Leinonen Sanna
Tays Eye Centre, Tampere University Hospital, Tampere, Finland.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Acta Ophthalmol. 2023 Jun;101(4):465-468. doi: 10.1111/aos.15299. Epub 2022 Dec 2.
The purpose of this perspective was to shed light on screening of uveitis among Nordic children with juvenile idiopathic arthritis (JIA).
A literature search was conducted to review predictors of JIA-uveitis and previous JIA-uveitis screening recommendations.
Predictors of uveitis in JIA are younger age and positive antinuclear antibody titre at onset of JIA, specific subtypes of JIA (extended and persistent oligoarthritis, rheumatoid factor negative polyarthritis and psoriatic arthritis) and short duration of JIA. Methotrexate and monoclonal tumour necrosis factor (TNF) inhibitor treatment reduce the risk JIA-uveitis.
Children with all of the above risk factors should be screened frequently but if they receive TNF inhibitor or methotrexate therapy, they may be screened less frequently. Children with none of the risk factors do not benefit from long-term screening for uveitis. A guideline for intervals and overall length of screening was prepared considering currently known risk factors for JIA-uveitis, the Nordic population and previous guidelines.
本观点文章的目的是阐明北欧青少年特发性关节炎(JIA)患儿葡萄膜炎的筛查情况。
进行文献检索,以回顾JIA相关葡萄膜炎的预测因素及既往JIA相关葡萄膜炎的筛查建议。
JIA相关葡萄膜炎的预测因素包括发病时年龄较小、抗核抗体滴度呈阳性、JIA的特定亚型(扩展性和持续性少关节炎、类风湿因子阴性多关节炎和银屑病关节炎)以及JIA病程较短。甲氨蝶呤和单克隆肿瘤坏死因子(TNF)抑制剂治疗可降低JIA相关葡萄膜炎的风险。
具有上述所有风险因素的儿童应频繁接受筛查,但如果他们接受TNF抑制剂或甲氨蝶呤治疗,则筛查频率可降低。无任何风险因素的儿童无法从长期葡萄膜炎筛查中获益。考虑到目前已知的JIA相关葡萄膜炎风险因素、北欧人群及既往指南,制定了筛查间隔和总时长的指南。