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Published in: Rheumatology International 5/2015

01-05-2015 | Review Article - Recommendations and Guidelines

Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus

Authors: Rosa Bou, Alfredo Adán, Fátima Borrás, Beatriz Bravo, Inmaculada Calvo, Jaime De Inocencio, Jesús Díaz, Julia Escudero, Alex Fonollosa, Carmen García de Vicuña, Victoria Hernández, Rosa Merino, Jesús Peralta, María-Jesús Rúa, Pilar Tejada, Jordi Antón

Published in: Rheumatology International | Issue 5/2015

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Abstract

Uveitis associated with juvenile idiopathic arthritis (JIA) typically involves the anterior chamber segment, follows an indolent chronic course, and presents a high rate of uveitic complications and a worse outcome as compared to other aetiologies of uveitis. Disease assessment, treatment, and outcome measures have not been standardized. Collaboration between pediatric rheumatologists and ophthalmologists is critical for effective management and prevention of morbidity, impaired vision, and irreparable visual loss. Although the Standardization of Uveitis Nomenclature Working Group recommendations have been a great advance to help clinicians to improve consistency in grading and reporting data, difficulties arise at the time of deciding the best treatment approach in the individual patient in routine daily practice. For this reason, recommendations for a systematized control and treatment strategies according to clinical characteristics and disease severity in children with JIA-related uveitis were developed by a panel of experts with special interest in uveitis associated with JIA. A clinical management algorithm organized in a stepwise regimen is here presented.
Literature
1.
go back to reference Carvounis PE, Herman DC, Cha S, Burke JP (2006) Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature. Graefes Arch Clin Exp Ophthalmol 244:281–290CrossRefPubMed Carvounis PE, Herman DC, Cha S, Burke JP (2006) Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature. Graefes Arch Clin Exp Ophthalmol 244:281–290CrossRefPubMed
2.
go back to reference Sabri K, Saurenmann RK, Silverman ED, Levin AV (2008) Course, complications, and outcome of juvenile arthritis-related uveitis. J AAPOS 12:539–545CrossRefPubMed Sabri K, Saurenmann RK, Silverman ED, Levin AV (2008) Course, complications, and outcome of juvenile arthritis-related uveitis. J AAPOS 12:539–545CrossRefPubMed
3.
go back to reference Heiligenhaus AI, Niewerth M, Ganser G, Heinz C, Minden K (2007) Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology (Oxford) 46:1015–1019CrossRef Heiligenhaus AI, Niewerth M, Ganser G, Heinz C, Minden K (2007) Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology (Oxford) 46:1015–1019CrossRef
6.
go back to reference Heiligenhaus A, Foeldvari I, Edelsten C, Smith JR, Saurenmann RK, Bodaghi B, de Boer J, Graham E, Anton J, Kotaniemi K, Mackensen F, Minden K, Nielsen S, Rabinovich EC, Ramanan AV, Strand V (2012) Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis: a consensus effort from the multinational interdisciplinary working group for uveitis in childhood. Arthritis Care Res (Hoboken) 64:1365–1372CrossRef Heiligenhaus A, Foeldvari I, Edelsten C, Smith JR, Saurenmann RK, Bodaghi B, de Boer J, Graham E, Anton J, Kotaniemi K, Mackensen F, Minden K, Nielsen S, Rabinovich EC, Ramanan AV, Strand V (2012) Proposed outcome measures for prospective clinical trials in juvenile idiopathic arthritis-associated uveitis: a consensus effort from the multinational interdisciplinary working group for uveitis in childhood. Arthritis Care Res (Hoboken) 64:1365–1372CrossRef
7.
go back to reference Cassidy J, Kivlin J, Lindsley C, Nocton J (2006) Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics 117:1843–1845CrossRefPubMed Cassidy J, Kivlin J, Lindsley C, Nocton J (2006) Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics 117:1843–1845CrossRefPubMed
8.
go back to reference Jabs DA, Nussenblatt RB, Rosenbaum JT (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 140:509–516CrossRefPubMed Jabs DA, Nussenblatt RB, Rosenbaum JT (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 140:509–516CrossRefPubMed
9.
go back to reference Chylack LT Jr, Leske MC, McCarthy D, Khu P, Kashiwagi T, Sperduto R (1989) Lens opacities classification system II (LOCS II). Arch Ophthalmol 107:991–997CrossRefPubMed Chylack LT Jr, Leske MC, McCarthy D, Khu P, Kashiwagi T, Sperduto R (1989) Lens opacities classification system II (LOCS II). Arch Ophthalmol 107:991–997CrossRefPubMed
10.
