Uveitis: Know the Risk Factors, Symptoms & Treatment Options

Adolescent and adult patients are likely to be more verbal in describing eye pain or vision issues than young children, Dr. O’Neil says. However, although these symptoms can help all rheumatologists suspect uveitis, she cautions that the most severe and damaging forms of uveitis are typically asymptomatic.

“This [reason] is why screening is so important, particularly when patients exhibit risk factors,” she says. The most common test to identify uveitis risk in JIA is an ANA test. Dr. O’Neil recommends pediatric patients with JIA be screened with regular slit lamp examinations according to established screening guidelines to stay vigilant for the earliest signs of uveitis.³

Treatment Approaches
The current uveitis treatment options include steroid drops, but often require long-term disease-modifying anti-rheumatic drug (DMARD) therapy, such as methotrexate or other systemic medicines. Monoclonal anti-TNF antibodies, abatacept  and tocilizumab in small series have demonstrated efficacy in treating uveitis, Dr. O’Neil says.^4,5 She also describes preliminary evidence that the rate of JIA-associated uveitis may be lower for the early treatment of JIA with methotrexate and/or TNF inhibitor.⁶

Even for patients without JIA, she says ophthalmologists are learning that certain systemic immunosuppressive therapies used to treat rheumatic diseases may be effective for controlling idiopathic uveitis. For patients with inflammatory diseases who present with uveitis, she says research is shedding new light on the best treatments, as well as the psycho-social challenges pediatric patients experience.^7,8

Carina Stanton is a freelance science journalist in Denver.

References

1. Giannini EH, Malagon CN, Van Kerckhove C, et al. Longitudinal analysis of HLA associated risks for iridocyclitis in juvenile rheumatoid arthritis. J Rheumatol. 1991;18(9):1394–1397.
2. Melin-Aldana H, Giannini EH, Taylor J, et al. Human leukocyte antigen-DRB1*1104 in the chronic iridocyclitis of pauciarticular juvenile rheumatoid arthritis. J Pediatr. 1992;121(1):56–60.
3. British Society for Paediatric and Adolescent Rheumatology, Royal College of Ophthalmologists. Guidelines for screening for Uveitis in Juvenile idiopathic arthritis. 2006.
4. Suhler EB. Abatacept treatment of uveitis (NCT01279954). ClinicalTrials.gov. 2018 Aug.
5. Hardwick B. Tocilizumab in anti-TNF refractory patients with JIA associated uveitis (ISRCTN95363507). ISRCTN registry. 2015 Jun.
6. Foeldvari I, Becker I, Horneff G. Uveitis events during adalimumab, etanercept, and methotrexate therapy in juvenile idiopathic arthritis: Data from the biologics in pediatric rheumatology registry. Arthritis Care Res (Hoboken). 2015 Nov;67(11):1529–1535.
7. Angeles-Han ST, Lo MS, Henderson LA, et al. Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for juvenile idiopathic arthritis-associated and idiopathic chronic anterior uveitis. Arthritis Care Res. 2018 May 28. doi: 10.1002/acr.23610.
8. Parker DM, Angeles-Han ST, Stanton AL, et al. Chronic anterior uveitis in children: Psychosocial challenges for patients and their families. Am J Ophthalmol. 2018 Jul;191:xvi–xxiv.