POS1324 TREATMENT OF UVEITIS ASSOCIATED WITH JUVENILE IDIOPATHIC ARTHRITIS: A SEVEN YEARS’ SINGLE-CENTRE EXPERIENCE

Abstract

Background:Uveitis (U) is one of the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA). It is usually revealed in 10-20% of children with JIA, often asymptomatic and sometimes the onset of U precedes the onset of arthritis. Being inappropriately treated, U leads to vision loss in up to 20% of children. Despite the efforts of the Standardization of Uveitis Nomenclature (SUN) Working Group and the European initiative Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) which optimized management of JIA-associated U [1], the actual treatment is mostly based on physicians’ experience. Initial treatment typically includes topical glucocorticoids (G) or systemic immunosuppressive therapy if topical G don’t work. Methotrexate (MTX) is the first-line systemic immunosuppressive agent, followed by tumor necrosis factor inhibitors (TNFi) [1,2].Objectives:To provide treatment recommendations for JIA-associated U based on monitoring of 221 patients during 7 years.Methods:Data collected during 2240 hospitalisations of 221 patients aged 3 - 17 years treated at the State Pediatric Medical University in years 2014 - 2020 were analyzed. U and JIA were diagnosed according to the SUN and ACR recommendations. Initial treatment of U included topical G or non-steroidal anti-inflammatory drugs (NSAIDs). Treatment of JIA included systemic NSAIDs, cytostatics (MTX, Cyclosporine or Cyclophosphamide) and biologics: Adalimumab (Ada), Infliximab (Inf), Etanercept (Eta), Abatacept (Aba), Tocilizumab (Toc), Golimumab (Gol). Statistical analysis included traditional Descriptive Statistics, Spearman Rank Order Correlation (SROC) and Multivariate Exploratory Techniques [Statistica for Windows, Statsoft].Results:Of all patients with JIA-associated U the proportion of those treated with biologics during the monitoring increased from 60 to 70% (of them, Ada 79 - 93%, Inf 7 - 1%, Eta 5 - 1%, Aba 7 - 3%, Toc 7 - 0%, Gol 0 - 3%). Of all children in whom U was diagnosed later than arthritis 36% were treated with systemic NSAIDs, 25% - with cytostatics (MTX - 84%, Cyclosporine - 8%, Cyclophosphamide - 8%), 23% - with systemic G, 6% - with biologics (Eta - 83%, Toc - 17%). Of patients in whom U and arthritis were diagnosed simultaneously, 95% were treated with cytostatics (MTX - 95%, Cyclosporine - 15%), 93% - with topical G, 91% - with topical NSAIDs, 81% - with systemic G, 60% - with systemic NSAIDs. Efficacy of treatment in terms of SROK showed evidence of steady improvement already after 1 month of therapy with TNFi or with MTX (increase of r during the first year from 0.37 to 0,62, p<0.02; from 0.37 to 0.55, p<0.05 respectively), though r was never higher than 0.84 during the first 3 years of treatment. Topical NSAIDs and G were less effective: improvement was revealed after 3 months of treatment, it was not so steady and r was never higher than 0.35. Systemic NSAID’s were not effective at all.Conclusion:1. The likelihood of improvement of U treated with TNFi (Eta excepted) after one month, after 1 and after 3 years of therapy was 37%, 62% and 84% respectively. For MTX this likelihood was 37% after 1 month and 55% after 3 months.2. TNFi (Eta excepted) in treatment of JIA prevents the onset of U, thereby supposing its early administration.3. Eta neither prevents nor treats U.4. Topical NSAIDs and G can hardly be recommended as a reliable means for treatment of U without TNFi and MTX.5. Systemic NSAIDs neither prevent nor treat JIA-associated U.