Journal article
2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis
Arthritis & rheumatology (Hoboken, N.J.), Vol.71(6), pp.864-877
06/2019
DOI: 10.1002/art.40885
PMCID: PMC6788287
PMID: 31021511
Abstract
To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA).
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.
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.
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.
Details
- Title: Subtitle
- 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis
- Creators
- Sheila T Angeles-Han - Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OhioSarah Ringold - Seattle Children's Hospital, Seattle, WashingtonTimothy Beukelman - University of Alabama, BirminghamDaniel Lovell - Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OhioCarlos A Cuello - McMaster University, Hamilton, Ontario, CanadaMara L Becker - Children's Mercy Hospital, Kansas City, MissouriRobert A Colbert - National Institutes of Health, Bethesda, MarylandBrian M Feldman - The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CanadaGary N Holland - UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaPolly J Ferguson - University of Iowa Carver College of Medicine, Iowa CityHarry Gewanter - Children's Hospital of Richmond, Virginia Commonwealth University, RichmondJaime Guzman - BC Children's Hospital, Vancouver, British Columbia, CanadaJennifer Horonjeff - Columbia University Medical Center, New York, New YorkPeter A Nigrovic - Brigham & Women's Hospital and Boston Children's Hospital, Boston, MassachusettsMichael J Ombrello - National Institutes of Health, Bethesda, MarylandMurray H Passo - Medical University of South Carolina, CharlestonMatthew L Stoll - University of Alabama, BirminghamC Egla Rabinovich - Duke University, Durham, North CarolinaH Nida Sen - National Eye Institute, National Institutes of Health, Bethesda, MarylandRayfel Schneider - The Hospital for Sick Children, University of Toronto, Toronto, Ontario, CanadaOlha Halyabar - Boston Children's Hospital, Boston, MassachusettsKimberly Hays - Medical University of South Carolina, CharlestonAmit Aakash Shah - American College of Rheumatology, Atlanta, GeorgiaNancy Sullivan - ECRI Institute, Plymouth Meeting, PennsylvaniaAnn Marie Szymanski - National Institutes of Health, Bethesda, MarylandMarat Turgunbaev - American College of Rheumatology, Atlanta, GeorgiaAmy Turner - American College of Rheumatology, Atlanta, GeorgiaJames Reston - ECRI Institute, Plymouth Meeting, Pennsylvania
- Resource Type
- Journal article
- Publication Details
- Arthritis & rheumatology (Hoboken, N.J.), Vol.71(6), pp.864-877
- DOI
- 10.1002/art.40885
- PMID
- 31021511
- PMCID
- PMC6788287
- NLM abbreviation
- Arthritis Rheumatol
- ISSN
- 2326-5191
- eISSN
- 2326-5205
- Publisher
- United States
- Grant note
- AR-041184 / NIH HHS AR-059-703 / NIH HHS AR-041198 / NIH HHS K23 EY021760 / NEI NIH HHS EY-000356-16 / NEI NIH HHS K23-EY-021760 / NEI NIH HHS
- Language
- English
- Date published
- 06/2019
- Academic Unit
- Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Rheumatology, Allergy, and Immunology
- Record Identifier
- 9984070510002771
Metrics
19 Record Views