Uveitis bei juveniler idiopathischer Arthritis

ZUSAMMENFASSUNG

Darstellung der aktualisierten deutschsprachigen interdisziplinären Leitlinie zur Diagnostik und Therapie der juvenilen idiopathischen Arthritis (JIA)-assoziierten Uveitis. Nach JIA-Erstdiagnose sollten zeitnah regelmäßige augenärztliche Kontrollen erfolgen mit dem Ziel, die Uveitis vor Manifestation irreversibler Folgeschäden zu diagnostizieren. Zur antientzündlichen Therapie finden aktuell Kortikosteroide, konventionell synthetische (cs), biologische (b) und andere Disease-Modifying Antirheumatic Drugs (DMARD) Verwendung. Eine enge Kooperation durch einen mit der JIA-assoziierten Uveitis und ihrer Behandlung erfahrenen Augenarzt und einen Kinder- und Jugendrheumatologen sollte gewährleistet werden. Frühzeitige Diagnose und aktuelle leitliniengerechte Therapie können die Langzeitprognose der JIA-assoziierten Uveitis wesentlich verbessern. Ausgewählte Kasuistiken illustrieren das therapeutische Management bei therapierefraktärem Krankheitsverlauf.

Schlüsselwörter

Juvenile idiopathische Arthritis - Diagnostik - Therapie - Uveitis

Publication History

Article published online:
19 June 2024

• Literatur

• 1 Heiligenhaus A, Niewerth M, Ganser G. et al Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology 2007; 46: 1015-1019
• 2 Kotaniemi K, Kautiainen H, Karma A. et al Occurrence of uveitis in recently diagnosed juvenile chronic arthritis. A prospective study. Ophthalmology 2001; 108: 2071-2075
• 3 Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005; 140: 509-516
• 4 Walscheid K, Glandorf K, Rothaus K. et al Enthesitis-related arthritis: prevalence and complications of associated uveitis in children and adolescents from a population-based nationwide study in Germany. J Rheumatol 2021; 48: 262-269
• 5 De Boer J, Steijaert A, van den Bor R. et al Development of macular edema and impact and visual acuity in uveitis associated with juvenile idiopathic arthritis. Ocul Immunol Inflamm 2015; 23: 67-73
• 6 Böhm MR, Tappeiner C, Breitbach MA. et al Ocular hypotony in patients with juvenile idiopathic arthritis-associated uveitis. Am J Ophthalmol 2017; 173: 45-55
• 7 Thorne JE, Woreta FA, Dunn JP. et al Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology 2010; 117: 1436-1441
• 8 Vitale AT, Graham E, de Boer JH. Juvenile idiopathic arthritis-associated uveitis: clinical features and complications, risk factors for severe course, and visual outcome. Ocul Immunol Inflamm 2013; 21: 478-485
• 9 De Boer J, Wulffraat N, Rothova A. Visual loss in uveitis of childhood. Br J Ophthalmol. 2003; 87: 879-884
• 10 Heiligenhaus A, Klotsche J, Niewerth M. et al Similarities in clinical course and outcome between juvenile idiopathic arthritis (JIA)-associated and ANA-positive idiopathic anterior uveitis: data from a population-based nationwide study in Germany. Arthritis Res Ther 2020; 22: 81
• 11 Kothari S, Foster CS, Pistilli M. et al The risk of intraocular pressure elevation in pediatric non-infectious uveitis. Ophthalmology 2015; 122: 1987-2001
• 12 Tappeiner C, Klotsche J, Schenck S. et al Temporal change in prevalence and complications of uveitis associated with juvenile idiopathic arthritis: data from a cross-sectional analysis of a prospective nationwide study. Clin Exp Rheumatol 2015; 33: 936-944
• 13 Kostik MM, Gaidar EV, Hynnes AY. et al Methotrexate treatment may prevent uveitis onset in patients with juvenile idiopathic arthritis: experiences and subgroup analysis in a cohort with frequent methotrexate use. Clin Exp Rheumatol 2016; 34: 714-718
• 14 Papadopoulou C, Kostik M, Böhm M. et al Methotrexate therapy may prevent the onset of uveitis in juvenile idiopathic arthritis. J Pediatr 2013; 163: 879-884
• 15 Tappeiner C, Schenck S, Niewerth M. et al Impact of antiinflammatory treatment on the onset of uveitis in juvenile idiopathic arthritis: longitudinal analysis from a nationwide pediatric rheumatology database. Arthritis Care Res 2016; 68: 46-54
• 16 Lerman MA, Burnham JM, Chang PY. et al Response of pediatric uveitis to tumor necrosis factor-α inhibitors. J Rheumatol 2013; 40: 1394-1403
