2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis–Associated Uveitis

作者：Sheila T. Angeles‐Han, Sarah Ringold, Timothy Beukelman, Daniel J. Lovell, Carlos A. Cuello‐García, Mara L. Becker, Robert A. Colbert, Brian M. Feldman, Gary N. Holland, Polly J. Ferguson, Harry L. Gewanter, Jaime Guzmán, Jennifer Horonjeff, Peter A. Nigrović, Michael J. Ombrello, Murray H. Passo, Matthew L. Stoll, C. Egla Rabinovich, H. Nida Sen, Rayfel Schneider, Olha Halyabar, Kimberly A. Hays, Amit Shah, Nancy Sullivan, Ann Marie Szymanski, Marat Turgunbaev, Amy S. Turner, James Reston · 发表于：Arthritis Care & Research · 年份：2019 · DOI：10.1002/acr.23871 · 被引用次数：315 · 研究领域：Ocular Diseases and Behçet’s Syndrome、Autoimmune and Inflammatory Disorders Research、Sarcoidosis and Beryllium Toxicity Research

OBJECTIVE: To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS: Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS: Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab...