Methotrexate for resistant chronic uveitis in children with juvenile rheumatoid arthritis☆,☆☆,★,★★
Section snippets
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
References (16)
- et al.
Iridocyclitis associated with juvenile rheumatoid arthritis
Am J Ophthalmol
(1975) - et al.
Cataract development and cataract surgery in patients with juvenile rheumatoid arthritis-associated iridocyclitis
Ophthalmology
(1993) - et al.
Prognostic factors in the uveitis of juvenile rheumatoid arthritis
Ophthalmology
(1987) - et al.
Treatment of uveitis with methotrexate
Am J Ophthalmol
(1969) - et al.
Low-dose methotrexate therapy for ocular inflammatory disease
Ophthalmology
(1992) - et al.
Systemic uveitis syndromes in childhood. An analysis of 340 cases
Ophthalmology
(1984) Uveitis in childhood, Part 1. Anterior
Ann Ophthalmol
(1989)- et al.
Clinical patterns of chronic iridocyclitis in children with juvenile rheumatoid arthritis
Arthritis Rheum
(1997)
Cited by (112)
Uveitis in Children and Adolescents
2021, Rheumatic Disease Clinics of North AmericaCitation Excerpt :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
Immunosuppressive therapy in severe or chronic pediatric uveitis: Review of the literature
2021, Journal Francais d'OphtalmologieUpdate of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis
2019, Seminars in Arthritis and RheumatismClinical Features and Treatment of Juvenile Idiopathic Arthritis
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.).
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Reprint requests: Avery H. Weiss, MD, CHRMC Eye Clinic, Box 359300, Mail Stop: CH-61, Seattle, WA 98195-9300.
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0022-3476/98/$5.00 + 0 9/21/90770