Table 3

Recommendations for treatment in juvenile idiopathic arthritis (JIA)-related uveitis

LSAgreement (%)References
9. Active uveitis in JIA usually requires immediate treatment.2BB100 69 71 78–80
10. Topical corticosteroids (preferably prednisolone acetate or dexamethasone) are the first-line treatment of anterior uveitis.4D100 81
11. Topical and systemic NSAIDs have no demonstrable effect as monotherapy, but may be used as additional therapy.3C92 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.2A100 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.2BB100 55 59 68 69 78 80 85–87
14. Methotrexate is the first choice as systemic immunosuppression.4D100 68 84 88–95
15. In case of methotrexate inefficacy or intolerance, adding or switching to biological treatment is recommended.3C92 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.3C100 86 100 101 104–117 120–124 126 127
17. Based on the current evidence, etanercept should not be considered for JIA-associated uveitis.1BA100 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.3C100 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.4D100
20. Tocilizumab, rituximab and abatacept might be potential options for cases refractory to previous anti-TNF therapy.3C100 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.