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Juvenile idiopathic arthritis-associated uveitis

Key sources
The following summarized guidelines for the evaluation and management of juvenile idiopathic arthritis-associated uveitis are prepared by our editorial team based on guidelines from the Arthritis Foundation (AF/ACR 2019), the German Society of Pediatric Rheumatology (GKJR/BVA/DGRh/DOG 2019), and the Single Hub and Access Point for Pediatric Rheumatology in Europe (SHARE initiative 2018).
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Guidelines

1.Screening and diagnosis

Indications for screening: as per ACR 2019 guidelines, consider obtaining ophthalmic screening every 3 months in pediatric and adolescent patients with JIA at high risk of developing uveitis.
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2.Classification and risk stratification

Severity assessment: insufficient evidence to recommend a validated biomarker to follow the activity of uveitis.
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3.Medical management

General principles: as per DOG 2019 guidelines, initiate treatment in patients with JIA-associated active uveitis.
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More topics in this section

  • Topical corticosteroids

  • DMARDs (conventional DMARDs)

  • DMARDs (biological DMARDs)

  • Systemic corticosteroids

  • NSAIDs

  • Cycloplegics

4.Therapeutic procedures

Ocular corticosteroid injections: consider administering ocular corticosteroid injections as rescue therapy in individual patients with unilateral or bilateral severe active uveitis with prognostic risk factors for impending uveitis-related deterioration of vision (such as hypotony, macular edema, or dense vitreous opacities), after exhaustion of all other treatment options.
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5.Patient education

General counseling: educate pediatric and adolescent patients with spondyloarthritis regarding the warning signs of acute anterior uveitis for the purpose of decreasing the delay in treatment, duration of symptoms, or complications of iritis.
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6.Follow-up and surveillance

Assessment of treatment response: as per ACR 2019 guidelines, obtain ophthalmic monitoring within 1 month after each change of topical corticosteroids in patients with controlled uveitis tapering or discontinuing topical corticosteroids.
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More topics in this section

  • Treatment tapering