Subsequent 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.

* For the algorithm, we consider patients to have persistent active CAU if inflammation persists despite 3 months of therapy or if patients are unable to taper off of topical glucocorticoids.

¶ DMARD therapy may be required to treat other manifestations of JIA, such as peripheral or axial arthritis, enthesitis, dactylitis, and/or related comorbid conditions (eg, psoriasis, inflammatory bowel disease).

Δ DMARDs vary in their efficacy for treating certain disease manifestations of JIA, including uveitis, peripheral and axial arthritis, enthesitis, and dactylitis. Methotrexate is typically given subcutaneously for patients with CAU related to JIA. 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. 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.

◊ Etanercept is not effective for JIA-associated CAU. Data to support the use of biosimilars of other TNF inhibitors are very limited.

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