Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 864-877 |
| Number of pages | 14 |
| Journal | Arthritis and Rheumatology |
| Volume | 71 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2019 |
Fingerprint
All Science Journal Classification (ASJC) codes
- Immunology and Allergy
- Rheumatology
- Immunology
Cite this
}
2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis. / Angeles-Han, Sheila T.; Ringold, Sarah; Beukelman, Timothy; Lovell, Daniel; Cuello, Carlos A.; Becker, Mara L.; Colbert, Robert A.; Feldman, Brian M.; Holland, Gary N.; Ferguson, Polly J.; Gewanter, Harry; Guzman, Jaime; Horonjeff, Jennifer; Nigrovic, Peter A.; Ombrello, Michael J.; Passo, Murray H.; Stoll, Matthew L.; Rabinovich, C. Egla; Sen, H. Nida; Schneider, Rayfel; Halyabar, Olha; Hays, Kimberly; Shah, Amit Aakash; Sullivan, Nancy; Szymanski, Ann Marie; Turgunbaev, Marat; Turner, Amy; Reston, James.
In: Arthritis and Rheumatology, Vol. 71, No. 6, 01.06.2019, p. 864-877.Research output: Contribution to journal › Article
TY - JOUR
T1 - 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis
AU - Angeles-Han, Sheila T.
AU - Ringold, Sarah
AU - Beukelman, Timothy
AU - Lovell, Daniel
AU - Cuello, Carlos A.
AU - Becker, Mara L.
AU - Colbert, Robert A.
AU - Feldman, Brian M.
AU - Holland, Gary N.
AU - Ferguson, Polly J.
AU - Gewanter, Harry
AU - Guzman, Jaime
AU - Horonjeff, Jennifer
AU - Nigrovic, Peter A.
AU - Ombrello, Michael J.
AU - Passo, Murray H.
AU - Stoll, Matthew L.
AU - Rabinovich, C. Egla
AU - Sen, H. Nida
AU - Schneider, Rayfel
AU - Halyabar, Olha
AU - Hays, Kimberly
AU - Shah, Amit Aakash
AU - Sullivan, Nancy
AU - Szymanski, Ann Marie
AU - Turgunbaev, Marat
AU - Turner, Amy
AU - Reston, James
PY - 2019/6/1
Y1 - 2019/6/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85064822235&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85064822235&partnerID=8YFLogxK
U2 - 10.1002/art.40885
DO - 10.1002/art.40885
M3 - Article
VL - 71
SP - 864
EP - 877
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
SN - 2326-5191
IS - 6
ER -