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/acr.23871
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发表时间：
2019-06-01
影响因子：
4.7
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
目的制定幼年特发性关节炎 (JIA) 儿童葡萄膜炎筛查、监测和治疗的建议。方法儿科风湿病专家、具有葡萄膜炎专业知识的眼科医生、患者代表和方法学家提出了本指南要解决的关键临床问题。随后根据 GRADE（建议评估、制定和评估分级）方法对现有证据进行了系统的文献综述和评级。采用小组共识流程来制定最终建议，并将其强度评级为有条件或强。结果由于缺乏证据质量好的文献，建议是根据现有证据和专家共识制定的。由于存在葡萄膜炎的风险，建议对幼年特发性关节炎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。建议对患有葡萄膜炎的儿童进行定期眼科监测，监测间隔应根据眼部检查结果和治疗方案而定。眼科监测建议之所以强烈，主要是因为担心葡萄膜炎的视力威胁并发症，且监测不频繁。应使用外用糖皮质激素作为初始治疗，以控制炎症。当需要全身治疗来治疗葡萄膜炎时，建议使用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。建议及时添加非生物和生物药物，以维持对存在持续视力丧失风险的儿童葡萄膜炎的控制。结论本指南为临床医生和患者/家长在 JIA 和葡萄膜炎儿童的筛查、监测和管理方面做出决策提供了指导，该指南采用 GRADE 方法，并根据风湿病学和眼科专家、当前文献以及患者/家长偏好和价值观的共识流程提供信息。
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.