go back to reference Nussenblatt RB, Palestine AG, Chan CC, Roberge F (1985) Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology 92:467–471CrossRefPubMed Nussenblatt RB, Palestine AG, Chan CC, Roberge F (1985) Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology 92:467–471CrossRefPubMed
11.
go back to reference Samudre SS, Lattanzio FA Jr, Williams PB, Sheppard JD Jr (2004) Comparison of topical steroids for acute anterior uveitis. J Ocul Pharmacol Ther 20:533–547CrossRefPubMed Samudre SS, Lattanzio FA Jr, Williams PB, Sheppard JD Jr (2004) Comparison of topical steroids for acute anterior uveitis. J Ocul Pharmacol Ther 20:533–547CrossRefPubMed
12.
go back to reference Thorne JE, Woreta FA, Dunn JP, Jabs DA (2010) Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology 117:1436–1441CrossRefPubMedCentralPubMed Thorne JE, Woreta FA, Dunn JP, Jabs DA (2010) Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology 117:1436–1441CrossRefPubMedCentralPubMed
13.
go back to reference Lovasik JV (1986) Pharmacokinetics of topically applied cyclopentolate HCl and tropicamide. Am J Optom Physiol Opt 63:787–803CrossRefPubMed Lovasik JV (1986) Pharmacokinetics of topically applied cyclopentolate HCl and tropicamide. Am J Optom Physiol Opt 63:787–803CrossRefPubMed
14.
go back to reference Foeldvari I, Wierk A (2005) Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis. J Rheumatol 32:362–365PubMed Foeldvari I, Wierk A (2005) Methotrexate is an effective treatment for chronic uveitis associated with juvenile idiopathic arthritis. J Rheumatol 32:362–365PubMed
15.
go back to reference Heiligenhaus A, Mingels A, Heinz C, Ganser G (2007) Methotrexate for uveitis associated with juvenile idiopathic arthritis: value and requirement for additional anti-inflammatory medication. Eur J Ophthalmol 17:743–748PubMed Heiligenhaus A, Mingels A, Heinz C, Ganser G (2007) Methotrexate for uveitis associated with juvenile idiopathic arthritis: value and requirement for additional anti-inflammatory medication. Eur J Ophthalmol 17:743–748PubMed
16.
go back to reference Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U, Niehues T, Baus H, Becker M, Bertram B, Dannecker G, Deuter C, Foeldvari I, Frosch M, Ganser G, Gaubitz M, Gerdes G, Horneff G, Illhardt A, Mackensen F, Minden K, Pleyer U, Schneider M, Wagner N, Zierhut M (2012) Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int 32:1121–1133CrossRefPubMed Heiligenhaus A, Michels H, Schumacher C, Kopp I, Neudorf U, Niehues T, Baus H, Becker M, Bertram B, Dannecker G, Deuter C, Foeldvari I, Frosch M, Ganser G, Gaubitz M, Gerdes G, Horneff G, Illhardt A, Mackensen F, Minden K, Pleyer U, Schneider M, Wagner N, Zierhut M (2012) Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Rheumatol Int 32:1121–1133CrossRefPubMed
17.
go back to reference Ferrante P, Ramsey A, Bunce C, Lightman S (2004) Clinical trial to compare efficacy and side-effects of injection of posterior sub-Tenon triamcinolone versus orbital floor methylprednisolone in the management of posterior uveitis. Clin Exp Ophthalmol 32:563–568CrossRef Ferrante P, Ramsey A, Bunce C, Lightman S (2004) Clinical trial to compare efficacy and side-effects of injection of posterior sub-Tenon triamcinolone versus orbital floor methylprednisolone in the management of posterior uveitis. Clin Exp Ophthalmol 32:563–568CrossRef
18.
go back to reference Zannin ME, Birolo C, Gerloni VM, Miserocchi E, Pontikaki I, Paroli MP, Bracaglia C, Shardlow A, Parentin F, Cimaz R, Simonini G, Falcini F, Corona F, Viola S, De Marco R, Breda L, La Torre F, Vittadello F, Martini G, Zulian F (2013) Safety and efficacy of infliximab and adalimumab for refractory uveitis in juvenile idiopathic arthritis: 1-year followup data from the Italian Registry. J Rheumatol 40:74–79CrossRefPubMed Zannin ME, Birolo C, Gerloni VM, Miserocchi E, Pontikaki I, Paroli MP, Bracaglia C, Shardlow A, Parentin F, Cimaz R, Simonini G, Falcini F, Corona F, Viola S, De Marco R, Breda L, La Torre F, Vittadello F, Martini G, Zulian F (2013) Safety and efficacy of infliximab and adalimumab for refractory uveitis in juvenile idiopathic arthritis: 1-year followup data from the Italian Registry. J Rheumatol 40:74–79CrossRefPubMed
19.
