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2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis.

Publication ,  Journal Article
Angeles-Han, ST; Ringold, S; Beukelman, T; Lovell, D; Cuello, CA; Becker, ML; Colbert, RA; Feldman, BM; Holland, GN; Ferguson, PJ; Gewanter, H ...
Published in: Arthritis Rheumatol
June 2019

OBJECTIVE: To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS: Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS: Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION: This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.

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Published In

Arthritis Rheumatol

DOI

EISSN

2326-5205

Publication Date

June 2019

Volume

71

Issue

6

Start / End Page

864 / 877

Location

United States

Related Subject Headings

  • Uveitis
  • Tumor Necrosis Factor Inhibitors
  • Methotrexate
  • Mass Screening
  • Infliximab
  • Humans
  • Glucocorticoids
  • Arthritis, Juvenile
  • Antirheumatic Agents
  • Administration, Ophthalmic
 

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Angeles-Han, S. T., Ringold, S., Beukelman, T., Lovell, D., Cuello, C. A., Becker, M. L., … Reston, J. (2019). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Rheumatol, 71(6), 864–877. https://doi.org/10.1002/art.40885
Angeles-Han, Sheila T., Sarah Ringold, Timothy Beukelman, Daniel Lovell, Carlos A. Cuello, Mara L. Becker, Robert A. Colbert, et al. “2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis.Arthritis Rheumatol 71, no. 6 (June 2019): 864–77. https://doi.org/10.1002/art.40885.
Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Rheumatol. 2019 Jun;71(6):864–77.
Angeles-Han, Sheila T., et al. “2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis.Arthritis Rheumatol, vol. 71, no. 6, June 2019, pp. 864–77. Pubmed, doi:10.1002/art.40885.
Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Holland GN, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Sen HN, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Rheumatol. 2019 Jun;71(6):864–877.
Journal cover image

Published In

Arthritis Rheumatol

DOI

EISSN

2326-5205

Publication Date

June 2019

Volume

71

Issue

6

Start / End Page

864 / 877

Location

United States

Related Subject Headings

  • Uveitis
  • Tumor Necrosis Factor Inhibitors
  • Methotrexate
  • Mass Screening
  • Infliximab
  • Humans
  • Glucocorticoids
  • Arthritis, Juvenile
  • Antirheumatic Agents
  • Administration, Ophthalmic