Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi

Merih ORAY, (İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Göz Hastalıkları Anabilim Dalı, İstanbul, Türkiye)
İlknur TUĞAL TUTKUN (İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Göz Hastalıkları Anabilim Dalı, İstanbul, Türkiye)
Türk Oftalmoloji Dergisi
23 3
Yıl: 2016 Cilt: 46 Sayı: 2 Sayfa Aralığı: 77 - 82 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi

Öz:
Pediatrik yaş grubunda üveit, zamanında ve uygun tedavi edilmez ise körlüğe kadar varan komplikasyonlar ile ciddi bir sağlık problemi olarak karşımıza çıkmaktadır. Juvenil idiyopatik artrit (JİA) ile ilişkili üveit, kronik sinsi seyirli, ciddi oküler komplikasyonlara ve görme kaybına neden olabilen ön üveit ile karakterizedir. JİA tanısı alan hastalarda oküler komplikasyon gelişmeden erken tanı için periyodik göz muayenesi yapılması gerekmektedir. Erken tanı ve uygun immünomodülatuvar tedavi uzun dönemde iyi görsel prognoz açısından çok önemlidir. Tedavide amaç, ilaç kesildikten sonra kalıcı remisyon elde edebilmek için hastaya uygun tedavi yaklaşımını hasta bazında planlayabilmektir. Önemli bir nokta da olası yan etkiler nedeniyle sistemik immünomodülatuvar tedavi almakta olan hastalar yakın takip altında tutulmalıdır. Lokal ve sistemik kortikosteroid ajanlar tedavinin önemli bir bölümünü oluştursa da potansiyel ciddi yan etkileri nedeniyle uzun süreli kullanımdan kaçınılmaktadır. JİA ile ilişkili üveit tedavisinde kortikosteroid dışı uzun süreli tedavi seçenekleri arasında antimetabolitler ve klasik tedaviye dirençli olgularda biyolojik ajanlar bulunmaktadır. İmmünomodülatuvar tedavi içinde birinci tercih çocukluk çağında etkinlik ve güvenilirliği iyi bilinen, uzun vadede kanser riskini arttırmayan bir ajan olan metotreksattır. Azatioprin, mikofenolat mofetil ve siklosporin metotreksata alternatif olabilen veya metotreksat ile kombine kullanılabilen klasik immünomodülatuvar ajanlardır. Antimetabolit veya kombinasyon tedavisine yeterli cevap alınamayan olgularda başta tümör nekroz faktör-alfa inhibitörü infliksimab ve adalimumab olmak üzere farklı biyolojik ajanlar kullanılabilir
Anahtar Kelime:

Konular: Dermatoloji Hematoloji Göz Hastalıkları

Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis

Öz:
Pediatric uveitis may be a serious health problem because of the lifetime burden of vision loss due to severe complications if the problem is not adequately treated. Juvenile idiopathic arthritis (JIA)-associated uveitis is characterized by insidious onset and potentially blinding chronic anterior uveitis. Periodic ophthalmologic screening is of utmost importance for early diagnosis of uveitis. Early diagnosis and proper immunomodulatory treatment are essential for good visual prognosis. The goal of treatment is to achieve enduring drug-free remission. The choice of therapeutic regimen needs to be tailored to each individual case. One must keep in mind that patients under immunomodulatory treatment should be monitored closely due to possible side effects. Local and systemic corticosteroids have long been the mainstay of therapy; however, long-term corticosteroid therapy should be avoided due to serious side effects. Steroid-sparing agents in the treatment of JIA-associated uveitis include antimetabolites and biologic agents in refractory cases. Among the various immunomodulatory agents, methotrexate is generally the first choice, as it has a well-established safety and efficacy profile in pediatric cases and does not appear to increase the risk of cancer. Other classic immunomodulators that may also be used in combination with methotrexate include azathioprine, mycophenolate mofetil, and cyclosporin A. Biologic agents, primarily tumor necrosis factor alpha inhibitors including infliximab or adalimumab, should be considered in cases of treatment failure with classic immunomodulatory agents
Anahtar Kelime:

