Problemi non correnti
L’uveite nell’artrite idiopatica giovanile
UVEITIS ASSOCIATED WITH JUVENILE IDIOPATHIC ARTHRITIS
MARIA ELISABETTA ZANNIN, GIORGIA MARTINI, LUISA PINELLO, FRANCO ZACCHELLO, FRANCESCO ZULIAN
Servizio di Oftalmologia e di Reumatologia, Dipartimento di Pediatria, Universitŕ di Padova
Giugno 2004 - pagg. 383 -388
Abstract
Uveitis is a frequent complication of rheumatic diseases, and represents one of the main causes
of visual loss in the pediatric age. In 80% of the cases anterior uveitis is associated with
juvenile idiopathic arthritis (JIA) and is chronic and asymptomatic, with severe complications
if undiagnosed. The most severe forms can be complicated by synechiae, glaucoma, cataract,
band keratopathy, cystoid macular edema and ultimately loss of vision in a proportion
of patients ranging from 15% to 40%. Early diagnosis and management of intraocular
inflammation can reduce the incidence of complications and improve the visual outcome. The
characterization of early predictors of uveitis is crucial in order to identify, at the onset of JIA,
patients at high risk for developing severe uveitis and who need early initiation of immunosuppressive
treatment. The role of the pediatrician in the early diagnosis of JIA and in its management
through close collaboration with rheumatologists and ophthalmologists is essential
to optimize treatment and improve prognosis.
Parole chiave
Classificazione MeSH
Bibliografia
1. Smiley WK. The eye in juvenile rheumatoid
arthritis. Trans Ophthalmol Soc UK 1974;94:
817-29.
2. Chylack LT Jr. The ocular manifestations in juvenile rheumatoid arthritis. Arthritis Rheum 1977;20:217-23.
3. Cassidy JT, Sullivan DB, Petty RE. Clinical patterns of chronic iridocyclitis in children with juvenile rheumatoid arthritis. Arthritis Rheum 1977;20 Suppl:224-7.
4. Kanski JJ. Uveitis in juvenile chronic arthritis: incidence, clinical features and prognosis. Eye 1988;2:641-5.
5. Cabral DA, Petty RE, Malleson PN, et al. Visual prognosis in children with chronic anterior uveitis and arthritis. J Rheumatol 1994; 21:2370-5.
6. Andersson GB, Fasth A. The natural history of juvenile chronic arthritis: A population based cohort study. 1. Onset and disease proccess. J Rheumatol 1995;22:295-307.
7. Candell Chalom E, Goldsmith DP, Koehler MA, Bittar B, Rose CD, Ostrov BE, Keenan GF. Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. J Rheumatol 1997;24:2031-4.
8. Moe N, Rygg M. Epidemiology of juvenile chronic arthritis in northern Norway: A tenyear retrospective study. Clin Exp Rheumatol 1998;16:99-101.
9. Guillaume S, Prieur AM, Coste J, Job-Deslandre C. Long-term outcome and prognosis in oligoarticular-onset juvenile idiopathic arthritis. Arthritis Rheum 2000;43(8):1858-65.
10. Kotaniemi K, Kautiainen H, Karma A, Aho K. Occurrence of uveitis in recently diagnosed oligoarticular juvenile idiopathic arthritis: a perspective study. Ophthalmology 2001;108: 2071-75.
11. Zulian F. Registry of Rheumatic Diseases in children. Padua, 2002; personal communication.
12. American Academy of Pediatrics Section on Rheumatology and Section on Ophthalmology. Guidelines for ophthalmologic examinations in children with rheumatoid arthritis. Pediatrics 1993;92:295-6.
13. Zulian F, Martini G, Falcini F, Gerloni V, Zannin ME, Pinello L, Fantini F, Facchin P. Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. J Rheumatol 2002;29:2446-53.
14. Chia A, Lee V, Graham EM, Edelsten C. Factors related to severe uveitis at diagnosis in children with juvenile idiopathic arthritis in a screening program. Am J Ophthalmol 2003; 135(6);757-62.
15. Davis JL, Dacanay LM, Holland GN, et al. Laser flare photometry and complications of chronic uveitis in children. Am J Ophthalmol 2003;135:763-71.
16. Wolf MD, Lichter PR, Ragsdale CG. Prognostic factors in the uveitis of juvenile rheumatoid arthritis. Ophthalmology 1987;94(10): 1242-8.
17. Edelsten C, Lee V, Bentley CR, Kansky JJ, Graham EM. An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. Br J Ophthalmol 2002;86:51-6.
18. Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS. Visual outcome prognosticators in juvenile rheumatoid arthritis-associated uveitis. Ophthalmology 1997;104:236-44.
19. Holland GN, Stiehm ER. Special considerations in the evaluation and management of uveitis in children. Am J Ophthalmol 2003; 135(6):867-78.
