2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis
2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis
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DOI：
10.1002/art.40885
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发表时间：
2019-06-01
影响因子：
13.3
通讯作者：
Reston, James
中科院分区：
文献类型：
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作者：
Angeles-Han, Sheila T.;Ringold, Sarah;Reston, James
ObjectiveDevelopmentRecommendations for the screening，monitoring，and treatment of uveitis in children with juvenic idiopathic arthritis（JIA）. MethodsPediatric rheologists，眼科专家在葡萄膜炎的专业知识，患者代表，和方法学家产生的关键临床问题，要解决这个指南。随后进行了系统的文献综述，并根据GRADE（建议评估、发展和评价分级）方法对现有证据进行了评级。一组共识的过程被用来组成的最终建议和等级的实力为有条件的或strongly.ResultsDue的文献质量良好的证据，建议制定的基础上，现有的证据和共识的专家意见。由于存在葡萄膜炎的风险，建议对JIA儿童进行定期眼科筛查，筛查频率应根据个体风险因素而定。建议对葡萄膜炎儿童进行定期眼科监测，间隔时间应基于眼部检查结果和治疗方案。眼科监测的建议是强烈的，主要是因为担心威胁视力的葡萄膜炎并发症与不频繁的监测。局部糖皮质激素应作为初始治疗，以达到控制炎症。甲氨蝶呤和单克隆抗体肿瘤坏死因子抑制剂阿达木单抗和英夫利昔单抗推荐时，需要全身治疗葡萄膜炎的管理。及时增加非生物和生物药物的建议，以维持葡萄膜炎控制的儿童谁是在持续的风险视力loss.ConclusionThis指南提供了方向，为临床医生和患者/家长作出决定的筛选，监测和管理的儿童与JIA和葡萄膜炎，使用GRADE方法和知情的共识过程与输入从风湿病学和眼科专家，目前的文献，以及患者/父母的偏好和价值观。
ObjectiveTo develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA).MethodsPediatric 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.ResultsDue 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 are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss.ConclusionThis guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.