Juvenile idiopathic arthritis-associated uveitis in the era of biological therapy: how the disease changed in more than 20 years of observation in a tertiary referral center in Rome (Italy)

E Del Giudice; C Simio; A Scala; A Di Coste; G La Torre; L Spadea; R Lubrano; M Duse; M P Paroli

doi:10.1007/s10792-021-02043-1

Juvenile idiopathic arthritis-associated uveitis in the era of biological therapy: how the disease changed in more than 20 years of observation in a tertiary referral center in Rome (Italy)

Int Ophthalmol. 2022 Mar;42(3):775-784. doi: 10.1007/s10792-021-02043-1. Epub 2021 Oct 20.

Authors

E Del Giudice¹, C Simio², A Scala², A Di Coste³, G La Torre⁴, L Spadea², R Lubrano¹, M Duse³, M P Paroli⁵

Affiliations

¹ Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Italy.
² Department of Sense Organs, Eye Clinic, Uveitis Unit, Sapienza University of Rome, V.le del Policlinico 155, 00161, Rome, Italy.
³ Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy.
⁴ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
⁵ Department of Sense Organs, Eye Clinic, Uveitis Unit, Sapienza University of Rome, V.le del Policlinico 155, 00161, Rome, Italy. mariapia.paroli@uniroma1.it.

Abstract

Objectives: To describe the ophthalmological characteristics in a Juvenile idiopathic arthritis (JIA) cohort and to evaluate how therapeutic advances have changed the course of the uveitis.

Methods: Analysis of a retrospective cohort study of consecutive JIA pediatric patients including JIA-associated uveitis (JIA-U) and comparison with a previous study in the same uveitis center assessed before the wide-spread of biological therapy.

Results: The total of 49 JIA patients were analyzed, of whom 18 JIA-U, compared with a JIA-U past cohort of 66 patients. Systemic corticosteroids were used significantly less in the current JIA-U group (p = 0.008) than in the past one. JIA-U present cohort was on therapy more frequently with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) than the past group (p = 0.039), mostly treated with methotrexate (93.3%). Furthermore, a larger use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) was described in the current JIA-U group (p = 0.005) also associated with csDMARDs (p = 0.003). Adalimumab was used more (72.7%) in the present JIA-U cohort compared to a larger treatment with infliximab (61.5%) in the past (p = 0.005). Higher number of uveitis recurrences was observed in the previous cohort compared to the current one (p = 0.005). Fewer complications were described in this study than in the previous: posterior synechiae (p = 0.007), cataract (p < 0.001), band keratopathy (p < 0.001), and elevated intraocular pressure (IOP) (p = 0.047).

Conclusion: Current therapies reduced the uveitis recurrences and ocular complications including cataract due also to the lower use of corticosteroids. The new close collaboration with the pediatric rheumatologic center in the same University has contributed to the care improvement and decrease of uveitis complications.

Keywords: Biological therapy; Juvenile idiopathic arthritis; Ocular complications; Uveitis; Visual prognosis.

MeSH terms

Arthritis, Juvenile* / complications
Arthritis, Juvenile* / drug therapy
Biological Therapy / adverse effects
Child
Humans
Italy / epidemiology
Retrospective Studies
Risk Factors
Rome
Tertiary Care Centers
Uveitis* / diagnosis
Uveitis* / drug therapy
Uveitis* / etiology