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The protective role of biological therapy on cataract development in juvenile idiopathic arthritis-associated uveitis patients

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First Author: M.Barišić Kutija CROATIA

Co Author(s):    N. Vukojević   S. Perić                 

Abstract Details

Purpose:

Juvenile idiopathic arthritis is the most common rheumatic disease in childhood, and juvenile idiopathic arthritis-associated uveitis (JIA-U) is its most common and most devastating extraarticular manifestation. Despite advances in management, due to the chronic intraocular inflammation and topical corticosteroid (TCS) use, JIA-U is still one of the leading causes of vision impairment and even blindness in childhood. The most common complication of JIA-U is cataract. The frequency of complications is increasing during time. The aim of this study is to evaluate the association of immunomodulatory treatment (IMT) use with diminishing risk of cataract occurrence during follow-up in JIA-U patients.

Setting:

The research was conducted in University Hospital Centre Zagreb, Eye Clinic, Department of Children Ophthalmology. Patients were examined during routine work in children ophthalmology practice. Respondents were included in the study in the period from January 2011 until January 2018.

Methods:

38 children (69 eyes) aged 2 to 15 years who fulfilled inclusion criteria of having active JIA-U and taking IMT (methotrexate (MTX) or MTX+biologics) and TCS treatment for JIA-U were included. This was a longitudinal observational study with mean follow-up of 4,4 years. Patient disease data (demographics, systemic therapy, TCS dose, anterior chamber (AC) inflammation grade (according to Standard Uveitis Nomenclature (SUN) grade), complications of JIA-U) from all (1205) control examinations were collected. Association of IMT use with cataract occurence and the applied daily TCS dose and AC inflammation rate were analyzed.

Results:

Higher intensity of TCS use (OR 95% CI 1,18 (1,04 – 1,34), p<0.012) and higher AC inflammation rate (OR 95% CI 2,27 (0,98 – 5,29), p<0.05) were independently associated with greater prospects for cataract development. Our study also showed the decreasing trend and statistically significant reduction of TCS dose during IMT use, relative to the initial measurement in the whole period of follow-up (p=0,001). The use of MTX+biologics was independently associated with a lower chance of finding a cataract (OR 95% CI 0,43 (0,23, 0,81), p<0.008), while MTX alone was not (OR 95% CI 1,00 (0,51, 1,96) p<0,995).

Conclusions:

Introduction of biological systemic therapy for JIA-U showed positive impact on reducing intraocular inflammation, corticosteroid-sparing potential, and therefore reduced the risk of JIA-U complications rate. MTX showed similar tendency, but without statistical significance. Our results showed that biologic therapy along with MTX is an effective and useful option for JIA-U patients. We also pointed out that biological therapy had a more favorable effect on the course of JIA-U than MTX and can encourage clinicians to introduce biological therapy earlier, in severe cases and without prior introduction of MTX alone, to save time before the onset of permanent complications.

Financial Disclosure:

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