Worldwide, around one million patients have been treated with tumour necrosis factor (TNF)-α antagonists (etanercept, infliximab or adalimumab) for rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and inflammatory bowel disease. Treatment results in substantial improvement in the signs and symptoms of arthritis (inhibition of progression of radiographic joint damage in psoriatic arthritis, resumption of growth in juvenile idiopathic arthritis (JIA) and attenuation of spinal inflammation in ankylosing spondylitis) as well as improved functional status and quality of life.¹ The use of TNF antagonists in adult uveitis has also been promising in small series.^2–4 Recently, TNF antagonists were also used in paediatric uveitis^5,6 and studies have shown the superiority of infliximab to etanercept in juvenile uveitis.⁷ Vasquez-Kobian et al⁵ released their results in October 2006 regarding the use of adalimumab in juvenile uveitis. Similarly in this issue, Biester et al⁸ report that the use of adalimumab in refractory juvenile uveitis has good visual outcome (see page 319). However, since the approval of TNF antagonists, concerns have been raised regarding their safety especially in children. We describe the differences between the three biologic therapies regarding modes of action, visual results, side effects and economic impact on health, and review preliminary evidence suggesting the potential superiority of adalimumab in JIA uveitis.

Adalimumab is a fully human immunoglobulin G1 monoclonal antibody that binds with high affinity and specificity to TNF and neutralises the biological activities of this cytokine by blocking its interaction with the p55 and p75 cell surface TNF receptors. Given the known role of TNF in uveitis, the efficacy and safety of adalimumab in the treatment of uveitis in JIA was analysed by Biester et al.⁸ Chronic asymptomatic anterior uveitis occurs in 10–30% of patients with …