• 17 Acharya N, Patel S, Homayounfar G. et al Relapse of juvenile idiopathic arthritis associated uveitis after discontinuation of immunomodulatory therapy. Ocul Immunol Inflamm 2019; 27: 686-692
• 18 Lerman MA, Lewen MD, Kempen JH, Mills MD. Uveitis reactivation in children treated with tumor necrosis factor alpha inhibitors. Am J Ophthalmol 2015; 160: 193-200
• 19 Horton S, Jones AP, Guly CM. et al Adalimumab in juvenile idiopathic arthritis-associated uveitis: 5-year follow-up of the Bristol participants of the SYCAMORE trial. Am J Ophthalmol 2019; 207: 170-179
• 20 Ramanan AV, Dick AD, Jones AP. et al Adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis. N Engl J Med 2017; 376: 1637-1646
• 21 Simonini G, Druce K, Cimaz R. et al Current evidence of anti-tumor necrosis factor a treatment efficacy in childhood chronic uveitis: a systemic review and meta-analysis approach of individual drugs. Arthritis Care Res 2014; 66: 1073-1084
• 22 Saurenmann RK, Levin AV, Feldman BM. et al Risk of new-onset uveitis in patients with juvenile idiopathic arthritis treated with anti-TNF alpha agents. J Pediatr 2006; 149: 833-836
• 23 Calvo-Rio V, Santos-Gomez M, Calvo I. et al Anti-IL-6R tocilizumab for severe juvenile idiopathic arthritis-associated uveitis refractory to anti-TNF therapy. A multicenter study of 25 patients. Arthritis Rheumatol 2016; 69: 668-675
• 24 Tappeiner C, Mesquida M, Adan A. et al Evidence for tocilizumab as a treatment option in refractory uveitis associated with juvenile idiopathic arthritis. J Rheumatol 2016; 43: 2183-2188
• 25 Ramanan AV, Dick AD, Guly C. et al Tocilizumab in patients with anti-TNF refractory juvenile idiopathic arthritis-associated uveitis (APTITUDE): a multicentre, single-arm, phase 2 trial. Lancet Rheumatol 2020; 02: e135-e141
• 26 Angeles-Han S, Flynn T, Lehman T. Abatacept for refractory juvenile idiopathic arthritis-associated uveitis – a case report. J Rheumatol 2008; 35: 1897-1898
• 27 Tappeiner C, Miserocchi E, Bodaghi B. et al Abatacept in the treatment of severe, longstanding and refractory uveitis associated with juvenile idiopathic arthritis. J Rheumatol 2015; 42: 706-711
• 28 Ruperto N, Brunner HI, Synoverska O. et al Tofacitinib in juvenile idiopathic arthritis: a double-blind, placebo-controlled, withdrawal phase 3 randomised trial. Lancet 2021; 398: 1984-1996
• 29 Bauermann P, Heiligenhaus A, Heinz C. Effect of janus kinase inhibitor treatment on anterior uveitis and associated macular edema in an adult patient with juvenile idiopathic arthritis. Ocular Immunol Inflamm 2019; 27: 1232-1234
• 30 Miserocchi E, Giuffre C, Cornalba M. et al JAK inhibitors in refractory juvenile idiopathic arthritis-associated uveitis. Clin Rheumatol 2020; 39: 847-851
• 31 Baquet-Walscheid K, Heinz C, Rath T. et al Beneficial effect of upadacitinib in an adult patient with juvenile idiopathic arthritis-associated uveitis after unsatisfactory response to tofacitinib: a case report. Ocul Immunol Inflamm 2023; 31: 1079-1080
• 32 Ramanan AV, Guly CM, Keller SY. et al Clinical effectiveness and safety of baricitinib for the treatment of juvenile idiopathic arthritis-associated uveitis or chronic anterior antinuclear antibody-positive uveitis: study protocol for an open-label, adalimumab active-controlled phase 3 clinical trial (JUVE-BRIGHT). Trials 2021; 22: 689
• 33 Heiligenhaus A, Miserocchi E, Heinz C. et al Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology 2011; 50: 1390-1394
• 34 Miserocchi E, Pontikaki I, Modorati G. et al Rituximab for uveitis. Ophthalmology 2011; 118: 223-224
• 35 Miserocchi E, Modorati G, Berchicci L. et al Long-term treatment with rituximab in severe juvenile idiopathic arthritis-associated uveitis. Br J Ophthalmol 2016; 100: 782-786
• 36 Baquet-Walscheid K, Wildschütz L, Kasper M. et al Assessment of angiogenesis-related parameters in juvenile idiopathic arthritis-associated uveitis. Mol Biol Rep 2022; 49: 6093-6102
• 37 Ayuso VK, van de Winkel EL, Rothova A. et al Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis. Am J Ophthalmol 2011; 151: 217-222