Skip to main content

Abstract

Pediatric uveitis embraces a group of inflammatory diseases affecting the vascular layer of the eye. Among the broad spectrum of possible etiologies, juvenile idiopathic arthritis stands for the most common cause of anterior chronic uveitis in Western countries. Despite being considered a rare disease, non-infectious chronic uveitis is a serious and disabling sight-threatening condition accounting for up to 10 % of pathologies leading to blindness. Visual complications arise as a consequence of persistent or recurrent ocular inflammation, but also as result of chronic steroid treatment. Targeted antimicrobial treatment is necessary for infectious uveitis. On the other hand, non-infectious uveitis is managed trough a “step-by-step” approach, in order to control local inflammation, achieve a corticosteroid-sparing effect and reduce the risk of visual complications. Therapeutic options include corticosteroids, conventional immune-modulatory therapy and tumor necrosis factor α [TNF-α] antagonists. Preliminary evidence suggests a possible role of non anti-TNF-α modifier immunosuppressive treatment for refractory cases, accounting for about 25 % of total patients. Given the high cost and the lack of long-term safety data, the experience with these agents is still limited to few cases managed in highly specialized centers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Miserocchi E, Fogliato G, Modorati G, Bandello F (2013) Review on the worldwide epidemiology of uveitis. Eur J Ophthalmol 23(5):705–717

    Article  PubMed  Google Scholar 

  2. Petty RE, Rosenbaum JT (2011) Uveitis in juvenile idiopatic arthritis. In: Cassidy J (ed) Textbook of pediatric rheumatology 6th edn. Saunders, Philadelphia, pp 305–314

    Google Scholar 

  3. Saurenmann RK, Levin AV, Feldman BM, Rose JB, Laxer RM, Schneider R, Silverman ED (2007) Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum 56:647–657

    Article  CAS  PubMed  Google Scholar 

  4. Rosenberg K, Feuer WJ, Davis JL (2004) Ocular complications of pediatric uveitis. Ophthalmology 111:2299–2306

    Article  PubMed  Google Scholar 

  5. Simonini G, Cantarini L, Bresci C, Lorusso M, Galeazzi M, Cimaz R (2010) Current therapeutic approaches to autoimmune chronic uveitis in children. Autoimmun Rev 9:674–683

    Article  CAS  PubMed  Google Scholar 

  6. Cantarini L, Simonini G, Frediani B, Pagnini I, Galeazzi M, Cimaz R (2012) Treatment strategies for childhood noninfectious chronic uveitis: an update. Expert Opin Investig Drugs 21:1–6

    Article  CAS  PubMed  Google Scholar 

  7. Rabinovich CE (2011) Treatment of juvenile idiopathic arthritis-associated uveitis: challenges and update. Curr Opin Rheumatol 23:432–436

    Article  CAS  PubMed  Google Scholar 

  8. Simonini G, Paudyal P, Jones GT, Cimaz R, Macfarlane GJ (2012) Current evidence of methotrexate efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach. Rheumatology 52:825–831

    Article  PubMed  Google Scholar 

  9. Simonini G, Taddio A, Cattalini M, Caputo R, libero C, Naviglio S, Bresci C, Lorusso M, Lepore L, Cimaz R (2011) Prevention off flare recurrences in childhood-refractory chronic uveitis: an open-label comparative study of adalimumab versus infliximab. Arthritis Care Res 63:612–618

    Article  CAS  Google Scholar 

  10. Simonini G, Taddio A, Cattalini M, Caputo R, de Libero C, Parentin F, Pagnini I, Lepore L, Cimaz R (2013) Superior efficacy of adalimumab in treating childhood refractory chronic uveitis when used as first biologic modifier drug: adalimumab as starting anti-TNF-α therapy in childhood chronic uveitis. Pediatr Rheumatol Online J 15:11–16

    Google Scholar 

  11. Simonini G, Druce K, Cimaz R, Macfarlane GJ, Jones GT (2014) Current evidence of anti-tumor necrosis factor α treatment efficacy in childhood chronic uveitis: a systematic review and meta-analysis approach of individual drugs. Arthritis Care Res 66:1073–1084

    Article  CAS  Google Scholar 

  12. Angeles-Han S, Flynn T, Lehman T (2008) Abatacept for refractory juvenile idiopathic arthritis-associated uveitis-a case report. J Rheumatol 35:1897–1898

    PubMed  Google Scholar 

  13. Elhai M, Deslandre CJ, Kahan A (2011) Abatacept for refractory juvenile idiopathic arthritis-associated uveitis: two new cases. Comment on the article by Zulian et al. Arthritis Care Res 63:307–308

    Article  Google Scholar 

  14. Kenawy N, Cleary G, Mewar D, Beare N, Chandna A, Pearce I (2011) Abatacept: a potential therapy in refractory cases of juvenile idiopathic arthritis-associated uveitis. Graefes Arch Clin Exp Ophthalmol 249:297–300

    Article  PubMed  Google Scholar 

  15. Zulian F, Balzarin M, Falcini F, Martini G, Alessio M, Cimaz R et al (2010) Abatacept for severe anti-tumor necrosis factor alpha refractory juvenile idiopathic arthritis-related uveitis. Arthritis Care Res 62:821–825

    Article  CAS  Google Scholar 

  16. Tappeiner C, Miserocchi E, Bodaghi B, Kotaniemi K, Mackensen F, Gerloni V et al (2015) Abatacept in the treatment of severe, longstanding, and refractory uveitis associated with juvenile idiopathic arthritis. J Rheumatol 42:706–711

    Article  CAS  PubMed  Google Scholar 

  17. Marrani E, Paganelli V, de Libero C, Cimaz R, Simonini G (2015) Long-term efficacy of abatacept in pediatric patients with idiopathic uveitis: a case series. Graefes Arch Clin Exp Ophthalmol 253:1813–1816

    Article  CAS  PubMed  Google Scholar 

  18. Simonini G, Cimaz R, Jones GT, Macfarlane GJ (2015) Non-anti-TNF biologic modifier drugs in non-infectious refractory chronic uveitis: the current evidence from a systematic review. Semin Arthritis Rheum 45:238–250

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gabriele Simonini .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Brambilla, A., Cimaz, R., Simonini, G. (2016). Childhood Uveitis. In: Dammacco, F., Ribatti, D., Vacca, A. (eds) Systemic Vasculitides: Current Status and Perspectives. Springer, Cham. https://doi.org/10.1007/978-3-319-40136-2_24

Download citation

Publish with us

Policies and ethics