L | S | Agreement (%) | References | |
9. Active uveitis in JIA usually requires immediate treatment. | 2B | B | 100 | 69 71 78–80 |
10. Topical corticosteroids (preferably prednisolone acetate or dexamethasone) are the first-line treatment of anterior uveitis. | 4 | D | 100 | 81 |
11. Topical and systemic NSAIDs have no demonstrable effect as monotherapy, but may be used as additional therapy. | 3 | C | 92 | 79 81 82 |
12. Systemic immunosuppression in active uveitis is recommended if poor prognostic factors are present at the first visit. Poor prognostic factors including lack of remission later on during the disease course require systemic immunosuppression. | 2A | 100 | 4 19 22 29 55 56 65 78 83 84 | |
13. Systemic immunosuppression is recommended if inactivity could not be reached within 3 months or inflammation is reactivating during steroid dose reduction. | 2B | B | 100 | 55 59 68 69 78 80 85–87 |
14. Methotrexate is the first choice as systemic immunosuppression. | 4 | D | 100 | 68 84 88–95 |
15. In case of methotrexate inefficacy or intolerance, adding or switching to biological treatment is recommended. | 3 | C | 92 | 91–104 |
16. The use of anti-TNF treatment strategies (adalimumab>infliximab>golimumab) is recommended in patients with uveitis refractory/resistant to DMARD therapy, principally methotrexate. | 3 | C | 100 | 86 100 101 104–117 120–124 126 127 |
17. Based on the current evidence, etanercept should not be considered for JIA-associated uveitis. | 1B | A | 100 | 87 100 109 117–121 |
18. Switching between different anti-TNF treatments might be valuable if uveitis is refractory to the first anti-TNF, even though the present evidence comes from small case series or inception cohorts. | 3 | C | 100 | 87 113 116 122 |
19. In case of lack of efficacy, consider testing for antidrug antibodies and drug trough level. If the patient has no antibodies but has low trough levels, consider increasing the dose or shortening the interval. | 4 | D | 100 | |
20. Tocilizumab, rituximab and abatacept might be potential options for cases refractory to previous anti-TNF therapy. | 3 | C | 100 | 123–125 |
Agreement indicates the % of experts that agreed on the recommendation during the final voting round of the consensus meeting.
1A, meta-analysis of cohort studies; 1B, meta-analysis of case–control studies; 2A, controlled study without randomisation; 2B, quasi-experimental study; 3, descriptive study; 4, expert opinion; A, based on level 1 evidence; B, based on level 2 or extrapolated from level 1; C, based on level 3 or extrapolated from level 1 or 2; D, based on level 4 or extrapolated from level 3 or 4 expert opinion.; DMARD, disease-modifying antirheumatic drugs; L, level of evidence; NSAIDs, non-steroidal anti-inflammatory drugs; S, strength of evidence; TNF, tumour necrosis factor.