Konular: Dermatoloji Hematoloji Göz Hastalıkları
Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık
  • Holland GN, Stiehm ER. Special considerations in the evaluation and management of uveitis in children. J Ophthalmology. 2003;135:867-878.
  • Cuningham ET Jr. Uveitis in children. Ocul Immunol Inflamm. 2000;8:251- 261.
  • Heiligenhaus A, Heinz C, Edelsten C, Kotaniemi K, Minden K. Review for disease of the year: epidemiology of juvenile idiopathic arthritis and its associated uveitis: the probable risk factors. Ocul Immunol Inflamm. 2013;21:180-191.
  • Tugal-Tutkun I, Havrlikova K, Power WJ, Foster CS. Changing patterns of uveitis of childhood. Ophthalmology. 1996;103:375-383.
  • Tugal-Tutkun I. Pediatric uveitis. J Ophthalmic Vis Res. 2011;6:259-269.
  • Foster CS. Diagnosis and treatment of juvenile idiopathic arthritis-associated uveitis. Curr Opin Ophthalmol. 2003;14:395-398.
  • Wentworth BA, Freitas-Neto CA, Foster CS. Management of pediatric uveitis. F1000Prime Rep. 2014;6:41.
  • Kadayıfçılar S, Eldem B, Tumer B. Uveitis in childhood. J Pediatr Ophthalmol Strabismus. 2003;40:335-340.
  • Metindoğan S, Akova YA, Güngör SG, Baskın E. Pediatrik üveit olgularında etiyoloji ve klinik özellikler. Turk J Ophthalmol. 2009;39:393-398.
  • Ozdal PC, Sen E, Yazici A, Ozturk F. Patterns of childhood-onset uveitis in a referral center in Turkey. J Ophthal Inflamm Infect. 2012;2:13-19.
  • Soylu M, Özdemir G, Anli A. Pediatric uveitis in Southern Turkey. Ocul Immunol Inflamm. 1997;5:197-202.
  • Kotaniemi K, Savolainen A, Karma A, Aho K. Recent advances in uveitis of juvenile idiopathic arthritis. Surv Ophthalmol. 2003;48:489-502.
  • Petty RE, Smith JR, Rosenbaum JT. Arthritis and uveitis in children: a pediatric rheumatology perspective. Am J Ophthalmol. 2003;135:879-884.
  • Rosenberg AM, Oen KG. The relationship between ocular and articular disease activity in children with juvenile rheumatoid arthritis and associated uveitis. Arthritis Rheum. 1986;29:797-800.
  • Zannin ME, Buscain I, Vittadello F, Martini G, Alessio M, Orsoni JG, Breda L, Rigante D, Cimaz R, Zulian F. Timing of uveitis onset in oligoarticular juvenile idiopathic arthritis (JIA) is the main predictor of severe course uveitis. Acta Ophthalmol. 2012;90:91-95.
  • Zierhut M, Michels S, Stübiger N, Besch D, Deuter C, Heiligenhaus A. Uveitis in children. Int Ophthalmol Clin. 2005;45:135-156.
  • Cassidy J, Kivlin J, Lindsley C, Nocton J; Section on Rheumatology; Section on Ophthalmology. Ophthalmic examinations in children with juvenile rheumatoid arthritis. Pediatrics. 2006;117:1843-1845.
  • Vitale AT, Graham E, de-Boer JH. Juvenile idiopathic arthritis-associated uveitis: clinical features and complications, risk factors for severe course, and visual outcome. Ocul Immunol Inflamm. 2013;21:478-485.
  • Madigan WP, Raymond WR, Wroblewski KJ, Thebpatiphat N, Birdsong RH, Jaafar MS. A review of pediatric uveitis: Part II. Autoimmune diseases and treatment modalities. J Pediatr Ophthalmol Strabismus. 2008;45:202- 219.
  • Vastert SJ, Bhat P, Goldstein DA. Pathophysiology of JIA-associated uveitis. Ocul Immunol Inflamm. 2014:22:414-423.
  • Gregory AC, Kempen JH, Daniel E, et al. Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the systemic immunosuppressive therapy for eye diseases study. Ophthalmology. 2013;120:186-192.
  • Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K. Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatol (Oxford). 2011;50:1390-1394.
  • Tugal-Tutkun İ. Çocukluk çağı romatizmal hastalıklarında göz tutulumu. Turkiye Klinikleri J Pediatr Sci. 2008;4:139-143.
  • Skarin A, Elborgh R, Edlund E, Bengtsson-Stigmar E. Long-term folllow-up of patients with uveitis associated with juvenile idiopathic arthritis: a cohort study. Ocul Immunol Inflamm. 2009;17:104-108.
