P. Rodríguez González, D. Fernández Fernández, I. Gonzalez Fernandez, R. Dos-Santos, P. Castro-Santamaria, M. Sanchez-Wonenburger, J. L. Puga Guzmán, A. Mata, A. Souto Vilas, E. Perez-Pampín, A. Mera Varela
2022 Annals of the Rheumatic Diseases  
BackgroundJuvenile idiopathic arthritis (JIA) is the most common rheumatic disease in pediatric age, uveitis IS the most frequent extra-articular complication (1). Uveitis, if not properly treated, can lead to potentially irreversible ocular complications such as blindness.The treatment of uveitis associated with JIA (U-JIA) remains a challenge due to the aggressiveness of the disease and the frequency of complications.Following the current guidelines for screening and treatment of uveitis, the
more » ... use of topical and sistemic corticosteroids, Methotrexate, cyclosporine or some biological drugs such as Adalimumab constitute the mainstay of treatment in this manifestation.In some refractory cases, the use of Abatacept has been reportedObjectivesTo analyze the efficacy of Abatacept in the treatment of U-JIA from the data avaliable in the scientific literature.MethodsWe perform a systematic review of the scientific literature, following the PRISMA statement, using the following electronic databases: Medline, Embase, Cochrane Library and Web of Science.ResultsAn overall of 89 bibliographic references fulfill the inclusion criteria. A total of 64 patients from 6 studies were followed for a mean time per patient of 11.5 months. The mean age of onset of JIA was 5.25 years, with a time of evolution of the disease of 7 and 11.85 years.In all the series included, a high percentage of patients showed complications secondary to ocular inflammation (synechia, band keratopathy, cataracts, macular cystic edema and/or ocular hypertension) as well as visual deficits secondary to JIA-U.All patients, fhave shown refractoriness to conventional DMARDs, as well as anti-TNF biological drugs.In all the studies, the best correct visual activity (BCVA) is used as main outcome measure. Another outcome measures were used: number of uveitis flares, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), or the number of cells present in the anterior eye chamber.Four series of cases showed an improvement or stabilization of visual acuity after Abatacept treatment. Two studies provided variations in visual acuity that are not statistically significant.Regarding the efficacy of Abatacept, we can observe improvement, in the most of the studies we observed a decrease in the severity of the ocular inflammation and/or its complete remission.Due to the lack of comparable data, a meta-analysis could not be performed. However the data suggest a clear recovery of t JIA-U patients refractory to conventional treatment.ConclusionAbatacept is shown as a promising drug in the treatment of U-JIA, considering its efficacy in improving visual acuity, as well as in the control of flare-ups and the decrease in inflammatory eye symptoms. However, more studies are necessary to corroborate the efficacy of AbataceptReferences[1]Sen ES, Ramanan A V. Juvenile idiopathic arthritis-associated uveitis. Best Pract Res Clin Rheumatol. 2017;31(4):517-534. doi:10.1016/j.berh.2018.01.002[2]Constantin T, Foeldvari I, Anton J, et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: The SHARE initiative. Ann Rheum Dis. 2018;77(8):1107-1117. doi:10.1136/annrheumdis-2018-213131Disclosure of InterestsNone declared
doi:10.1136/annrheumdis-2022-eular.2451 fatcat:cbg3f5yzhnbfzj5ckxql4akkjq