go back to reference Kotaniemi K, Säilä H, Kautiainen H (2011) Long-term efficacy of adalimumab in the treatment of uveitis associated with juvenile idiopathic arthritis. Clin Ophthalmol 5:1425–1429CrossRefPubMedCentralPubMed Kotaniemi K, Säilä H, Kautiainen H (2011) Long-term efficacy of adalimumab in the treatment of uveitis associated with juvenile idiopathic arthritis. Clin Ophthalmol 5:1425–1429CrossRefPubMedCentralPubMed
20.
go back to reference Díaz-Llopis M, Salom D, Garcia-de-Vicuña C, Cordero-Coma M, Ortega G, Ortego N, Suarez-de-Figueroa M, Rio-Pardo MJ, Fernandez-Cid C, Fonollosa A, Blanco R, Garcia-Aparicio AM, Benitez-Del-Castillo JM, Olea JL, Arevalo JF (2012) Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients. Ophthalmology 119:1575–1578CrossRefPubMed Díaz-Llopis M, Salom D, Garcia-de-Vicuña C, Cordero-Coma M, Ortega G, Ortego N, Suarez-de-Figueroa M, Rio-Pardo MJ, Fernandez-Cid C, Fonollosa A, Blanco R, Garcia-Aparicio AM, Benitez-Del-Castillo JM, Olea JL, Arevalo JF (2012) Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients. Ophthalmology 119:1575–1578CrossRefPubMed
21.
go back to reference García-De-Vicuña C, Díaz-Llopis M, Salom D, Bou R, Díaz-Cascajosa J, Cordero-Coma M, Ortega G, Ortego-Centeno N, Suarez-De-Figueroa M, Cruz-Martínez J, Fonollosa A, Blanco R, García-Aparicio ÁM, Benítez-Del-Castillo JM, Antón J (2013) Usefulness of adalimumab in the treatment of refractory uveitis associated with juvenile idiopathic arthritis. Mediators Inflamm. doi:10.1155/2013/560632 PubMedCentralPubMed García-De-Vicuña C, Díaz-Llopis M, Salom D, Bou R, Díaz-Cascajosa J, Cordero-Coma M, Ortega G, Ortego-Centeno N, Suarez-De-Figueroa M, Cruz-Martínez J, Fonollosa A, Blanco R, García-Aparicio ÁM, Benítez-Del-Castillo JM, Antón J (2013) Usefulness of adalimumab in the treatment of refractory uveitis associated with juvenile idiopathic arthritis. Mediators Inflamm. doi:10.​1155/​2013/​560632 PubMedCentralPubMed
22.
go back to reference Mok CC, van der Kleij D, Wolbink GJ (2013) Drug levels, anti-drug antibodies, and clinical efficacy of the anti-TNFα biologics in rheumatic diseases. Clin Rheumatol 32:1429–1435CrossRefPubMed Mok CC, van der Kleij D, Wolbink GJ (2013) Drug levels, anti-drug antibodies, and clinical efficacy of the anti-TNFα biologics in rheumatic diseases. Clin Rheumatol 32:1429–1435CrossRefPubMed
23.
go back to reference Murias S, Alcobendas R, Pascual-Salcedo D, Remesal A, Peralta J, Merino R (2014) Anti-adalimumab antibodies in paediatric rheumatology patients: a pilot experience. Rheumatology (Oxford) 53:2124–2126CrossRef Murias S, Alcobendas R, Pascual-Salcedo D, Remesal A, Peralta J, Merino R (2014) Anti-adalimumab antibodies in paediatric rheumatology patients: a pilot experience. Rheumatology (Oxford) 53:2124–2126CrossRef
24.
go back to reference Tambralli A, Beukelman T, Weiser P, Atkinson TP, Cron RQ, Stoll ML (2013) High doses of infliximab in the management of juvenile idiopathic arthritis. J Rheumatol 40:1749–1755CrossRefPubMed Tambralli A, Beukelman T, Weiser P, Atkinson TP, Cron RQ, Stoll ML (2013) High doses of infliximab in the management of juvenile idiopathic arthritis. J Rheumatol 40:1749–1755CrossRefPubMed
25.