  • Taylor SR, Tomkins-Netzer O, Joshi L, Morarji J, McLoone E, Lightman S. Dexamethasone implant in pediatric uveitis. Ophthalmology. 2012;119:2412.
  • Sella R, Oray M, Friling R, Umar L, Tugal-Tutkun I, Kramer M. Dexamethasone intravitreal implant (Ozurdex) for pediatric uveitis. Graefes Arch Clin Exp Ophthalmol. 2015;253:1777-1782.
  • Kumari N, Parchand S, Kaushik S, Singh R. Intractable glaucoma necessitating dexamethasone implant (Ozurdex) removal and glaucoma surgery in a child with uveitis. BMJ Case Rep. 2013:2013.
  • Buchman AL. Side effects of corticosteroid therapy. J Clin Gastroenterol. 2001;33:289-294.
  • Fiorelli VM, Bhat P, Foster CS. Nonsteroidal anti-inflammatory therapy and recurrent acute anterior uveitis. Ocul Immunol Inflamm. 2010;18:116-120.
  • Levy-Clarke GA, Nussenblatt RB, Smith JA. Management of chronic pediatric uveitis. Cur Opin Ophthalmol. 2005;16:281-288.
  • Simonini G, Paudyal P, Jones GT, Cimaz R, Macfarlane GJ. Current evidence of methotrexate efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach. Rheumatol (Oxford). 2013;52:825-831.
  • Kalinina Ayuso V, van de Winkel EL, Rothova A, de Boer JH. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis. Am J Ophthalmol. 2011;151:217-222.
  • Wallace CA. The use of methotrexate in childhood rheumatic diseases. Arthritis Rheum. 1998;41:381-391.
  • Samson CM, Waheed N, Baltatzis S, Foster CS. Methotrexate therapy for chronic noninfectious uveitis: analysis of a case series of 160 patients. Ophthalmology. 2001;108:1134-1139.
  • Goebel JC, Roesel M, Heinz C, Michels H, Ganser G, Heiligenhaus A. Azathioprine as a treatment option for uveitis in patients with juvenile idiopathic arthritis. Br J Ophthalmol. 2011;95:209-213.
  • Pasadhika S, Kempen JH, Newcomb CW, Liesegang TL, Pujari SS, Rosenbaum JT, Thorne JE, Foster CS, Jabs DA,Levy-Clarke GA, Nussenblatt RB, Suhler EB. Azathioprine for ocular inflammatory diseases. Am J Ophthalmol. 2009;148:500-509.
  • Sobrin L, Christen W, Foster CS. Mycophenolate mofetil after metotrexate failure or intolerance in the treatment of scleritis and uveitis. Ophthalmology. 2008;115:1416-1421.
  • Tappeiner C, Roesel M, Heinz C, Michels H, Ganser G, Heiligenhaus A. Limited value of cyclosporine A for the treatment of patients with uveitis associated with juvenile idiopathic arthritis. Eye (Lond). 2009;23:1192-1198.
  • Galego-Pinazo R, Dolz-Marco R, Martinez-Castillo S, Arevalo JF, Diaz- Llopis M. Update on the principles and novel local and systemic therapies for the treatment of non-infectious uveitis. Inflamm Allergy Drug Targets. 2013;12:38-45.
  • Larson T, Nussenblatt RB, Sen HN. Emerging drugs for uveitis. Expert Opin Emerg Drugs. 2011;16:309-322.
  • Pujari SS, Kempen JH, Newcomb CW, Gangaputra S, Daniel E, Suhler EB, Thorne JE, Jabs DA, Levy-Clarke GA,Nussenblatt RB, Rosenbaum JT, Foster CS. Cyclophosohamide for ocular inflammatory diseases. Ophthalmology. 2010;117:356-365.
  • Tambralli A, Beukelman T, Weiser P, Atkinson TP, Cron RQ, Stoll ML. High doses of Infliximab in the management of juvenile idiopathic arthritis. J Rheumatol. 2013;40;1749-1755.
  • Horneff G. Update on biologicals for treatment of juvenile idiopathic arthritis. Expert Opin Biol Ther. 2013;13:361-376.
  • Ayranci O, Tugal-Tutkun I, Kasapcopur O. Infliximab treatment for refractory childhood uveitis. 9th International Congress IOIS 2007 abstract no: OP10-05.
  • Vazquez-Cobian LB, Flynn T, Lehman JA. Adalimumab therapy for childhood uveitis. J Pediatr. 2006;149:572-575.
  • Biester S, Deuter C, Michels H, Haefner R, Kuemmerle-Deschner J, Doycheva D, Zierhut M. Adalimumab in the therapy of uveitis in childhood. Br J Ophthalmol. 2007;91:319-324.
