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Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative
  1. Tamas Constantin1,
  2. Ivan Foeldvari2,
  3. Jordi Anton3,
  4. Joke de Boer4,
  5. Severine Czitrom-Guillaume5,
  6. Clive Edelsten6,
  7. Raz Gepstein7,
  8. Arnd Heiligenhaus8,9,
  9. Clarissa A Pilkington10,
  10. Gabriele Simonini11,
  11. Yosef Uziel12,
  12. Sebastian J Vastert13,
  13. Nico M Wulffraat13,
  14. Anne-Mieke Haasnoot4,
  15. Karoline Walscheid8,
  16. Annamária Pálinkás1,
  17. Reshma Pattani6,
  18. Zoltán Györgyi1,
  19. Richárd Kozma1,
  20. Victor Boom14,
  21. Andrea Ponyi1,
  22. Angelo Ravelli15,
  23. Athimalaipet V Ramanan16
  1. 1 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
  2. 2 Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
  3. 3 Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
  4. 4 Department of Ophthalmology, University Hospital Utrecht, Utrecht, The Netherlands
  5. 5 Service de médecine des adolescents, CHU Bicêtre, AP-HP, 78, rue du Général-Leclerc, Paris, France
  6. 6 Department of Ophthalmology, Great Ormond Street Hospital, London, UK
  7. 7 Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel
  8. 8 Department of Ophthalmology, Uveitis-Center, and Ophtha Lab, at St. Franziskus Hospital, Muenster, Germany
  9. 9 University of Duisburg-Essen, Duisburg, Germany
  10. 10 Department of Rheumatology, Great Ormond Street Hospital, London, UK
  11. 11 Department of Paediatrics, Rheumatology Unit, Anna Meyer Children’s Hospital, University of Florence, Florence, Italy
  12. 12 Department of Paediatrics, Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
  13. 13 Department of Pediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
  14. 14 Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
  15. 15 Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
  16. 16 University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
  1. Correspondence to Prof Athimalaipet V Ramanan, University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol BS8 1TH, UK; avramanan{at}


Background In 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is possibly its most devastating extra-articular manifestation. Evidence-based guidelines are sparse and management is mostly based on physicians’ experience. Consequently, treatment practices differ widely, within and between nations.

Objectives To provide recommendations for the diagnosis and treatment of JIA-associated uveitis.

Methods Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of nine experienced paediatric rheumatologists and three experts in ophthalmology from Europe. Recommendations derived from a validated systematic literature review were evaluated by an Expert Committee and subsequently discussed at two consensus meetings using nominal group techniques. Recommendations were accepted if >80% agreement was reached (including all three ophthalmologists).

Results In total, 22 recommendations were accepted (with >80% agreement among experts): 3 on diagnosis, 5 on disease activity measurements, 12 on treatment and 2 on future recommendations.

Conclusions The SHARE initiative aims to identify best practices for treatment of patients suffering from JIA-associated uveitis. Within this remit, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated by an evidence-informed consensus process to suggest a standard of care for JIA-associated uveitis patients throughout Europe.

  • juvenile idiopathic arthritis
  • Tnf-alpha
  • methotrexate

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  • Handling editor Josef S Smolen

  • Contributors AVR is senior author. NMW and SJV designed the SHARE initiative. AP, VB, A-MH, ZG and RK performed the systematic literature review, supervised by SJV, JdB and NMW. Validity assessment of selected papers was done by TC, IF, JA, JdB, SC-G, CE, RG, AH, CAP, GS, YU, NMW, KW and SJV. Recommendations were formulated by TC, GS, YU, RG and JdB. Provisional recommendations were reviewed by a panel of three experts (IF, NMW and JdB). The expert committee consisted of IF, JA, JdB, SC-G, CE, RG, AH, CAP, GS, YU, SJV and NW; they completed the online surveys and/or participated in the subsequent consensus meeting. AR assisted in the preparation of the live consensus meeting and facilitated the consensus procedure using nominal group technique. TC and AVR wrote the manuscript, with contribution and approval of all coauthors.

  • Funding Literature search in the preparation of the manuscript was supported by an unrestricted grant from Abbvie. Prof Ramanan is Co-Chief Investigator of APTITUDE Study funded by Arthritis Research UK (Grant Ref 20659).

  • Competing interests AH: research grants from BMBF, Pfizer and Novartis and honoraria from AbbVie, Alimera Sciences, Allergan, MSD Sharp and Dohme, Pfizer, Santen, and Xoma. JdB: lectures and advisory board sponsored by AbbVie. SC-G: Pfizer, occasional consulting and registration fees to EULAR/PReS congress and Novartis, registration fees for PReS. IF: advisory board: Abbvie, Novartis, Chugai, Lilly, Medac, Genentech, Bayer. CE: Abbvie: receipt of honoraria and travel expenses. JA has received research grants, speakers bureau or has participated in advisory groups for Abbvie, Pfizer, Roche and BMS. CAP, educational sponsorship from Abbvie. AVR, co-chief investigator of Sycamore Study (funded by NIHR and ARUK). Honoraria/speaker fees from Abbvie, Roche, Lily, UCB and SOBI.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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