Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK.
Retinal Treatment and Research Unit, Bristol Eye Hospital, Bristol, UK; Department of Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, UK; Department of Ocular Immunology, National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Surv Ophthalmol. 2016 Mar-Apr;61(2):197-210. doi: 10.1016/j.survophthal.2015.10.005. Epub 2015 Oct 24.
Bilateral chronic anterior uveitis is an extra-articular feature of juvenile idiopathic arthritis. Although figures vary, uveitis occurs in approximately 11%-13% of patients with this disease and is most commonly associated with the female gender, oligoarthritis, and presence of antinuclear antibodies. The disease has an insidious onset and is often asymptomatic. Managing patients with juvenile idiopathic arthritis-associated uveitis remains challenging as the disease may prove to be refractory to traditional treatment regimens. Stepwise immunomodulatory therapy is indicated, with new biologic drugs being used last in cases of refractory uveitis. Small scale studies and practice have provided the evidence to undertake randomized control trials to evaluate the efficacy, safety, and cost-effectiveness of anti-tumor necrosis factor-α therapies, such as infliximab and adalimumab. These have demonstrated promising results, with further data awaited from ongoing trials for adalimumab (as SYCAMORE and ADJUVITE trials). Lower grade evidence is supporting the use of newer biologics such as rituximab, daclizumab, tocilizumab, and abatacept in those cases refractory to anti-tumor necrosis factor-α therapy.
双侧慢性前葡萄膜炎是幼年特发性关节炎的关节外表现。尽管数据有所不同，但大约有 11%-13%的此类疾病患者会发生葡萄膜炎，且该疾病最常与女性、寡关节炎和抗核抗体有关。这种疾病起病隐匿，常无症状。幼年特发性关节炎相关葡萄膜炎的治疗具有挑战性，因为这种疾病可能对传统治疗方案产生抗药性。需要进行逐步的免疫调节治疗，新型生物药物仅在难治性葡萄膜炎病例中使用。小规模的研究和实践为开展评估抗肿瘤坏死因子-α治疗（如英夫利昔单抗和阿达木单抗）的疗效、安全性和成本效益的随机对照试验提供了证据。这些试验结果令人鼓舞，正在进行的阿达木单抗（如 SYCAMORE 和 ADJUVITE 试验）试验还在等待进一步的数据。较低等级的证据支持在抗肿瘤坏死因子-α治疗耐药的情况下使用利妥昔单抗、达珠单抗、托珠单抗和阿巴西普等新型生物制剂。
