Canadian Rheumatology Association Recommendations for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis

Roberta Berard; Hon Yan Ng; Andrea Human; David Piskin; Muhammed Dhalla; Chloe Gottlieb; Michelle Batthish; Gaëlle Chédeville; Christina Forest; Eric Fortin; Jane Gardiner; Kerstin Gerhold; Andre Jastrzebski; Bianca Lang; Paivi M H Miettunen; Sabrina Morgenstern; Marie-Paule Morin; Alan Rosenberg; Dax G Rumsey; Carlos E Solarte; Nasrin Tehrani; Karen Watanabe Duffy; Jordi Pardo Pardo; Glen S Hazlewood; Deborah M Levy

doi:10.3899/jrheum.220261

Canadian Rheumatology Association Recommendations for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis

J Rheumatol. 2023 Mar;50(3):390-399. doi: 10.3899/jrheum.220261. Epub 2022 Oct 15.

Authors

Roberta Berard¹, Hon Yan Ng², Andrea Human³, David Piskin⁴, Muhammed Dhalla⁵, Chloe Gottlieb⁶, Michelle Batthish⁷, Gaëlle Chédeville⁸, Christina Forest⁹, Eric Fortin¹⁰, Jane Gardiner¹¹, Kerstin Gerhold¹², Andre Jastrzebski¹³, Bianca Lang¹⁴, Paivi M H Miettunen¹⁵, Sabrina Morgenstern¹⁶, Marie-Paule Morin¹⁷, Alan Rosenberg¹⁸, Dax G Rumsey¹⁹, Carlos E Solarte²⁰, Nasrin Tehrani²¹, Karen Watanabe Duffy²², Jordi Pardo Pardo²³, Glen S Hazlewood²⁴, Deborah M Levy²⁵

Affiliations

¹ R. Berard, MD, MSc, Division of Rheumatology, and Department of Pediatrics, Western University, London, Ontario; roberta.berard@lhsc.on.ca.
² H.Y. Ng, MD, Division of Pediatric Rheumatology, and Department of Pediatrics, University of Alberta, Edmonton, Alberta.
³ A. Human, MD, MSc, Division of Rheumatology, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia.
⁴ D. Piskin, MSc, Lawson Health Research Institute, London, Ontario.
⁵ M. Dhalla, MD, Division of Pediatric Rheumatology, and Department of Pediatrics, University of Calgary, Calgary, Alberta.
⁶ C. Gottlieb, MD, University of Ottawa Eye Institute and Department of Ophthalmology, Faculty of Medicine, University of Ottawa, and The Ottawa Hospital Research Institute, Ottawa, Ontario.
⁷ M. Batthish, MD, MSc, Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario.
⁸ G. Chédeville, MD, Division of Rheumatology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec.
⁹ C. Forest, BSc, Caregiver Champion, Montreal, Quebec.
¹⁰ E. Fortin, MD, Department of Ophthalmology, University of Montreal, Montreal, Quebec.
¹¹ J. Gardiner, MD, Department of Ophthalmology and Vision Science, University of British Columbia, Vancouver, British Columbia.
¹² K. Gerhold, MD, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada, and Mississippi Center for Advanced Medicine, Madison, Mississippi, USA.
¹³ A. Jastrzebski, MD, Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba.
¹⁴ B. Lang, MD, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia.
¹⁵ P.M.H. Miettunen, MD, Division of Rheumatology, University of Calgary and Alberta Children's Hospital, Calgary, Alberta.
¹⁶ S. Morgenstern, BA, BEd, Caregiver Champion, Saskatoon, Saskatchewan.
¹⁷ M.P. Morin, MD, PhD, Division of Immunology and Rheumatology, Department of Pediatrics, University of Montreal, Montreal, Quebec.
¹⁸ A. Rosenberg, MD, Division of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan.
¹⁹ D.G. Rumsey, MD, MSc, Department of Pediatrics, University of Alberta, Edmonton, Alberta.
²⁰ C.E. Solarte, MD, Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta.
²¹ N. Tehrani, MD, Division of Ophthalmology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario.
²² K.W. Duffy, MD, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario.
²³ J. Pardo Pardo, MSc, Cochrane Musculoskeletal, Faculty of Medicine, University of Ottawa, Ottawa, Ontario.
²⁴ G.S. Hazlewood, MD, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
²⁵ D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

PMID: 36243417
DOI: 10.3899/jrheum.220261

Abstract

Objective: To develop Canadian recommendations for the screening, monitoring, and treatment of uveitis associated with juvenile idiopathic arthritis (JIA).

Methods: Recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach. A working group of 14 pediatric rheumatologists, 6 ophthalmologists, 2 methodologists, and 3 caregiver/patient representatives reviewed recent American College of Rheumatology (ACR)/Arthritis Foundation (AF) recommendations and worked in pairs to develop evidence-to-decision (EtD) tables. A survey to assess agreement and recommendations requiring group discussion was completed. EtD tables were presented, discussed, and voted upon at a virtual meeting, to produce the final recommendations. A health equity framework was applied to all aspects of the adolopment process including the EtD tables, survey responses, and virtual meeting discussion.

Results: The survey identified that 7 of the 19 recommendations required rigorous discussion. Seventy-five percent of working group members attended the virtual meeting to discuss controversial topics as they pertained to the Canadian environment, including timing to first eye exam, frequency of screening, escalation criteria for systemic and biologic therapy, and the role of nonbiologic therapies. Equity issues related to access to care and advanced therapeutics across Canadian provinces and territories were highlighted. Following the virtual meeting, 5 recommendations were adapted, 2 recommendations were removed, and 1 was developed de novo.

Conclusion: Recommendations for JIA-associated uveitis were adapted to the Canadian context by a working group of pediatric rheumatologists, ophthalmologists with expertise in the management of uveitis, and parent/patient input, taking into consideration cost, equity, and access.

Keywords: GRADE-ADOLOPMENT; chronic anterior uveitis; evidence-to-decision framework; guidelines; juvenile idiopathic arthritis.

MeSH terms

Arthritis, Juvenile* / diagnosis
Canada
Child
Humans
Rheumatology*
Uveitis* / complications