Juvenile idiopathic arthritis (JIA) is the most common extraocular disease associated with pediatric uveitis. Despite the growing knowledge about the pathogenetic and clinical characteristics of the disease, it still remains a challenge for both the pediatric rheumatologist and ophthalmologist. Since uveitis is asymptomatic in most cases, it is generally detected by parents in a late phase of the disease when complications have occurred with consequent severe vision loss. Improvement in attentive screening and early treatment initiation to suppress inflammation has considerably reduced the sight-threatening outcomes of JIA-associated chronic anterior uveitis (JIA-CAU). Initial treatment with topical steroids is effective in most cases. However, more severe cases require the use of periocular or systemic corticosteroids, possibly leading to long-term complications. These include growth retardation, cataract and glaucoma. Systemic immunosuppressive agents are then employed in patients resistant to first-line therapy or to reduce steroid-associated complications. In this review, we will discuss the immunosuppressant agents currently employed for the treatment of the disease, including anti-tumor necrosis factor (TNF)α biologics approved or not by the regulatory agencies. We will also highlight how new therapeutic options like biologic targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4) co-stimulatory molecule, interleukin-6 receptor (IL-6R) or B lymphocytes might represent exciting new options for patients resistant to conventional therapy. Finally, the potential use of janus kinase (JAK) inhibitors recently approved for the treatment of several inflammatory rheumatic diseases in adults will be also discussed.

Management strategies of juvenile idiopathic arthritis-associated chronic anterior uveitis: current perspectives / Paroli, Maria Pia; Del Giudice, Emanuela; Giovannetti, Francesca; Caccavale, Rosalba; Paroli, Marino. - In: CLINICAL OPHTHALMOLOGY. - ISSN 1177-5483. - 16:(2022), pp. 1665-1673. [10.2147/OPTH.S342717]

Management strategies of juvenile idiopathic arthritis-associated chronic anterior uveitis: current perspectives

Paroli, Maria Pia
Primo
;
Del Giudice, Emanuela
Secondo
;
Giovannetti, Francesca;Caccavale, Rosalba
Penultimo
;
Paroli, Marino
Ultimo
2022

Abstract

Juvenile idiopathic arthritis (JIA) is the most common extraocular disease associated with pediatric uveitis. Despite the growing knowledge about the pathogenetic and clinical characteristics of the disease, it still remains a challenge for both the pediatric rheumatologist and ophthalmologist. Since uveitis is asymptomatic in most cases, it is generally detected by parents in a late phase of the disease when complications have occurred with consequent severe vision loss. Improvement in attentive screening and early treatment initiation to suppress inflammation has considerably reduced the sight-threatening outcomes of JIA-associated chronic anterior uveitis (JIA-CAU). Initial treatment with topical steroids is effective in most cases. However, more severe cases require the use of periocular or systemic corticosteroids, possibly leading to long-term complications. These include growth retardation, cataract and glaucoma. Systemic immunosuppressive agents are then employed in patients resistant to first-line therapy or to reduce steroid-associated complications. In this review, we will discuss the immunosuppressant agents currently employed for the treatment of the disease, including anti-tumor necrosis factor (TNF)α biologics approved or not by the regulatory agencies. We will also highlight how new therapeutic options like biologic targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4) co-stimulatory molecule, interleukin-6 receptor (IL-6R) or B lymphocytes might represent exciting new options for patients resistant to conventional therapy. Finally, the potential use of janus kinase (JAK) inhibitors recently approved for the treatment of several inflammatory rheumatic diseases in adults will be also discussed.
2022
JAK inhibitors; biologics; juvenile idiopathic arthritis; uveitis
01 Pubblicazione su rivista::01g Articolo di rassegna (Review)
Management strategies of juvenile idiopathic arthritis-associated chronic anterior uveitis: current perspectives / Paroli, Maria Pia; Del Giudice, Emanuela; Giovannetti, Francesca; Caccavale, Rosalba; Paroli, Marino. - In: CLINICAL OPHTHALMOLOGY. - ISSN 1177-5483. - 16:(2022), pp. 1665-1673. [10.2147/OPTH.S342717]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1643781
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