Late onset uveitis in juvenile-type chronic polyarthritis controlled with prednisolone, cyclosporin A and methotrexate.

A female with seronegative polyarthritis since early adulthood developed silent chronic uveitis 15 years after the onset of her arthritis. The patient was antinuclear antibody positive and carried the HLA B27 haplotype. Arthritis was refractory to conventional anti-rheumatic medication and severe uveitis did not respond to either topical corticosteroid treatment or to oral corticosteroid plus cyclosporine. Finally, a combination therapy with oral corticosteroids, cyclosporin A and methotrexate calmed down the sight-threatening uveitis and aggressive polyarthritis within three months. The collaboration of ophthalmologists with rheumatologists is important in treating patients with arthritis and uveitis in order to determine the optimal management strategy early in the disease course.