Treatment With DMARDS and bDMARDS for Pediatric Uveitis May Preserve Vision

Treatment with disease modifying antirheumatic drugs (DMARDs) and biologic disease modifying antirheumatic drugs (bDMARDs) may be effective for preserving vision among children diagnosed with uveitis, according to results of a longitudinal, population-based cohort study published in Pediatric Rheumatology.

While pediatric uveitis typically presents as asymptomatic, it can progress chronically, leading to damage of ocular structures and vision. Data on the long-term treatment effects of uveitis among children are lacking. Investigators assessed clinical characteristics, treatments, disease activity, and visual outcomes among children with with idiopathic uveitis (idio-U) or juvenile idiopathic arthritis associated uveitis (JIA-U).

Children aged less than 16 years presenting to the hospital with idio-U or JIA-U from January 2008 through December 2017 were included in the study. Visual outcomes were assessed via the Snellen chart, with an acuity of less than 0.3 (6/18) indicating impairment. Level of uveitis activity was classified according to Standardization of Uveitis Nomenclature.

A total of 119 children were included in the final analysis. Among them, 23% had idio-U (37% girls) and 77% had JIA-U (65% girls). The mean age at uveitis occurrence was 10 (SD, 3.4) years in the idio-U group vs 5.5 (SD, 3.3) years in the JIA-U group.

Uveitis was located in the anterior portion of the eye in 74% of patients with idio-U and 99% of those with JIA-U (P <.001). Chronic uveitis was diagnosed in 59% of patients with idio-U and 75% of patients with JIA-U.

The majority of patients in both the idio-U and JIA-U groups used topical corticosteroids at uveitis onset (89% and 100%, respectively). The use of systemic corticosteroids was less common (idio-U, 30%; JIA-U, 27%).

Eighty-five percent of patients with JIA-U were treated with DMARDs compared with 33% of patients with idio-U (P <.001). Similarly, bDMARDs were utilized more frequently in the JIA-U group (55%) vs the idio-U group (15%; P <.001).

According to the Snellen chart, 84% of patients overall had normal bilateral visual acuity (acuity >0.8), while 70% and 92% had best-corrected visual acuity greater than 0.8 and 0.5 in their worse eye, respectively. While 5 patients (4%) had visual impairment in one eye, no children had visual impairment in both eyes.

Among the idio-U and JIA-U groups, uveitis activity was 0+ in 81% and 72% of patients, 0.5+ in 19% and 25% of patients, and 1+ in 0% and 3% of patients, respectively.  Of the 3 patients (3%) with uveitis activity of 1+, all were in the JIA-U group and were treated with DMARDs or bDMARDs.

Patients who did not receive systemic treatment showed reduced signs of uveitis activity (100% had no cells). A total of 74% of patients who received systemic treatment showed grade 0+ uveitis activity, while 24% showed grade +0.5 uveitis activity.

This study was limited by its retrospective nature and difficulties assessing uveitis-based visual acuity among children simultaneously going through normal vision development.

Study authors concluded, “Early diagnosis of uveitis and efficient treatment with modern medications including DMARDs and bDMARDs are crucial in preventing visual loss.”