20. Zannin ME, Campa L, Falcini F, et al. Is there a consensus for activity and severity criteria of uveitis in Juvenile Idiopathic Arthritis (JIA)? Clin Exp Rheumatol 2003;21(4):538.
21. Nguyen QD, Foster CS. Saving the vision of children with juvenile rheumatoid arthritisassociated uveitis. JAMA 1998;280:1133-4.
22. Weiss AH, Wallace CA, Sherry DD. Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis. J Pediatr 1998;133:266-8.
23. Bom S, Zamiri P, Lightman S. Use of methotrexate in the management of sight-threatening uveitis. Ocul Immunol Inflamm 2001;9(1):35-40.
24. Walton RC, Nussenblatt RB, Whitcup SM. Cyclosporine therapy for severe sight-threatening uveitis in children and adolescents. Ophthalmology 1998 Nov;105 (11):2028-34.
25. Gerloni V, Cimaz R, Gattinara M, et al. Efficacy and safety profile of cyclosporin A in the treatment of juvenile chronic (idiopathic) arthritis. Results of a 10-year prospective study. Rheumatology 2001;40(8):907-13.
26. Lovell DJ, Giannini EH, Reiff A, et al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group. N Engl J Med 2000; 342:763-9.
27. Reiff A, Takei S, Sadeghi S, Stout A, Shaham B, Bernstein B, Gallagher K, Stout T. Etanercept therapy in children with treatmentresistant uveitis. Arthritis Rheum 2001; 44:1411-5.
28. Reddy AR, Backhouse OC. Does etanercept induce uveitis? Br J Ophthalmol 2003; 87(7): 925.
29. Reis A, Reinhard T, Sundmacher R, Althaus C, Voiculescu A, Kutkuhn B. Mycophenolatemofetil in ocular immunological disorders. A survey of the literature with 3 case reports. Klin Monatsbl Augenheilkd. 1998;213(5):257-61.
30. Larkin G, Lightman S. Mycophenolate mofetil. A useful immunosuppressive in inflammatory eye disease. Ophthalmology 1999; 106(9):1645.
31. Kilmartin DJ, Fletcher ZJ, Almeida JA, et al. CD69 expression on peripheral CD4+ T cells parallels disease activity and is reduced by mycophenolate mofetil therapy in uveitis. Invest Ophthalmol Vis Sci 2001;42 (6):1285-92.
32. Zierhut M, Stubiger N, Aboalchamat W, et al. Immunosuppressive therapy with mycophenolate mofetil (Cellcept) in treatment of uveitis. Ophthalmology 2001;98 (7):647-51.
33. Greiner K, Varikkara M, Santiago C, Forrester JV. Efficiency of mycophenolate mofetil in the treatment of intermediate and posterior uveitis. Ophthalmology 2002;99(9):691-4.
34. Joseph A, Raj D, Dua HS, et al. Infliximab in the treatment of refractory posterior uveitis. Ophthalmology 2003;110(7):1449-53.
35. Kotaniemi K, Pohjankoski H, Savolainen A. Short-term effect of infliximab on uveitis associated with juvenile idiopathic arthritis. Clin Exp Rheumatol 2003;21(4):542.
2. Chylack LT Jr. The ocular manifestations in juvenile rheumatoid arthritis. Arthritis Rheum 1977;20:217-23.
3. Cassidy JT, Sullivan DB, Petty RE. Clinical patterns of chronic iridocyclitis in children with juvenile rheumatoid arthritis. Arthritis Rheum 1977;20 Suppl:224-7.
4. Kanski JJ. Uveitis in juvenile chronic arthritis: incidence, clinical features and prognosis. Eye 1988;2:641-5.
5. Cabral DA, Petty RE, Malleson PN, et al. Visual prognosis in children with chronic anterior uveitis and arthritis. J Rheumatol 1994; 21:2370-5.
6. Andersson GB, Fasth A. The natural history of juvenile chronic arthritis: A population based cohort study. 1. Onset and disease proccess. J Rheumatol 1995;22:295-307.
7. Candell Chalom E, Goldsmith DP, Koehler MA, Bittar B, Rose CD, Ostrov BE, Keenan GF. Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. J Rheumatol 1997;24:2031-4.
8. Moe N, Rygg M. Epidemiology of juvenile chronic arthritis in northern Norway: A tenyear retrospective study. Clin Exp Rheumatol 1998;16:99-101.
9. Guillaume S, Prieur AM, Coste J, Job-Deslandre C. Long-term outcome and prognosis in oligoarticular-onset juvenile idiopathic arthritis. Arthritis Rheum 2000;43(8):1858-65.
10. Kotaniemi K, Kautiainen H, Karma A, Aho K. Occurrence of uveitis in recently diagnosed oligoarticular juvenile idiopathic arthritis: a perspective study. Ophthalmology 2001;108: 2071-75.
