2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis
Objective To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). Methods Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questio...
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| Veröffentlicht in: | Arthritis care & research (2010) 2019-06, Vol.71 (6), p.703-716 |
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| creator | Angeles‐Han, Sheila T. Ringold, Sarah Beukelman, Timothy Lovell, Daniel Cuello, Carlos A. Becker, Mara L. Colbert, Robert A. Feldman, Brian M. Holland, Gary N. Ferguson, Polly J. Gewanter, Harry Guzman, Jaime Horonjeff, Jennifer Nigrovic, Peter A. Ombrello, Michael J. Passo, Murray H. Stoll, Matthew L. Rabinovich, C. Egla Sen, H. Nida Schneider, Rayfel Halyabar, Olha Hays, Kimberly Shah, Amit Aakash Sullivan, Nancy Szymanski, Ann Marie Turgunbaev, Marat Turner, Amy Reston, James |
| description | Objective
To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA).
Methods
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.
Results
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.
Conclusion
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. |
| doi_str_mv | 10.1002/acr.23871 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6777949</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2230297280</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5091-bcf15465cd494e1e821442f7509555cf3af82366ead99534acbd78e1e1c2cb0d3</originalsourceid><addsrcrecordid>eNp1kd9qFDEUxoMottRe-AIS8Epwu_kz_3IjDEtbKxWhtuBdyCZndlJmkjXJrOyd7-BD-F4-idluXfTC3ORwvh_fOcmH0EtKzighbK50OGO8qekTdMxoSWdFVTZPD3Xx5QidxnhP8uGsabh4jo44JVkuyDH6yQgVuB0hWK0cXvhhgBVg3-GbHqZRJT_41XbehtQHm2zEF35yRiXrHb6crIHBOsCdDzj1gD_rAOCsW73FH72zyYeHWjmDbwOoNIJLO-8P0yZjA-ArY_1apd5qfBjx6_uPNkavrUpg8N0Gds0X6Fmnhginj_cJurs4v128n11_urxatNczXRJBZ0vd5XdVpTaFKIBCw2hRsK7OYlmWuuOqaxivKlBGiJIXSi9N3WSQaqaXxPAT9G7vu56WIxidFw5qkOtgRxW20isr_1Wc7eXKb2RV17UoRDZ4_WgQ_NcJYpL3fgou7ywZ44SJmjUkU2_2lA4-xgDdYQIlcherzLHKh1gz--rvlQ7knxAzMN8D3_KXbv_vJNvFzd7yN2xGsKY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2230297280</pqid></control><display><type>article</type><title>2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Angeles‐Han, Sheila T. ; Ringold, Sarah ; Beukelman, Timothy ; Lovell, Daniel ; Cuello, Carlos A. ; Becker, Mara L. ; Colbert, Robert A. ; Feldman, Brian M. ; Holland, Gary N. ; Ferguson, Polly J. ; Gewanter, Harry ; Guzman, Jaime ; Horonjeff, Jennifer ; Nigrovic, Peter A. ; Ombrello, Michael J. ; Passo, Murray H. ; Stoll, Matthew L. ; Rabinovich, C. Egla ; Sen, H. Nida ; Schneider, Rayfel ; Halyabar, Olha ; Hays, Kimberly ; Shah, Amit Aakash ; Sullivan, Nancy ; Szymanski, Ann Marie ; Turgunbaev, Marat ; Turner, Amy ; Reston, James</creator><creatorcontrib>Angeles‐Han, Sheila T. ; Ringold, Sarah ; Beukelman, Timothy ; Lovell, Daniel ; Cuello, Carlos A. ; Becker, Mara L. ; Colbert, Robert A. ; Feldman, Brian M. ; Holland, Gary N. ; Ferguson, Polly J. ; Gewanter, Harry ; Guzman, Jaime ; Horonjeff, Jennifer ; Nigrovic, Peter A. ; Ombrello, Michael J. ; Passo, Murray H. ; Stoll, Matthew L. ; Rabinovich, C. Egla ; Sen, H. Nida ; Schneider, Rayfel ; Halyabar, Olha ; Hays, Kimberly ; Shah, Amit Aakash ; Sullivan, Nancy ; Szymanski, Ann Marie ; Turgunbaev, Marat ; Turner, Amy ; Reston, James</creatorcontrib><description>Objective
To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA).
