Initial treatment of active chronic anterior uveitis (CAU) in patients with juvenile idiopathic arthritis (JIA)

CAU: chronic anterior uveitis; DMARD: disease-modifying antirheumatic drug; JIA: juvenile idiopathic arthritis; TNF: tumor necrosis factor.

* DMARDs vary in their efficacy for treating certain disease manifestations of JIA, including uveitis, peripheral and axial arthritis, enthesitis, and dactylitis. For more information on the types and choice of DMARD(s), as well as dosing and potential adverse effects, refer to UpToDate content on treatment of uveitis in the setting of JIA.

¶ If patients are taking methotrexate orally at baseline, we switch to subcutaneous administration. Adjusting therapy often involves adding or switching to a monoclonal TNF inhibitor. Etanercept is not effective for JIA-associated CAU. Data to support the use of biosimilars of other TNF inhibitors are very limited.

Δ We reserve systemic glucocorticoids for patients who require rapid control of ocular inflammation to treat severe inflammation (eg, those with macular edema).