11. Zulian F. Registry of Rheumatic Diseases in children. Padua, 2002; personal communication.
12. American Academy of Pediatrics Section on Rheumatology and Section on Ophthalmology. Guidelines for ophthalmologic examinations in children with rheumatoid arthritis. Pediatrics 1993;92:295-6.
13. Zulian F, Martini G, Falcini F, Gerloni V, Zannin ME, Pinello L, Fantini F, Facchin P. Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. J Rheumatol 2002;29:2446-53.
14. Chia A, Lee V, Graham EM, Edelsten C. Factors related to severe uveitis at diagnosis in children with juvenile idiopathic arthritis in a screening program. Am J Ophthalmol 2003; 135(6);757-62.
15. Davis JL, Dacanay LM, Holland GN, et al. Laser flare photometry and complications of chronic uveitis in children. Am J Ophthalmol 2003;135:763-71.
16. Wolf MD, Lichter PR, Ragsdale CG. Prognostic factors in the uveitis of juvenile rheumatoid arthritis. Ophthalmology 1987;94(10): 1242-8.
17. Edelsten C, Lee V, Bentley CR, Kansky JJ, Graham EM. An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. Br J Ophthalmol 2002;86:51-6.
18. Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS. Visual outcome prognosticators in juvenile rheumatoid arthritis-associated uveitis. Ophthalmology 1997;104:236-44.
19. Holland GN, Stiehm ER. Special considerations in the evaluation and management of uveitis in children. Am J Ophthalmol 2003; 135(6):867-78.
20. Zannin ME, Campa L, Falcini F, et al. Is there a consensus for activity and severity criteria of uveitis in Juvenile Idiopathic Arthritis (JIA)? Clin Exp Rheumatol 2003;21(4):538.
21. Nguyen QD, Foster CS. Saving the vision of children with juvenile rheumatoid arthritisassociated uveitis. JAMA 1998;280:1133-4.
22. Weiss AH, Wallace CA, Sherry DD. Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis. J Pediatr 1998;133:266-8.
23. Bom S, Zamiri P, Lightman S. Use of methotrexate in the management of sight-threatening uveitis. Ocul Immunol Inflamm 2001;9(1):35-40.
24. Walton RC, Nussenblatt RB, Whitcup SM. Cyclosporine therapy for severe sight-threatening uveitis in children and adolescents. Ophthalmology 1998 Nov;105 (11):2028-34.
25. Gerloni V, Cimaz R, Gattinara M, et al. Efficacy and safety profile of cyclosporin A in the treatment of juvenile chronic (idiopathic) arthritis. Results of a 10-year prospective study. Rheumatology 2001;40(8):907-13.
26. Lovell DJ, Giannini EH, Reiff A, et al. Etanercept in children with polyarticular juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group. N Engl J Med 2000; 342:763-9.
27. Reiff A, Takei S, Sadeghi S, Stout A, Shaham B, Bernstein B, Gallagher K, Stout T. Etanercept therapy in children with treatmentresistant uveitis. Arthritis Rheum 2001; 44:1411-5.
28. Reddy AR, Backhouse OC. Does etanercept induce uveitis? Br J Ophthalmol 2003; 87(7): 925.
29. Reis A, Reinhard T, Sundmacher R, Althaus C, Voiculescu A, Kutkuhn B. Mycophenolatemofetil in ocular immunological disorders. A survey of the literature with 3 case reports. Klin Monatsbl Augenheilkd. 1998;213(5):257-61.
30. Larkin G, Lightman S. Mycophenolate mofetil. A useful immunosuppressive in inflammatory eye disease. Ophthalmology 1999; 106(9):1645.
31. Kilmartin DJ, Fletcher ZJ, Almeida JA, et al. CD69 expression on peripheral CD4+ T cells parallels disease activity and is reduced by mycophenolate mofetil therapy in uveitis. Invest Ophthalmol Vis Sci 2001;42 (6):1285-92.
32. Zierhut M, Stubiger N, Aboalchamat W, et al. Immunosuppressive therapy with mycophenolate mofetil (Cellcept) in treatment of uveitis. Ophthalmology 2001;98 (7):647-51.
33. Greiner K, Varikkara M, Santiago C, Forrester JV. Efficiency of mycophenolate mofetil in the treatment of intermediate and posterior uveitis. Ophthalmology 2002;99(9):691-4.
34. Joseph A, Raj D, Dua HS, et al. Infliximab in the treatment of refractory posterior uveitis. Ophthalmology 2003;110(7):1449-53.
35. Kotaniemi K, Pohjankoski H, Savolainen A. Short-term effect of infliximab on uveitis associated with juvenile idiopathic arthritis. Clin Exp Rheumatol 2003;21(4):542.