  • Simonini G, Taddio A, Cattalini M, Caputo R, De Libero C, Naviglio S, Bresci C, Lorusso M, Lepore L, Cimaz R. Prevention of flare recurrences in childhood- refractory chronic uveitis: an open-label comparative study of adalimumab versus infliximab. Arthritis Care Res. 2011;63:612-618.
  • Zannin ME, Birolo C, Gerloni VM, Miserocchi E, Pontikaki I, Paroli MP, Bracaglia C, Shardlow A, Parentin F, Cimaz R,Simonini G, Falcini F, Corona F, Viola S, De Marco R, Breda L, La Torre F, Vittadello F, Martini G, Zulian F. Safety and efficacy of infliximab and adalimumab for refractory uveitis in juvenile idiopathic arthritis: 1-year followup data from the Italian Registry. J Rheumatol. 2013;40:74-79.
  • Ramanan AV, Dick AD, Benton D, Compeyrot-Lacassagne S, Dawoud D, Hardwick B, Hickey H, Hughes D, Jones A,Woo P, Edelsten C, Beresford MW; SYCAMORE Trial Management Group. A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate fort he treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). Trials. 2014;15:14.
  • Foeldvari I, Nielsen S, Kümmerle-Deschner J, Espada G, Horneff G, Bica B, Olivieri AN, Wierk A, Saurenmann RK. Tumor necrosis factor-alpha blocker in treatment of juvenile idiopathic arthritis-associated uveitis refractory to second-line agents: results of a multinational survey. J Rheumatol. 2007;34:1146-1150.
  • Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Vangelder RN. Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology. 2013;121:785-796.
  • Schmeling H, Horneff G. Etanercept and uveitis in patients with juvenile idiopathic arthritis. Rheumatology (Oxford). 2005;44:1008-1011.
  • Tynjala P, Lindahl P, Honkanen V, Lahdenne P, Kotaniemi K. Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis. Br J Ophthalmol. 2007;66:548-550.
  • Miserocchi E, Modorati G, Pontikaki I, Meroni PL, Gerloni V. Long-term treatment with golimumab for severe uveitis. Ocul Immunol Inflamm. 2014;22:90-95.
  • Sanchez-Cano D, Callejas-Rubio JL, Ruiz-Villaverde R, Rios-Fernandez R, Ortego-Centeno N. Off-label uses of anti-TNF therapy in three frequent disorders: Behçet's disease, sarcoidosis, and noninfectious uveitis. Mediators Inflamm. 2013;2013:286857.
  • Muselier A, Bielefeld P, Bidot S, Vinit J, Besancenot JF, Bron A. Efficacy of tocilizumab in two patients with anti-TNF-alpha refractory uveitis. Ocul Immunol Inflamm. 2011;19:382-383.
  • Tappeiner C, Heinz C, Gasner G, Heiligenhaus A. Is tocilizumab an effective option for treatment of refractory uveitis associated with juvenile idiopathic arthritis? J Rheumatol. 2012;39:1294-1295.
  • Zulian F, Balzarin M, Falcini F, Martini G, Alessio M, Cimaz R, Cimino L, Zannin ME. Abatacept for severe anti-tumor necrosis factor alpha refractory juvenile idiopathic arthritis-related uveitis. Arthritis Care Res (Hoboken). 2010;62:821-825.
  • Hayward K, Wallace CA. Recent developments in anti-rheumatic drugs in pediatrics: treatment of juvenile idiopathic arthritis. Arthritis Res Ther. 2009;11:216.
  • Sen HN, Levy-Clarke G, Faia LJ, Li Z, Yeh S, Barron KS, Ryan JG, Hammel K, Nussenblatt RB. High-dose daclizumab for the treatment of juvenile idiopathic arthritis-associated active anterior uveitis. Am J Ophthalmol. 2009;148:696-703.
  • Najjar DM, Cohen EJ, Rapuano CJ, Laibson PR. EDTA chelation for calcific band keratopathy: results and long-term follow-up. Am J Ophthalmol. 2004;137:1056-1064.
  • Kanski JJ. Juvenile arthritis and uveitis. Surv Ophthalmol. 1990;34:253-267.
  • Holand GN. Intraocular lens implantation in patients with juvenile rheumatoid arthritis-associated uveitis: an unresolved management issue. Am J Ophthalmol. 1996;122:255-257.
  • Sijssens KM, Los LI, Rothova A, Schellekens PA, van de Does P, Stilma JS, de Boer HJ. Long-term ocular complications in aphakic versus pseudophakic eyes of children with juvenile idiopathic arthritis-associated uveitis. Br J Ophthalmol. 2010;94:1145-1149.
