Treating juvenile idiopathic arthritis (JIA)-related uveitis beyond TNF-α inhibition: a narrative review

Chronic anterior uveitis is the most frequent among extra-articular manifestations of juvenile idiopathic arthritis (JIA) and a relevant cause of ocular morbidity in children. Asymmetric arthritis, early onset disease, female sex, and anti-nuclear antibody (ANA) positivity are counted among risk fac...

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Bibliographic Details
Published in:Clinical rheumatology 2020-02, Vol.39 (2), p.327-337
Main Authors: Gaggiano, Carla, Rigante, Donato, Tosi, Gian Marco, Vitale, Antonio, Frediani, Bruno, Grosso, Salvatore, Fabiani, Claudia, Cantarini, Luca
Format: Article
Language:English
Subjects:
Abatacept - therapeutic use
Antibodies, Monoclonal, Humanized - therapeutic use
Arthritis
Arthritis, Juvenile - complications
Biological Therapy
Humans
Medicine
Medicine & Public Health
Monoclonal antibodies
Morbidity
Patients
Remission
Review Article
Rheumatology
Risk factors
Rituximab
Rituximab - therapeutic use
Treatment Failure
Tumor Necrosis Factor Inhibitors - therapeutic use
Tumor necrosis factor-TNF
Tumor necrosis factor-α
Uveitis
Uveitis, Anterior - drug therapy
Uveitis, Anterior - etiology
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Summary:Chronic anterior uveitis is the most frequent among extra-articular manifestations of juvenile idiopathic arthritis (JIA) and a relevant cause of ocular morbidity in children. Asymmetric arthritis, early onset disease, female sex, and anti-nuclear antibody (ANA) positivity are counted among risk factors for developing this complication. It usually has insidious onset and asymptomatic chronic-relapsing course, but the persistence of low-grade chronic inflammation can lead to irreversible structural ocular damage and to vision-threatening complications. For such reasons, achieving a complete absence of inflammation through early targeted and aggressive treatments is a primary therapeutic goal in these patients. This review is aimed at summarizing scientific evidence about biologic rescue therapy of JIA-related uveitis in patients who fail to achieve clinical remission, in spite of being treated with conventional disease-modifying anti-rheumatic drugs (cDMARDs) and at least one biologic tumor necrosis factor (TNF)-α inhibitor. Interleukin (IL)-6 inhibition appears a promising and safe option for refractory JIA-related uveitis. Abatacept and rituximab proved to be beneficial as well, but their efficacy together with some safety concerns needs to be more extensively evaluated.
ISSN:0770-3198
1434-9949
DOI:10.1007/s10067-019-04763-3