Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis,☆☆,,★★

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Abstract

We used low-dose methotrexate to treat seven children with juvenile rheumatoid arthritis-associated uveitis complicated by cataract and glaucoma or resistant to topical corticosteroid. The use of methotrexate decreased the severity of uveitis in six of seven patients and allowed for the discontinuation or reduction of corticosteroid drops. (J Pediatr 1998;133:266-8)

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Patients and Methods

Between January 1994 and December 1996, seven female patients (4 to 22 years old) with JRA-associated uveitis refractory to corticosteroids were treated with MTX. All had pauciarticular onset JRA according to The American College of Rheumatology criteria, and all had antinuclear antibodies. All patients had chronic active uveitis for at least 1 year (range 1 to 17 years) inadequately suppressed with corticosteroids and had progressive steroid-related cataract or glaucoma. Three patients were

Results

Patient 1 had persistent bilateral uveitis despite using topical corticosteroids hourly during waking hours and Decadron ointment at night. She also had secondary glaucoma in the left eye. After starting MTX she had a dramatic reduction in the severity of uveitis at 1 month, allowing for a successful trabeculectomy at 3 months. One year later she has no inflammation in either eye but requires one or two corticosteroid drops to keep her trabeculectomy open.

Patient 2 had uncontrolled uveitis and

Discussion

In these selected patients with chronic active uveitis, low-dose weekly MTX was effective and well tolerated. At the time MTX was started, all patients had active uveitis despite frequent administration of topical corticosteroids and previous treatment with high doses of periocular or oral corticosteroids. After treatment with MTX, six of seven children had a significant reduction in the severity of uveitis. Five of these six children were able to discontinue or significantly reduce the number

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    Despite decades of experience with MTX, there is scant literature on its effectiveness in childhood uveitis. The earliest case series in 1998 reported six of seven children with JIA-U significantly reduced or discontinued topical GC.108 A retrospective study of 38 patients with JIA-U describes 25 treated with MTX for uveitis.109

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    2016, Kelley and Firestein's Textbook of Rheumatology: Volumes 1-2, Tenth Edition
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From the Departments of Ophthalmology and Pediatrics, University of Washington and Children’s Hospital and Regional Medical Center, Seattle, Washington.

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Supported in part by a departmental award from Research to prevent blindness, Inc. (A. H. W.).

Reprint requests: Avery H. Weiss, MD, CHRMC Eye Clinic, Box 359300, Mail Stop: CH-61, Seattle, WA 98195-9300.

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