Methods
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.
Results
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.
Conclusion
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.</description><identifier>ISSN: 2151-464X</identifier><identifier>EISSN: 2151-4658</identifier><identifier>DOI: 10.1002/acr.23871</identifier><identifier>PMID: 31021540</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Arthritis ; Arthritis, Juvenile - diagnosis ; Arthritis, Juvenile - drug therapy ; Arthritis, Juvenile - epidemiology ; Biological Products - adverse effects ; Biological Products - therapeutic use ; Children ; Consensus ; Glucocorticoids ; Glucocorticoids - adverse effects ; Glucocorticoids - therapeutic use ; Humans ; Immunosuppressive Agents - adverse effects ; Immunosuppressive Agents - therapeutic use ; Infliximab ; Literature reviews ; Methotrexate ; Monoclonal antibodies ; Ophthalmology - standards ; Patients ; Predictive Value of Tests ; Rheumatology ; Rheumatology - standards ; Risk Factors ; Treatment Outcome ; Tumor Necrosis Factor Inhibitors - adverse effects ; Tumor Necrosis Factor Inhibitors - therapeutic use ; Tumor necrosis factor-α ; Uveitis ; Uveitis - diagnosis ; Uveitis - drug therapy ; Uveitis - epidemiology ; Vision</subject><ispartof>Arthritis care & research (2010), 2019-06, Vol.71 (6), p.703-716</ispartof><rights>2019, American College of Rheumatology</rights><rights>2019, American College of Rheumatology.</rights><rights>2019 American College of Rheumatology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5091-bcf15465cd494e1e821442f7509555cf3af82366ead99534acbd78e1e1c2cb0d3</citedby><cites>FETCH-LOGICAL-c5091-bcf15465cd494e1e821442f7509555cf3af82366ead99534acbd78e1e1c2cb0d3</cites><orcidid>0000-0002-9552-6464</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Facr.23871$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Facr.23871$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31021540$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Angeles‐Han, Sheila T.</creatorcontrib><creatorcontrib>Ringold, Sarah</creatorcontrib><creatorcontrib>Beukelman, Timothy</creatorcontrib><creatorcontrib>Lovell, Daniel</creatorcontrib><creatorcontrib>Cuello, Carlos A.</creatorcontrib><creatorcontrib>Becker, Mara L.</creatorcontrib><creatorcontrib>Colbert, Robert A.</creatorcontrib><creatorcontrib>Feldman, Brian M.</creatorcontrib><creatorcontrib>Holland, Gary N.</creatorcontrib><creatorcontrib>Ferguson, Polly J.</creatorcontrib><creatorcontrib>Gewanter, Harry</creatorcontrib><creatorcontrib>Guzman, Jaime</creatorcontrib><creatorcontrib>Horonjeff, Jennifer</creatorcontrib><creatorcontrib>Nigrovic, Peter A.</creatorcontrib><creatorcontrib>Ombrello, Michael J.</creatorcontrib><creatorcontrib>Passo, Murray H.</creatorcontrib><creatorcontrib>Stoll, Matthew L.</creatorcontrib><creatorcontrib>Rabinovich, C. Egla</creatorcontrib><creatorcontrib>Sen, H. Nida</creatorcontrib><creatorcontrib>Schneider, Rayfel</creatorcontrib><creatorcontrib>Halyabar, Olha</creatorcontrib><creatorcontrib>Hays, Kimberly</creatorcontrib><creatorcontrib>Shah, Amit Aakash</creatorcontrib><creatorcontrib>Sullivan, Nancy</creatorcontrib><creatorcontrib>Szymanski, Ann Marie</creatorcontrib><creatorcontrib>Turgunbaev, Marat</creatorcontrib><creatorcontrib>Turner, Amy</creatorcontrib><creatorcontrib>Reston, James</creatorcontrib><title>2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis</title><title>Arthritis care & research (2010)</title><addtitle>Arthritis Care Res (Hoboken)</addtitle><description>Objective
To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA).
