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

Sheila T. Angeles-Han, Sarah Ringold, Timothy Beukelman, Daniel Lovell, Carlos A. Cuello, Mara L. Becker, Robert A. Colbert, Brian M. Feldman, Gary N. Holland, Polly J. Ferguson, Harry Gewanter, Jaime Guzman, Jennifer Horonjeff, Peter A. Nigrovic, Michael J. Ombrello, Murray H. Passo, Matthew L. Stoll, C. Egla Rabinovich, H. Nida Sen, Rayfel Schneider & 8 others Olha Halyabar, Kimberly Hays, Amit Aakash Shah, Nancy Sullivan, Ann Marie Szymanski, Marat Turgunbaev, Amy Turner, James Reston

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)864-877
Number of pages14
JournalArthritis and Rheumatology
Volume71
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Uveitis
Arthritis
Guidelines
Juvenile Arthritis
Consensus
Therapeutics
Patient Advocacy
Group Processes
Patient Preference
Expert Testimony
Rheumatology
Ophthalmology
Methotrexate
Glucocorticoids
Decision Making
Tumor Necrosis Factor-alpha
Parents
Monoclonal Antibodies
Pediatrics
Inflammation

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Rheumatology
  • Immunology

Cite this

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. / 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis. In: Arthritis and Rheumatology. 2019 ; Vol. 71, No. 6. pp. 864-877.
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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.",
author = "Angeles-Han, {Sheila T.} and Sarah Ringold and Timothy Beukelman and Daniel Lovell and Cuello, {Carlos A.} and Becker, {Mara L.} and Colbert, {Robert A.} and Feldman, {Brian M.} and Holland, {Gary N.} and Ferguson, {Polly J.} and Harry Gewanter and Jaime Guzman and Jennifer Horonjeff and Nigrovic, {Peter A.} and Ombrello, {Michael J.} and Passo, {Murray H.} and Stoll, {Matthew L.} and Rabinovich, {C. Egla} and Sen, {H. Nida} and Rayfel Schneider and Olha Halyabar and Kimberly Hays and Shah, {Amit Aakash} and Nancy Sullivan and Szymanski, {Ann Marie} and Marat Turgunbaev and Amy Turner and James Reston",
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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, '2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis', Arthritis and Rheumatology, vol. 71, no. 6, pp. 864-877. https://doi.org/10.1002/art.40885

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 journalArticle

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.

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