Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Visual Sciences Study Centre, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Academic Health Science Centre, Manchester, UK.
Surv Ophthalmol. 2024 Jan-Feb;69(1):103-121. doi: 10.1016/j.survophthal.2023.01.002. Epub 2023 Jan 19.
Noninfectious uveitis (NIU) in children and adolescents is a rare but treatable cause of visual impairment in children. Treatments for pediatric NIU and their side effects, along with the risks of vision loss and the need for long-term disease monitoring, pose significant challenges for young patients and their families. Treatment includes local and systemic approaches and this review will focus on systemic therapies that encompass corticosteroids, conventional synthetic disease-modifying antirheumatic drugs (csDMARD), and biological disease-modifying antirheumatic drugs (bDMARD). Treatment is generally planned in a stepwise approach. Methotrexate is well-established as the preferential csDMARD in pediatric NIU. Adalimumab, an antitumor necrosis factor (TNF) agent, is the only bDMARD formally approved for pediatric NIU and has a good safety and efficacy profile. Biosimilars are gaining increasing visibility in the treatment of pediatric NIU. Other bDMARD with some evidence in literature for the treatment of pediatric NIU include infliximab, tocilizumab, abatacept, rituximab and, more recently, Janus kinase inhibitors. Important aspects of managing children on these systemic therapies include vaccination issues, risk of infection, and psychological distress. Also, strategies need to address regarding primary nonresponse/secondary loss of response to anti-TNF treatment, biological switching, and monitoring regimens for these drugs. Optimal management of pediatric uveitis involves a multidisciplinary team, including specialist pediatric uveitis and rheumatology nurses, pediatric rheumatologists, psychological support, orthoptic and optometry support, and play specialists.
儿童和青少年的非感染性葡萄膜炎（NIU）是儿童视力损害的一种罕见但可治疗的原因。儿科 NIU 的治疗方法及其副作用，以及视力丧失的风险和长期疾病监测的需要，对年轻患者及其家庭构成了重大挑战。治疗包括局部和全身方法，本综述将重点介绍涵盖皮质类固醇、传统合成疾病修饰抗风湿药物（csDMARD）和生物疾病修饰抗风湿药物（bDMARD）的全身治疗方法。治疗通常按逐步的方法进行规划。甲氨蝶呤是儿科 NIU 中首选的 csDMARD，已得到充分证实。阿达木单抗，一种抗肿瘤坏死因子（TNF）药物，是唯一一种正式批准用于儿科 NIU 的 bDMARD，具有良好的安全性和疗效。生物类似药在儿科 NIU 的治疗中越来越受到关注。其他在文献中有治疗儿科 NIU 证据的 bDMARD 包括英夫利昔单抗、托珠单抗、阿巴西普、利妥昔单抗，以及最近的 Janus 激酶抑制剂。管理接受这些全身治疗的儿童的重要方面包括疫苗接种问题、感染风险和心理困扰。此外，还需要制定策略来解决原发性无应答/继发性对 TNF 治疗的无应答、生物转换以及这些药物的监测方案。儿童葡萄膜炎的最佳管理涉及多学科团队，包括专门的儿科葡萄膜炎和风湿病护士、儿科风湿病学家、心理支持、斜视和验光支持以及游戏专家。
