Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis
Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis
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DOI：
10.1016/j.semarthrit.2018.11.004
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发表时间：
2019-08-01
影响因子：
5
通讯作者：
Lehmann, H. W.
中科院分区：
文献类型：
--
作者：
Heiligenhaus, A.;Minden, K.;Lehmann, H. W.
背景：幼年型特发性关节炎(JIAU)的葡萄膜炎常与并发症和视力丧失有关。外用皮质类固醇是一线治疗方法，通常使用的是抗风湿药物(DMARDS)。方法：在德国科学医学学会的主持下，由德国眼科学会、儿科风湿病学会、专业眼科医生协会、德国风湿病学会、家长团体的代表共同制定了跨学科指南。对MEDLINE进行了系统的文献分析，对证据和建议进行了评级，在协商一致的会议上讨论了抗炎治疗的算法和最终声明(名义小组技术)，初步草案进行了微调并随后由所有参与者讨论(Delphi程序)。结果：在建议上达成了共识，包括根据患者葡萄膜炎的严重程度制定标准化的治疗策略。因此，对于对低剂量葡萄膜炎无效的葡萄膜炎，应采用甲氨蝶呤。结论：提出了一种跨学科、循证的治疗指南。(C)2018年作者。由Elsevier Inc.出版。这是一篇CC BY-NC-ND许可下的开放获取文章。(http://creativecommons.org/licenses/by-nc-nd/4.0/)
Background: Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized.Methods: Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure).Results: Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (= 2 years of uveitis inactivity.Conclusions: An interdisciplinary, evidence-based treatment guideline for JIAU is presented. (C) 2018 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)