Pediatric Rheumatology, Centre de Référence des Maladies Auto-Inflammatoires, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University Hospital, Le Kremlin-Bicêtre, France.
Pediatric Rheumatology, Centre de Référence des Maladies Auto-Inflammatoires, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University Hospital, Le Kremlin-Bicêtre, France.
J Pediatr. 2017 Jul;186:131-137.e1. doi: 10.1016/j.jpeds.2017.03.052. Epub 2017 Apr 27.
To evaluate treatment, ocular complications and outcomes of children with pediatric uveitis not associated with juvenile idiopathic arthritis.
This was a retrospective chart review of pediatric uveitis in children under 16 years of age, recruited from the pediatric rheumatology department at Bicêtre Hospital from 2005 to 2015. Patients with juvenile idiopathic arthritis-associated and infectious uveitis were excluded. We used the Standardization of Uveitis Nomenclature Working Group to classify uveitis, disease activity, and treatment end points.
We enrolled 56 patients and 102 affected eyes. The mean age at diagnosis was 10 ± 3.5 years (range 3-15), and the mean follow-up 4.2 ± 3.3 years (1-15). The main diagnoses were idiopathic (55%), Behçet disease (15%), and sarcoidosis (5%). The main localization was panuveitis in 44 of 102 eyes (43%). Corticosteroid sparing treatment was needed in 62 of 102 eyes (60%). Second-line therapies included methotrexate and azathioprine, and the third-line therapy was a biologic agent, mainly infliximab, in 33 of 102 eyes (32%). Infliximab achieved uveitis inactivity in 14 of 18 eyes (80%), in all etiologies. Severe complications were present in 68 of 102 eyes (67%). The most common were synechiae 33% of eyes, cataract (20%), and macular edema (25%). Of these, 37% were present at diagnosis. Remission was achieved in 22 of 102 eyes (21%).
Conventional therapies were insufficient to treat many of the cases of posterior or panuveitis. This study underlines the need for earlier and more aggressive treatment and antitumor necrosis factor-α therapy was rapidly efficient in most cases of refractory uveitis.
评估与幼年特发性关节炎无关的儿童葡萄膜炎的治疗、眼部并发症和结局。
这是一项回顾性图表研究，纳入了 2005 年至 2015 年期间从比塞特医院儿科风湿病科招募的 16 岁以下儿童的小儿葡萄膜炎患者。排除了与幼年特发性关节炎相关和感染性葡萄膜炎的患者。我们使用葡萄膜炎命名标准工作组对葡萄膜炎、疾病活动度和治疗终点进行分类。
我们纳入了 56 名患者和 102 只受累眼。诊断时的平均年龄为 10 ± 3.5 岁（范围 3-15 岁），平均随访时间为 4.2 ± 3.3 年（1-15 年）。主要诊断为特发性（55%）、贝切特病（15%）和结节病（5%）。102 只眼中 44 只（43%）主要为全葡萄膜炎。102 只眼中 62 只（60%）需要皮质类固醇保留治疗。二线治疗包括甲氨蝶呤和硫唑嘌呤，三线治疗是生物制剂，主要是英夫利昔单抗，在 102 只眼中的 33 只（32%）。英夫利昔单抗使 18 只眼中的 14 只（80%），所有病因的葡萄膜炎均处于无活动状态。102 只眼中有 68 只（67%）出现严重并发症。最常见的是虹膜粘连（33%）、白内障（20%）和黄斑水肿（25%）。其中 37%在诊断时存在。102 只眼中有 22 只（21%）达到缓解。
常规治疗不足以治疗许多后部或全葡萄膜炎病例。本研究强调需要更早、更积极的治疗，肿瘤坏死因子-α 治疗在大多数难治性葡萄膜炎病例中迅速有效。
