Sousa-Neves Filipe, Braga Joana, Teixeira Sara, Barge Sidnei, Fonseca Sofia, Meira Dália, Rodrigues Lúcia, Varandas Rosário
Centro Hospitalar Vila Nova de Gaia/Espinho.
Acta Reumatol Port. 2019 Apr-Jun;44(2):151-154.
We report a 9-year follow-up of a child with refractory juvenile idiopathic arthritis (JIA) with associated uveitis in which tocilizumab proved to be effective in achieving disease control.
A 16-month child was diagnosed with JIA and at the age of 3 developed bilateral non-granulomatous anterior uveitis. Throughout the follow-up, the patient presented frequent joint and ocular flares. Refractory anterior uveitis and topical corticosteroid therapy resulted in the development of bilateral cataract and high intraocular pressure (IOP). The patient underwent multiple ocular surgeries along with corticosteroids, immunosuppressive therapy with Methotrexate and Adalimumab failing to reach disease control. Only after the introduction of Tocilizumab a lower disease activity was achieved.
Management of JIA-associated uveitis is challenging and requires a close collaboration between paediatric rheumatologists and ophthalmologists. Clinical remission can be difficult to achieve. However, one should always pursuit JIA inactivity with IOP and inflammation control. This report supports Tocilizumab as a useful therapeutic option for JIA-associated uveitis.
我们报告了一名患有难治性幼年特发性关节炎（JIA）并伴有葡萄膜炎的儿童的9年随访情况，其中托珠单抗被证明在实现疾病控制方面是有效的。
一名16个月大的儿童被诊断为JIA，3岁时出现双侧非肉芽肿性前葡萄膜炎。在整个随访过程中，患者频繁出现关节和眼部炎症发作。难治性前葡萄膜炎和局部皮质类固醇治疗导致双侧白内障和高眼压（IOP）。患者接受了多次眼科手术，同时使用皮质类固醇、甲氨蝶呤免疫抑制治疗和阿达木单抗均未能实现疾病控制。仅在引入托珠单抗后，疾病活动度才有所降低。
JIA相关性葡萄膜炎的管理具有挑战性，需要儿科风湿病学家和眼科医生密切合作。临床缓解可能难以实现。然而，应始终追求JIA不活动状态并控制眼压和炎症。本报告支持托珠单抗作为JIA相关性葡萄膜炎的一种有用治疗选择。
