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Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the
Tamas Constantin1, Ivan Foeldvari2, Jordi Anton3
12nd Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Insights
New European guidelines offer expert recommendations for diagnosing and treating juvenile idiopathic arthritis (JIA)-associated uveitis. These evidence-informed standards aim to improve care for children and young adults with this serious condition.
Area of Science:
- Pediatric Rheumatology
- Ophthalmology
- Evidence-Based Medicine
Background:
- Juvenile idiopathic arthritis (JIA) is the most prevalent rheumatic disease in children.
- Uveitis is a significant extra-articular manifestation of JIA, potentially leading to severe vision loss.
- Current management of JIA-associated uveitis lacks robust evidence-based guidelines, resulting in varied clinical practices across Europe.
Background:
In 2012, a European initiative called Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) was launched to optimise and disseminate diagnostic and management regimens in Europe for children and young adults with rheumatic diseases. Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is possibly its most devastating extra-articular manifestation. Evidence-based guidelines are sparse and management is mostly based on physicians' experience. Consequently, treatment practices differ widely, within and between nations.
Objectives:
To provide recommendations for the diagnosis and treatment of JIA-associated uveitis.
Methods:
Recommendations were developed by an evidence-informed consensus process using the European League Against Rheumatism standard operating procedures. A committee was constituted, consisting of nine experienced paediatric rheumatologists and three experts in ophthalmology from Europe. Recommendations derived from a validated systematic literature review were evaluated by an Expert Committee and subsequently discussed at two consensus meetings using nominal group techniques. Recommendations were accepted if >80% agreement was reached (including all three ophthalmologists).
Results:
In total, 22 recommendations were accepted (with >80% agreement among experts): 3 on diagnosis, 5 on disease activity measurements, 12 on treatment and 2 on future recommendations.
Conclusions:
The SHARE initiative aims to identify best practices for treatment of patients suffering from JIA-associated uveitis. Within this remit, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated by an evidence-informed consensus process to suggest a standard of care for JIA-associated uveitis patients throughout Europe.
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