go back to reference Suhler EB, Smith JR, Giles TR, Lauer AK, Wertheim MS, Kurz DE, Kurz PA, Lim L, Mackensen F, Pickard TD, Rosenbaum JT (2009) Infliximab therapy for refractory uveitis: 2-year results of a prospective trial. Arch Ophthalmol 127:819–822PubMed Suhler EB, Smith JR, Giles TR, Lauer AK, Wertheim MS, Kurz DE, Kurz PA, Lim L, Mackensen F, Pickard TD, Rosenbaum JT (2009) Infliximab therapy for refractory uveitis: 2-year results of a prospective trial. Arch Ophthalmol 127:819–822PubMed
26.
go back to reference Richards JC, Tay-Kearney ML, Murray K, Manners P (2005) Infliximab for juvenile idiopathic arthritis-associated uveitis. Clin Exp Ophthalmol 33:461–468CrossRef Richards JC, Tay-Kearney ML, Murray K, Manners P (2005) Infliximab for juvenile idiopathic arthritis-associated uveitis. Clin Exp Ophthalmol 33:461–468CrossRef
27.
go back to reference Tynjälä P, Lindahl P, Honkanen V, Lahdenne P, Kotaniemi K (2007) Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis. Ann Rheum Dis 66:548–550CrossRefPubMedCentralPubMed Tynjälä P, Lindahl P, Honkanen V, Lahdenne P, Kotaniemi K (2007) Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis. Ann Rheum Dis 66:548–550CrossRefPubMedCentralPubMed
28.
go back to reference Zulian F, Balzarin M, Falcini F, Martini G, Alessio M, Cimaz R, Cimino L, Zannin ME (2010) Abatacept for severe anti-tumor necrosis factor alpha refractory juvenile idiopathic arthritis-related uveitis. Arthritis Care Res (Hoboken) 62:821–825CrossRef Zulian F, Balzarin M, Falcini F, Martini G, Alessio M, Cimaz R, Cimino L, Zannin ME (2010) Abatacept for severe anti-tumor necrosis factor alpha refractory juvenile idiopathic arthritis-related uveitis. Arthritis Care Res (Hoboken) 62:821–825CrossRef
29.
go back to reference Tappeiner C, Heinz C, Ganser G, Heiligenhaus A (2012) Is tocilizumab an effective option for treatment of refractory uveitis associated with juvenile idiopathic arthritis? J Rheumatol 39:1294–1295CrossRefPubMed Tappeiner C, Heinz C, Ganser G, Heiligenhaus A (2012) Is tocilizumab an effective option for treatment of refractory uveitis associated with juvenile idiopathic arthritis? J Rheumatol 39:1294–1295CrossRefPubMed
30.
go back to reference Adán A, Mesquida M, Llorenç V, Espinosa G, Molins B, Hernández MV, Pelegrín L (2013) Tocilizumab treatment for refractory uveitis-related cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 251:2627–2632CrossRefPubMed Adán A, Mesquida M, Llorenç V, Espinosa G, Molins B, Hernández MV, Pelegrín L (2013) Tocilizumab treatment for refractory uveitis-related cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 251:2627–2632CrossRefPubMed
31.
go back to reference Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K (2011) Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology (Oxford) 50:1390–1394CrossRef Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K (2011) Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology (Oxford) 50:1390–1394CrossRef
33.
go back to reference Heiligenhaus A (2006) When should intraocular lenses be implanted in patients with juvenile idiopathic arthritis-associated iridocyclitis? Ophthalmic Res 38:316–317CrossRefPubMed Heiligenhaus A (2006) When should intraocular lenses be implanted in patients with juvenile idiopathic arthritis-associated iridocyclitis? Ophthalmic Res 38:316–317CrossRefPubMed
34.
go back to reference Grajewski RS, Zurek-Imhoff B, Roesel M, Heinz C, Heiligenhaus A (2012) Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis. Acta Ophthalmol 90:657–662CrossRefPubMed Grajewski RS, Zurek-Imhoff B, Roesel M, Heinz C, Heiligenhaus A (2012) Favourable outcome after cataract surgery with IOL implantation in uveitis associated with juvenile idiopathic arthritis. Acta Ophthalmol 90:657–662CrossRefPubMed
35.
