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Published on: December 17, 2021
Chronic and recurrent non-infectious paediatric-onset uveitis: a French cohort
Guillaume Morelle1,2, Julie Gueudry3, Florence Uettwiller4
1RAISE reference centre for rare diseases, IMAGINE Institute, Immunologie, Hématologie et Rhumatologie Pédiatrique, Hopital universitaire Necker-Enfants malades, Assistance Publique Hopitaux de Paris, Paris, France.
Insights
Chronic non-infectious pediatric uveitis causes significant complications but shows improved outcomes with newer treatments like biologics. Many patients achieve inactive disease or remission, even off medication.
Area of Science:
- Ophthalmology
- Rheumatology
- Pediatrics
Background:
- Paediatric-onset uveitis is a chronic inflammatory eye condition.
- It can lead to severe ocular complications and vision loss.
- Understanding its course and management is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the demographics, causes, complications, treatments, and visual prognoses of chronic and recurrent non-infectious paediatric-onset uveitis in France.
- To assess the impact of recent therapeutic advancements, including biologics, on disease activity and remission rates.
Main Methods:
- A descriptive, retrospective, bicentric study was conducted.
- Patients diagnosed before age 17 were included, with follow-up from January 2010 to May 2017.
- Data on demographics, aetiologies, complications, treatments, and outcomes were analyzed.
Main Results:
- 147 patients with 268 affected eyes were analyzed.
- Juvenile idiopathic arthritis was the most common associated condition (82 patients).
- Common complications included ocular hypertension, cataract, and decreased visual acuity (31 permanent visual loss). Treatments involved corticosteroids, methotrexate (58%), and biologics (38%). At follow-up, 45 patients achieved remission, 56 had inactive uveitis on topical steroids, and 48 had active uveitis.
Conclusions:
- Paediatric-onset uveitis is linked to a high rate of complications.
- The introduction of biologics, particularly anti-tumour necrosis factor alpha antibodies, has significantly improved disease control.
- A substantial proportion of patients achieved inactive uveitis or remission, with some achieving this off treatment.
Objective:
To evaluate the demographics, aetiologies, complications, treatments and visual prognoses of chronic and recurrent non-infectious paediatric-onset uveitis in France.
Methods:
Descriptive, retrospective and bicentric study in patients whose disease started before 17 and who were followed up in two centres from January 2010 to May 2017.
Results:
We included 147 patients with 268 affected eyes. Eighty-two had juvenile idiopathic arthritis-associated chronic uveitis, 58 were antinuclear antibody (ANA) positive and 24 were ANA negative, 36 had idiopathic uveitis, 9 had enthesitis-related arthritis-associated uveitis, 9 had sarcoidosis-associated uveitis and 11 had other inflammatory aetiologies. These patients cumulated 161 complications: ocular hypertension, cataract, band keratopathy, macular oedema, optic disk oedema and decreased visual acuity, including permanent visual loss for 31 patients. The most used treatments were corticosteroid (CS) eye drops (82%), systemic CSs (34%), methotrexate (58%) and biologics (38%). At the latest follow-up, 45 patients had achieved remission of uveitis without any treatment, 56 had inactive uveitis on topical steroids and 48 still had active uveitis.
Conclusion:
Paediatric-onset uveitis are associated with a high rate of complications. However, following the introduction of biologics and particularly antitumour necrosis factor alpha antibodies, a significant proportion of uveitis became inactive on or even off treatment.
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