Certain factors increase the risk of uveitis in JIA, including oligoarticular presentation, antinuclear antibody positivity and being female. Patients younger than 7 are also at higher risk, as well as patients whose diagnosis occurred within the last four years.1
Dr. Rozenblyum explained that guidelines from the ACR and the Canadian Rheumatology Association are similar with respect to uveitis screening in pediatrics. Essentially, patients with more risk factors require more frequent screening, with the recommended frequency varying from every three months to annually depending on the specific risk factors present.2,3
Practitioners can alternatively follow a simplified recommendation on uveitis screening from the Multinational Interdisciplinary Working Group for Uveitis in Childhood, which provides screening frequency recommendations based simply on current patient age and their age at diagnosis.4
If a patient is already being treated for uveitis, screening should be every one to two months while adjusting therapy and every three months if stable on treatment. For patients in remission and off medication, the recommendation is every four months for the first four years, with screening every six to 12 months until age 18.3,4
Guidelines for uveitis screening in patients with JIA after age 18 are not available due to the relative lack of data in this group, noted Dr. Rozenblyum. But she pointed to a 2021 study that followed JIA patients into young adulthood, which showed that some patients first developed uveitis after the age of 18 and greater than four years after their diagnosis even though factors make them relatively lower risk.5
“How long should we screen our patients in the adult world for uveitis? The real answer is that we don’t know,” Dr. Rozenblyum said. “But many continue to have active disease in adulthood, so it’s likely a good idea to keep going.” Every six to 12 months may be a reasonable approach, she added.
For treatment, close collaboration with ophthalmology is key. Prednisolone eye drops are the first-line treatment, adding another conventional synthetic DMARD, such as methotrexate or mycophenolate mofetil, if needed. If still insufficient, anti-tumor necrosis factor (TNF) monoclonal antibodies can used or another biologic for refractory disease, such as tocilizumab, abatacept or rituximab.2
Before considering withdrawing medication, patients should be in remission for two to three years. Dr. Rozenblum shared that recent data also support a slow taper over an abrupt one to reduce the risk of, and time to, flares.6,7
