MONDAY, May 6, 2019 (Pharmacist's Briefing) -- Recommendations have been developed for both uveitis in juvenile idiopathic arthritis (JIA) and JIA manifesting as nonsystematic polyarthritis, sacroiliitis, or enthesitis; the two guidelines were published online April 25 in Arthritis Care & Research.
Sarah Ringold, M.D., from Seattle Children's Hospital, and colleagues developed recommendations for children with JIA manifesting as nonsystematic polyarthritis, sacroiliitis, or enthesitis. Eight strong and 31 conditional recommendations were developed, with very low or low quality of evidence for 90 percent of the recommendations. The recommendations relate to use of nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids, as well as the use of physical and occupational therapy.
Sheila T. Angeles-Han, M.D., from the University of Cincinnati, and colleagues developed recommendations for uveitis in children with JIA. The authors note that due to the risk for uveitis, regular ophthalmic screening is recommended for children with JIA; the frequency of screening should be based on individual risk factors. Due to concerns of vision-threatening complications of uveitis with infrequent monitoring, ophthalmic monitoring recommendations were strong. To achieve control of inflammation, topical glucocorticoids should be used as initial treatment. When systemic treatment is needed for management, methotrexate and adalimumab and infliximab are recommended. To maintain uveitis control in children at continued risk for vision loss, the timely addition of nonbiologic and biologic drugs is recommended.
"Prevention of sight-threatening complications from uveitis is most important," Angeles-Han said in a statement. "It is crucial that children with JIA undergo scheduled ophthalmology screening to detect uveitis early since children are usually asymptomatic."
Several authors from both guidelines disclosed financial ties to the pharmaceutical industry.