Premium
2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis
Author(s) -
AngelesHan Sheila T.,
Ringold Sarah,
Beukelman Timothy,
Lovell Daniel,
Cuello Carlos A.,
Becker Mara L.,
Colbert Robert A.,
Feldman Brian M.,
Holland Gary N.,
Ferguson Polly J.,
Gewanter Harry,
Guzman Jaime,
Horonjeff Jennifer,
Nigrovic Peter A.,
Ombrello Michael J.,
Passo Murray H.,
Stoll Matthew L.,
Rabinovich C. Egla,
Sen H. Nida,
Schneider Rayfel,
Halyabar Olha,
Hays Kimberly,
Shah Amit Aakash,
Sullivan Nancy,
Szymanski Ann Marie,
Turgunbaev Marat,
Turner Amy,
Reston James
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23871
Subject(s) - medicine , uveitis , guideline , infliximab , adalimumab , arthritis , rheumatology , intensive care medicine , physical therapy , rheumatoid arthritis , immunology , pathology , tumor necrosis factor alpha
Objective To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis ( JIA ). Methods Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. Results Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision‐threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. Conclusion This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.