The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / New Guideline Recommends Frequent Monitoring & Collaboration for JIA-Associated Uveitis Management

New Guideline Recommends Frequent Monitoring & Collaboration for JIA-Associated Uveitis Management

May 8, 2019 • By Kelly Tyrrell

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Strong recommendations are those for which the guideline voting panel was confident the benefits of the action outweigh the risks and would apply to most or all patients.

You Might Also Like
  • Shared Decision Making, Good Disease Control Are Key Components of JIA Management
  • Pediatric Uveitis in the Biologic Age: Risk Factors, Treatment & Outcomes
  • Adalimumab for JIA-Associated Uveitis: 5-Year Follow-up
Explore This Issue
June 2019
Also By This Author
  • CMS Rule Reflects ACR’s Advocacy, but More Patient Protections Needed

Conditional recommendations are those for which the voting panel had less confidence in the risk–benefit assessment due to low quality evidence, with a preference for shared decision making because of known or expected variations in patient values and preferences. All treatment recommendations are conditional, the guideline authors say. For example, in children and adolescents with JIA and active chronic anterior uveitis starting systemic treatment, subcutaneous methotrexate is conditionally preferred over oral. So, too, is starting methotrexate and a monoclonal antibody TNFi immediately in cases of severe active chronic anterior uveitis and sight-threatening complications.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Treatment Tactics
The guideline also includes recommendations for tapering patients off treatment and for escalating treatment even when disease activity is low.

“Allowing disease to smolder at a low level is not good,” says Dr. Holland. “Even if a child is asymptomatic, ultimately, there’s a high risk of vision-limiting complications, like glaucoma or cataracts, so eye disease needs to be aggressively treated to suppress the activity.”

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Dr. Angeles-Han adds, “In general, children with uveitis tend to have a flare in their disease when treatment is tapered too early,” so the team recommends that disease be well controlled for at least two years before initiating taper in JIA-associated uveitis patients, accompanied by frequent monitoring.

She hopes better studies of JIA-associated uveitis will ultimately offer other treatment recommendations and to gain a better sense of the risk factors associated with the development of uveitis and severe disease in JIA patients.

Teamwork & Collaboration
Dr. Angeles-Han, Dr. Ringold and Dr. Holland each believe in the importance of teamwork and collaboration in the management of JIA patients with uveitis. “Patients deserve to be managed in a team approach,” says Dr. Holland. “Rheumatologists are the experts in the drugs and their side effects, but ophthalmologists are the experts in monitoring the effects of drugs on uveitis, so each group should understand what the other is doing.”

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

“I think what’s important—and what we are always going to go back to—is the ophthalmologic exam,” Dr. Angeles-Han says. “That’s where we need to have collaboration and communication between both subspecialists. … We have to all be on same page with screening and monitoring schedules and treatment.”


Kelly April Tyrrell writes about health, science and health policy. She lives in Madison, Wis.

Pages: 1 2 3 4 | Single Page

Filed Under: Conditions, Guidelines, Systemic Inflammatory Syndromes Tagged With: JIA-associated uveitis guideline, juvenile idiopathic arthritis (JIA), UveitisIssue: June 2019

You Might Also Like:
  • Shared Decision Making, Good Disease Control Are Key Components of JIA Management
  • Pediatric Uveitis in the Biologic Age: Risk Factors, Treatment & Outcomes
  • Adalimumab for JIA-Associated Uveitis: 5-Year Follow-up
  • Adalimumab + Methotrexate Effective for Uveitis in JIA

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)