Methods
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.
Results
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.
Conclusion
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.</description><subject>Arthritis</subject><subject>Arthritis, Juvenile - diagnosis</subject><subject>Arthritis, Juvenile - drug therapy</subject><subject>Arthritis, Juvenile - epidemiology</subject><subject>Biological Products - adverse effects</subject><subject>Biological Products - therapeutic use</subject><subject>Children</subject><subject>Consensus</subject><subject>Glucocorticoids</subject><subject>Glucocorticoids - adverse effects</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Humans</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Infliximab</subject><subject>Literature reviews</subject><subject>Methotrexate</subject><subject>Monoclonal antibodies</subject><subject>Ophthalmology - standards</subject><subject>Patients</subject><subject>Predictive Value of Tests</subject><subject>Rheumatology</subject><subject>Rheumatology - standards</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><subject>Tumor Necrosis Factor Inhibitors - adverse effects</subject><subject>Tumor Necrosis Factor Inhibitors - therapeutic use</subject><subject>Tumor necrosis factor-α</subject><subject>Uveitis</subject><subject>Uveitis - diagnosis</subject><subject>Uveitis - drug therapy</subject><subject>Uveitis - epidemiology</subject><subject>Vision</subject><issn>2151-464X</issn><issn>2151-4658</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kd9qFDEUxoMottRe-AIS8Epwu_kz_3IjDEtbKxWhtuBdyCZndlJmkjXJrOyd7-BD-F4-idluXfTC3ORwvh_fOcmH0EtKzighbK50OGO8qekTdMxoSWdFVTZPD3Xx5QidxnhP8uGsabh4jo44JVkuyDH6yQgVuB0hWK0cXvhhgBVg3-GbHqZRJT_41XbehtQHm2zEF35yRiXrHb6crIHBOsCdDzj1gD_rAOCsW73FH72zyYeHWjmDbwOoNIJLO-8P0yZjA-ArY_1apd5qfBjx6_uPNkavrUpg8N0Gds0X6Fmnhginj_cJurs4v128n11_urxatNczXRJBZ0vd5XdVpTaFKIBCw2hRsK7OYlmWuuOqaxivKlBGiJIXSi9N3WSQaqaXxPAT9G7vu56WIxidFw5qkOtgRxW20isr_1Wc7eXKb2RV17UoRDZ4_WgQ_NcJYpL3fgou7ywZ44SJmjUkU2_2lA4-xgDdYQIlcherzLHKh1gz--rvlQ7knxAzMN8D3_KXbv_vJNvFzd7yN2xGsKY</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Angeles‐Han, Sheila T.</creator><creator>Ringold, Sarah</creator><creator>Beukelman, Timothy</creator><creator>Lovell, Daniel</creator><creator>Cuello, Carlos A.</creator><creator>Becker, Mara L.</creator><creator>Colbert, Robert A.</creator><creator>Feldman, Brian M.</creator><creator>Holland, Gary N.</creator><creator>Ferguson, Polly J.</creator><creator>Gewanter, Harry</creator><creator>Guzman, Jaime</creator><creator>Horonjeff, Jennifer</creator><creator>Nigrovic, Peter A.</creator><creator>Ombrello, Michael J.</creator><creator>Passo, Murray H.</creator><creator>Stoll, Matthew L.</creator><creator>Rabinovich, C. Egla</creator><creator>Sen, H. Nida</creator><creator>Schneider, Rayfel</creator><creator>Halyabar, Olha</creator><creator>Hays, Kimberly</creator><creator>Shah, Amit Aakash</creator><creator>Sullivan, Nancy</creator><creator>Szymanski, Ann Marie</creator><creator>Turgunbaev, Marat</creator><creator>Turner, Amy</creator><creator>Reston, James</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>NAPCQ</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9552-6464</orcidid></search><sort><creationdate>201906</creationdate><title>2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis</title><author>Angeles‐Han, Sheila