  • Lam LA, Lowder CY, Baerveldt G, Smith SD, Traboulsi EI. Surgical management of cataracts in children with juvenile rheumatoid arthritis- associated uveitis. Am J Ophthalmol. 2003;135:772-778.
  • Sung VC, Barton K. Management of inflammatory glaucomas. Curr Opin Ophthalmol 2004;15:136-140.
  • Ladas JG, Yu F, Loo R, Davis JL, Coleman AL, Levinson RD, Holland GN. Relationship between aqueous humor protein level and outflow facility in patients with uveitis. Invest Ophthalmol Vis Sci. 2001;42:2584-2588.
  • Stavrou P, Murray PI. Long-term follow-up of trabeculectomy without antimetabolites in patients with uveitis. Am J Ophthalmol. 1999;128:434- 439.
  • Towler HM, McCluskey P, Shaer B, Lightman S. Long-term follow-up of trabeculectomy with intraoperative 5-fluorouracil for uveitis-related glaucoma. Ophthalmology. 2000;107:1822-1828.
  • Hill R, Ohanesian R, Voskanyan L, Malayan A. The Armenian Eye care project: surgical outcomes of complicated pediatric glaucoma. Br J Ophthalmol. 2003;87:673-676.
  • O'Malley Schotthoefer E, Yanovitch TL, Freedman SF. Aqueous drainage device surgery in refractory pediatric glaucomas: Long-term outcomes. J AAPOS. 2008;12:33-39.
  • Ozdal PC, Vianna RN, Deschenes J. Ahmed valve implantation in glaucoma secondary to chronic uveitis. Eye (Lond). 2006;20:178-183.
  • Freedman SF, Rodriguez-Rosa RE, Rojas MC, Enyedi LB. Goniotomy for glaucoma secondary to chronic childhood uveitis. Am J Ophthalmol. 2002;133:617-621.
  • Ho CL, Wong EY, Walton DS. Goniosurgery for glaucoma complicating chronic childhood uveitis. Arch Ophthalmol. 2004;122:838-844.
APA Oray M, TUĞAL TUTKUN İ (2016). Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. , 77 - 82.
Chicago Oray Merih,TUĞAL TUTKUN İlknur Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. (2016): 77 - 82.
MLA Oray Merih,TUĞAL TUTKUN İlknur Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. , 2016, ss.77 - 82.
AMA Oray M,TUĞAL TUTKUN İ Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. . 2016; 77 - 82.
Vancouver Oray M,TUĞAL TUTKUN İ Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. . 2016; 77 - 82.
IEEE Oray M,TUĞAL TUTKUN İ "Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi." , ss.77 - 82, 2016.
ISNAD Oray, Merih - TUĞAL TUTKUN, İlknur. "Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi". (2016), 77-82.
APA Oray M, TUĞAL TUTKUN İ (2016). Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. Türk Oftalmoloji Dergisi, 46(2), 77 - 82.
Chicago Oray Merih,TUĞAL TUTKUN İlknur Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. Türk Oftalmoloji Dergisi 46, no.2 (2016): 77 - 82.
MLA Oray Merih,TUĞAL TUTKUN İlknur Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. Türk Oftalmoloji Dergisi, vol.46, no.2, 2016, ss.77 - 82.
AMA Oray M,TUĞAL TUTKUN İ Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. Türk Oftalmoloji Dergisi. 2016; 46(2): 77 - 82.
Vancouver Oray M,TUĞAL TUTKUN İ Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi. Türk Oftalmoloji Dergisi. 2016; 46(2): 77 - 82.
IEEE Oray M,TUĞAL TUTKUN İ "Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi." Türk Oftalmoloji Dergisi, 46, ss.77 - 82, 2016.
ISNAD Oray, Merih - TUĞAL TUTKUN, İlknur. "Juvenil İdiyopatik Artrit ile İlişkili Üveit Tedavisi". Türk Oftalmoloji Dergisi 46/2 (2016), 77-82.
Sayfa Oluşturulma Tarihi
25-04-2024 2:28

İLETİŞİM

TÜBİTAK ULAKBİM TR Dizin

Yüzüncüyıl, İşçi Blokları Mahallesi

Muhsin Yazıcıoğlu Caddesi No:51/C

06530 Çankaya / ANKARA +90 (312) 298 92 00

trdizin@tubitak.gov.tr

TÜBİTAK ULAKBİM Ulusal Akademik Ağ ve Bilgi Merkezi Cahit Arf Bilgi Merkezi © Tüm Hakları Saklıdır. Gizlilik Politikası Kullanım Şartları