonal antibody that binds both circulating and membrane-bound TNF-alpha receptors) in the treatment of uveitis, associated with Juvenile idiopathic Arthritis (JIA). The incidence of eye involvement in JIA can be as high as 10–20%.
Methods Thirty-seven children with aggressive forms of JIA with uveitis who failed immunosuppressive agents were enrolled in the study. The age of the patients at the beginning of anti-TNF-alpha treatment ranged from 5 to 17 years. All patients were divided into two groups: one group received ADA (40 mg sc every 2 weeks), and the other group was received INF (iv 5–6 mg/kg at week 0–2-6 and after every 8 weeks). Duration of treatment was 3–48 months. The efficacy of treatment was assessed by reduction of flare-ups, reduction of topical and systemic steroids, immunosuppressive drugs and reduction of activity of uveitis.
Results In ADA group the remission was observed in 61% of cases, reduction of number of flare-ups was in 18% and in 14% we saw worsening of the disease due to discontinuation of non-biological drug. In INF group remission was in 78% and in 22% of the cases no improvement. The remission of uveitis was achieved in 0.5 - 4 months from the starting of ADA. Topical steroids was tapered within 1.5–3 months and none of the patient required regional injections of steroids. Therapy with ADA permitted to cease non-biological immunosuppressive agents, especially in children who received simultaneously 2 non-biological agents.
Conclusions Our experience in ADA treatment of uveitis shows good result in control of uveitis independent from the severity of the disease and despite it was used as a first-, second- or third-line agent among the biologics. The speed of remission in patients with JIA associated uveitis treated with ADA and INF depends on the severity of uveitis, the time between the beginning of the disease and administration of immunosuppressive therapy. This study needs to be continued to enroll more patients and to increase the follow-up time to evaluate the long-term efficacy and safety of anti-TNF-alpha agents in JIA associated uveitis.
Disclosure of Interest None declared
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