Taiwan ocular inflammation society consensus recommendations for the management of juvenile idiopathic arthritis-associated uveitis

Wei-Dar Chen; Cheng-Hsiu Wu; Po-Yi Wu; Chang-Ping Lin; Liang-Shiou Ou; De-Kuang Hwang; Shwu-Jiuan Sheu; Wei-Yu Chiang; Yo-Chen Chang; Chun-Ju Lin; Wei-Chun Chan; Yueh-Fu Fang; Jerry Chien-Chieh Huang; Tzu-En Kao; Fang-Yi Chiu; Ning-Yi Hsia; Yih-Shiou Hwang

doi:10.1016/j.jfma.2024.02.010

Taiwan ocular inflammation society consensus recommendations for the management of juvenile idiopathic arthritis-associated uveitis

J Formos Med Assoc. 2024 Feb 28:S0929-6646(24)00110-4. doi: 10.1016/j.jfma.2024.02.010. Online ahead of print.

Authors

Wei-Dar Chen¹, Cheng-Hsiu Wu², Po-Yi Wu³, Chang-Ping Lin⁴, Liang-Shiou Ou⁵, De-Kuang Hwang⁶, Shwu-Jiuan Sheu⁷, Wei-Yu Chiang⁸, Yo-Chen Chang⁹, Chun-Ju Lin¹⁰, Wei-Chun Chan¹¹, Yueh-Fu Fang¹², Jerry Chien-Chieh Huang², Tzu-En Kao¹³, Fang-Yi Chiu¹¹, Ning-Yi Hsia¹⁴, Yih-Shiou Hwang¹⁵

Affiliations

¹ Department of Ophthalmology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
² Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
³ Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
⁵ School of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
⁶ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁷ Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁹ School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁰ Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Optometry, Asia University, Taichung, Taiwan.
¹¹ Department of Ophthalmology, MacKay Memorial Hospital, Taipei, Taiwan.
¹² Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
¹³ Cheng-Ching Eye Center, Kaohsiung, Taiwan.
¹⁴ Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan.
¹⁵ School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; Department of Ophthalmology, Xiamen Chang Gung Memorial Hospital, Xiamen, China; Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan. Electronic address: yihshiou.hwang@gmail.com.

PMID: 38423923
DOI: 10.1016/j.jfma.2024.02.010

Abstract

We presented the development of a consensus guideline for managing juvenile idiopathic arthritis-associated uveitis (JIAU) in Taiwan, considering regional differences in manifestation and epidemiology. The Taiwan Ocular Inflammation Society (TOIS) committee formulated this guideline using a modified Delphi approach with two panel meetings. Recommendations were based on a comprehensive evidence-based literature review and expert clinical experiences, and were graded according to the Oxford Centre for Evidence-Based Medicine's "Levels of Evidence" guideline (March 2009). The TOIS consensus guideline consists of 10 recommendations in four categories: screening and diagnosis, treatment, complications, and monitoring, covering a total of 27 items. These recommendations received over 75% agreement from the panelists. Early diagnosis and a coordinated referral system between ophthalmologists and pediatric rheumatologists are crucial to prevent irreversible visual impairment in children with JIAU. However, achieving a balance between disease activity and medication use remains a key challenge in JIAU management, necessitating further clinical studies.

Keywords: Anti-tumor necrosis factor; DMARDs; Juvenile idiopathic arthritis-associated uveitis; Methotrexate; Taiwan.

Publication types

Review