T. ; Ringold, Sarah ; Beukelman, Timothy ; Lovell, Daniel ; Cuello, Carlos A. ; Becker, Mara L. ; Colbert, Robert A. ; Feldman, Brian M. ; Holland, Gary N. ; Ferguson, Polly J. ; Gewanter, Harry ; Guzman, Jaime ; Horonjeff, Jennifer ; Nigrovic, Peter A. ; Ombrello, Michael J. ; Passo, Murray H. ; Stoll, Matthew L. ; Rabinovich, C. Egla ; Sen, H. Nida ; Schneider, Rayfel ; Halyabar, Olha ; Hays, Kimberly ; Shah, Amit Aakash ; Sullivan, Nancy ; Szymanski, Ann Marie ; Turgunbaev, Marat ; Turner, Amy ; Reston, James</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5091-bcf15465cd494e1e821442f7509555cf3af82366ead99534acbd78e1e1c2cb0d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Arthritis</topic><topic>Arthritis, Juvenile - diagnosis</topic><topic>Arthritis, Juvenile - drug therapy</topic><topic>Arthritis, Juvenile - epidemiology</topic><topic>Biological Products - adverse effects</topic><topic>Biological Products - therapeutic use</topic><topic>Children</topic><topic>Consensus</topic><topic>Glucocorticoids</topic><topic>Glucocorticoids - adverse effects</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Humans</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Infliximab</topic><topic>Literature reviews</topic><topic>Methotrexate</topic><topic>Monoclonal antibodies</topic><topic>Ophthalmology - standards</topic><topic>Patients</topic><topic>Predictive Value of Tests</topic><topic>Rheumatology</topic><topic>Rheumatology - standards</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><topic>Tumor Necrosis Factor Inhibitors - adverse effects</topic><topic>Tumor Necrosis Factor Inhibitors - therapeutic use</topic><topic>Tumor necrosis factor-α</topic><topic>Uveitis</topic><topic>Uveitis - diagnosis</topic><topic>Uveitis - drug therapy</topic><topic>Uveitis - epidemiology</topic><topic>Vision</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Angeles‐Han, Sheila T.</creatorcontrib><creatorcontrib>Ringold, Sarah</creatorcontrib><creatorcontrib>Beukelman, Timothy</creatorcontrib><creatorcontrib>Lovell, Daniel</creatorcontrib><creatorcontrib>Cuello, Carlos A.</creatorcontrib><creatorcontrib>Becker, Mara L.</creatorcontrib><creatorcontrib>Colbert, Robert A.</creatorcontrib><creatorcontrib>Feldman, Brian M.</creatorcontrib><creatorcontrib>Holland, Gary N.</creatorcontrib><creatorcontrib>Ferguson, Polly J.</creatorcontrib><creatorcontrib>Gewanter, Harry</creatorcontrib><creatorcontrib>Guzman, Jaime</creatorcontrib><creatorcontrib>Horonjeff, Jennifer</creatorcontrib><creatorcontrib>Nigrovic, Peter A.</creatorcontrib><creatorcontrib>Ombrello, Michael J.</creatorcontrib><creatorcontrib>Passo, Murray H.</creatorcontrib><creatorcontrib>Stoll, Matthew L.</creatorcontrib><creatorcontrib>Rabinovich, C. Egla</creatorcontrib><creatorcontrib>Sen, H. Nida</creatorcontrib><creatorcontrib>Schneider, Rayfel</creatorcontrib><creatorcontrib>Halyabar, Olha</creatorcontrib><creatorcontrib>Hays, Kimberly</creatorcontrib><creatorcontrib>Shah, Amit Aakash</creatorcontrib><creatorcontrib>Sullivan, Nancy</creatorcontrib><creatorcontrib>Szymanski, Ann Marie</creatorcontrib><creatorcontrib>Turgunbaev, Marat</creatorcontrib><creatorcontrib>Turner, Amy</creatorcontrib><creatorcontrib>Reston, James</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Arthritis care & research (2010)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Angeles‐Han, Sheila T.