go back to reference Adán A, Gris O, Pelegrín L, Torras J, Corretger X (2009) Explantation of intraocular lenses in children with juvenile idioapathic arthritis-associated uveítis. J Cataract Refract Surg 35:603–605CrossRefPubMed Adán A, Gris O, Pelegrín L, Torras J, Corretger X (2009) Explantation of intraocular lenses in children with juvenile idioapathic arthritis-associated uveítis. J Cataract Refract Surg 35:603–605CrossRefPubMed
36.
go back to reference Bohnsack BL, Freedman SF (2013) Surgical outcomes in childhood uveitic glaucoma. Am J Ophthalmol 155:134–142CrossRefPubMed Bohnsack BL, Freedman SF (2013) Surgical outcomes in childhood uveitic glaucoma. Am J Ophthalmol 155:134–142CrossRefPubMed
37.
go back to reference Kotaniemi K, Sihto-Kauppi K (2007) Occurrence and management of ocular hypertension and secondary glaucoma in juvenile idiopathic arthritis-associated uveitis: an observational series of 104 patients. Clin Ophthalmol 1:455–459PubMedCentralPubMed Kotaniemi K, Sihto-Kauppi K (2007) Occurrence and management of ocular hypertension and secondary glaucoma in juvenile idiopathic arthritis-associated uveitis: an observational series of 104 patients. Clin Ophthalmol 1:455–459PubMedCentralPubMed
38.
go back to reference Najjar DM, Cohen EJ, Rapuano CJ, Laibson PR (2004) EDTA chelation for calcific band keratopathy: results and long-term follow-up. Am J Ophthalmol 137:1056–1064CrossRefPubMed Najjar DM, Cohen EJ, Rapuano CJ, Laibson PR (2004) EDTA chelation for calcific band keratopathy: results and long-term follow-up. Am J Ophthalmol 137:1056–1064CrossRefPubMed
39.
go back to reference Mackensen F, Heinz C, Becker MD, Heiligenhaus A (2008) Intravitreal bevacizumab (avastin) as a treatment for refractory macular edema in patients with uveitis: a pilot study. Retina 28:41–45CrossRefPubMed Mackensen F, Heinz C, Becker MD, Heiligenhaus A (2008) Intravitreal bevacizumab (avastin) as a treatment for refractory macular edema in patients with uveitis: a pilot study. Retina 28:41–45CrossRefPubMed
40.
go back to reference Cervantes-Castañeda RA, Giuliari GP, Gallagher MJ, Yilmaz T, MacDonell RE, Quinones K, Foster CS (2009) Intravitreal bevacizumab in refractory uveitic macular edema: one-year follow-up. Eur J Ophthalmol 19:622–629PubMed Cervantes-Castañeda RA, Giuliari GP, Gallagher MJ, Yilmaz T, MacDonell RE, Quinones K, Foster CS (2009) Intravitreal bevacizumab in refractory uveitic macular edema: one-year follow-up. Eur J Ophthalmol 19:622–629PubMed
41.
go back to reference Adán A, Pelegrín L, Rey A, Llorenç V, Mesquida M, Molins B, Ríos J, Keller J (2013) Dexamethasone intravitreal implant for treatment of uveitic persistent cystoid macular edema in vitrectomized patients. Retina 33:1435–1440CrossRefPubMed Adán A, Pelegrín L, Rey A, Llorenç V, Mesquida M, Molins B, Ríos J, Keller J (2013) Dexamethasone intravitreal implant for treatment of uveitic persistent cystoid macular edema in vitrectomized patients. Retina 33:1435–1440CrossRefPubMed
42.
go back to reference Yu EN, Paredes I, Foster CS (2007) Surgery for hypotony in patients with juvenile idiopathic arthritis-associated uveitis. Ocul Immunol Inflamm 15:11–17CrossRefPubMed Yu EN, Paredes I, Foster CS (2007) Surgery for hypotony in patients with juvenile idiopathic arthritis-associated uveitis. Ocul Immunol Inflamm 15:11–17CrossRefPubMed
Metadata
Title
Clinical management algorithm of uveitis associated with juvenile idiopathic arthritis: interdisciplinary panel consensus
Authors
Rosa Bou
Alfredo Adán
Fátima Borrás
Beatriz Bravo
Inmaculada Calvo
Jaime De Inocencio
Jesús Díaz
Julia Escudero
Alex Fonollosa
Carmen García de Vicuña
Victoria Hernández
Rosa Merino
Jesús Peralta
María-Jesús Rúa
Pilar Tejada
Jordi Antón
Publication date
01-05-2015
Publisher
Springer Berlin Heidelberg
Published in
Rheumatology International / Issue 5/2015
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-015-3231-3

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