Monitoring and Treatment of Juvenile Idiopathic Arthritis-associated Uveitis: Brazilian Evidence-based Practice Guidelines

ABSTRACT

Purpose

To present a national guideline for ophthalmologic care and surveillance of juvenile idiopathic arthritis-associated uveitis (JIA-uveitis).

Methods

Review article based on medical literature and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology/Brazilian Council of Ophthalmology and the Brazilian Society of Pediatrics/Brazilian Society of Rheumatology. Studies with a high level of evidence were selected by searching the PubMed/Medline database. The final document was approved by the experts.

Results

The main recommendations are that children/adolescents with JIA should undergo screening according to their risk factors. Ophthalmological checkups should also consider ocular inflammation and therapy. Topical glucocorticoids should be the first line of therapy, with systemic glucocorticoids acting as bridge treatments in severe uveitis. Methotrexate should be the first-line systemic therapy and anti-tumor necrosis factor (anti-TNF alpha) the second for uncontrolled uveitis.

Conclusions

This evidence-based guideline for JIA-uveitis will be useful for both ophthalmology and rheumatology practice.

KEYWORDS:

• Juvenile idiopathic arthritis
• anterior uveitis
• practice guideline
• methotrexate
• tumor necrosis factor-alpha
• childhood

Acknowledgments

Luciana Silva, MD, Ph.D. from the Federal University of Bahia and president of the Brazilian Society of Pediatrics.

Dirceu Solé, MD, Ph.D. from the Federal University of Sao Paulo and Scientific Committee Chief of the Brazilian Society of Pediatrics.

José Roberto Provenza, MD, Ph.D. from the Pontifical Catholic University of Campinas and president of the Brazilian Society of Rheumatology.

Eduardo dos Santos Paiva, MD, Ph.D. from the Federal University of Paraná and Scientific Committee Chief of the Brazilian Society of Rheumatology.

Disclosure of interests

There were no financial support to this sudy and the authors report no conflict of interest.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.