</au><au>Ringold, Sarah</au><au>Beukelman, Timothy</au><au>Lovell, Daniel</au><au>Cuello, Carlos A.</au><au>Becker, Mara L.</au><au>Colbert, Robert A.</au><au>Feldman, Brian M.</au><au>Holland, Gary N.</au><au>Ferguson, Polly J.</au><au>Gewanter, Harry</au><au>Guzman, Jaime</au><au>Horonjeff, Jennifer</au><au>Nigrovic, Peter A.</au><au>Ombrello, Michael J.</au><au>Passo, Murray H.</au><au>Stoll, Matthew L.</au><au>Rabinovich, C. Egla</au><au>Sen, H. Nida</au><au>Schneider, Rayfel</au><au>Halyabar, Olha</au><au>Hays, Kimberly</au><au>Shah, Amit Aakash</au><au>Sullivan, Nancy</au><au>Szymanski, Ann Marie</au><au>Turgunbaev, Marat</au><au>Turner, Amy</au><au>Reston, James</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis</atitle><jtitle>Arthritis care & research (2010)</jtitle><addtitle>Arthritis Care Res (Hoboken)</addtitle><date>2019-06</date><risdate>2019</risdate><volume>71</volume><issue>6</issue><spage>703</spage><epage>716</epage><pages>703-716</pages><issn>2151-464X</issn><eissn>2151-4658</eissn><abstract>Objective
To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA).
Methods
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.
Results
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.
Conclusion
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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31021540</pmid><doi>10.1002/acr.23871</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-9552-6464</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2151-464X |
| ispartof | Arthritis care & research (2010), 2019-06, Vol.71 (6), p.703-716 |
| issn | 2151-464X 2151-4658 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6777949 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Arthritis Arthritis, Juvenile - diagnosis Arthritis, Juvenile - drug therapy Arthritis, Juvenile - epidemiology Biological Products - adverse effects Biological Products - therapeutic use Children Consensus Glucocorticoids Glucocorticoids - adverse effects Glucocorticoids - therapeutic use Humans Immunosuppressive Agents - adverse effects Immunosuppressive Agents - therapeutic use Infliximab Literature reviews Methotrexate Monoclonal antibodies Ophthalmology - standards Patients Predictive Value of Tests Rheumatology Rheumatology - standards Risk Factors Treatment Outcome Tumor Necrosis Factor Inhibitors - adverse effects Tumor Necrosis Factor Inhibitors - therapeutic use Tumor necrosis factor-α Uveitis Uveitis - diagnosis Uveitis - drug therapy Uveitis - epidemiology Vision |
| title | 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T15%3A17%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=2019%20American%20College%20of%20Rheumatology/Arthritis%20Foundation%20Guideline%20for%20the%20Screening,%20Monitoring,%20and%20Treatment%20of%20Juvenile%20Idiopathic%20Arthritis%E2%80%93Associated%20Uveitis&rft.jtitle=Arthritis%20care%20&%20research%20(2010)&rft.au=Angeles%E2%80%90Han,%20Sheila%20T.&rft.date=2019-06&rft.volume=71&rft.issue=6&rft.spage=703&rft.epage=716&rft.pages=703-716&rft.issn=2151-464X&rft.eissn=2151-4658&rft_id=info:doi/10.1002/acr.23871&rft_dat=%3Cproquest_pubme%3E2230297280%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2230297280&rft_id=info:pmid/31021540&rfr_iscdi=true |