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Pediatric Rheumatology
Published in: Pediatric Rheumatology 1/2019

Open Access 01-12-2019 | Uveitis | Review

Defining outcome measures in juvenile idiopathic arthritis associated uveitis by a systematic review analysis: do we need a consensus?

Authors: Greta Mastrangelo, Ivan Foeldvari, Jordi Anton, Gabriele Simonini

Published in: Pediatric Rheumatology | Issue 1/2019

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Abstract

Background

Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) represents its most frequent extra-articular manifestation and the main cause of childhood uveitis in in developed countries. The broad variety of outcome measures utilized makes the comparison of the disease course, risk for complications, impairment in visual function, and responses to treatment quite difficult. Our aim was to summarize evidence regarding the current availability of outcome measures in JIA-U.

Methods

A systematic review between January 2000 and December 2018 was performed to identify studies investigating outcome measures used in JIA-U.

Results

The initial search identified 8254 articles of which 89 were potentially eligible. After the full text revision, a total of 27 studies, including 2 RCTs, were included. Among these studies 12 outcome measures for JIA-U use have been identified (grade of cells in the AC, grade of flare in the AC, VA, amblyopia, structural complications, use and sparing of oral corticosteroids and immunosuppressive drugs, surgery requirement, biomarkers, bilateral disease, JIA persistence, quality of life assessments, uveitis subtype). As regards primary outcome measures, 44% among studies included one or more variables related to disease activity (i.e. grade of flare, grade of cells); 56% included visual function performance (i.e. visual acuity); 68% (17/25) included one or more variables of disease-associated tissue damage or complications (i.e. cataract, amblyopia); 24% included disease features (i.e. bilateral disease; uveitis subtype); 44% included laboratory features (i.e. biomarkers); 8% included JIA features (i.e. persistence of disease); 12% included quality of life (i.e. EYE-Q); 44% included management (i.e. use and sparing of oral corticosteroids and other immunosuppressive drugs; surgery requirement).

Conclusions

Our systematic review surveys the heterogeneity around outcome measures related to JIA-U in children, even in RCTs. It does not provide the solution to overcome the heterogeneity in uveitis studies, but it does provide an estimate of the scale of the problems and provides data to inform this important debate; highlighting the requirement to obtain a new consensus regarding a common approach to identify suitable and efficient outcome measures in JIA-U.
Literature
1.
2.
Anesi SA, Foster CS. Importance of recognizing and preventing blindness from juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res. 2012;64:653–7.CrossRef
3.
Felius J, Stager DR Sr, Berry PM, Fawcett SL, Stager DR Jr, Salomao SR, et al. Development of an instrument to assess vision related quality of life in young children. Am J Ophthalmol. 2004;138:362–72.PubMedCrossRef
4.
Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature (SUN) working group. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol. 2005;140(3):509–16.PubMedCrossRef
5.
Heiligenhaus A, Foeldvari I, Edelsten C, Smith JR, Saurenmann RK, Bodaghi B, et al. Multinational Interdisciplinary Working Group for Uveitis in Childhood. 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). 2012;64(9):1365–72.CrossRef
6.
7.
Thorne JE, Woreta F, Kedhar SR, Dunn JP, Jabs DA. Juvenile idiopathic arthritis-associated uveitis: incidence of ocular complications and visual acuity loss. Am J Ophthalmol. 2007;143(5):840–6.PubMedCrossRef
8.
Woreta F, Thorne JE, Jabs DA, Kedhar SR, Dunn JP. Risk factors for ocular complications and poor visual acuity at presentation among patients with uveitis associated with juvenile idiopathic arthritis (JIA). Am J Ophthalmol. 2007;143(4):647–55.PubMedCrossRef
9.
Birolo C, Zannin ME, Arsenyeva S, Cimaz R, Miserocchi E, Dubko M, et al. Comparable efficacy of Abatacept used as first-line or second-line biological agent for severe juvenile idiopathic arthritis-related uveitis. J Rheumatol. 2016;43(11):2068–73.PubMedCrossRef
10.
Breitbach M, Tappeiner C, Böhm MR, Zurek-Imhoff B, Heinz C, Thanos S, et al. Discontinuation of long-term adalimumab treatment in patients with juvenile idiopathic arthritis-associated uveitis. Graefes Arch Clin Exp Ophthalmol. 2017;255(1):171–7.PubMedCrossRef
11.
Deitch I, Amer R, Tomkins-Netzer O, Habot-Wilner Z, Friling R, Neumann R, et al. The effect of anti-tumor necrosis factor alpha agents on the outcome in pediatric uveitis of diverse etiologies. Graefes Arch Clin Exp Ophthalmol. 2018;256(4):801–8.PubMedCrossRef
12.
Muñoz-Gallego A, Barral E, Enríquez E, Tejada P, Barceló A, de Inocencio J. Adalimumab for the treatment of refractory non infectious paediatric uveitis. Int Ophthalmol. 2017;37(3):719–25.PubMedCrossRef
13.
Tappeiner C, Mesquida M, Adán A, Anton J, Ramanan AV, Carreno E, et al. Evidence for tocilizumab as a treatment option in refractory uveitis associated with juvenile idiopathic arthritis. J Rheumatol. 2016;43(12):2183–8.PubMedCrossRef
14.
Vitale AT, Graham E, de Boer JH. Juvenile idiopathic arthritis-associated uveitis: clinical features and complications, risk factors for severe course, and visual outcome. Ocul Immunol Inflamm. 2013;21(6):478–85.PubMedCrossRef
15.
Paroli MP, Abbouda A, Restivo L, Sapia A, Abicca I, Pivetti Pezzi P. Juvenile idiopathic arthritis-associated uveitis at an Italian tertiary referral center: clinical features and complications. Ocul. Immunol. Inflamm. 2015;23(1):74–81.PubMedCrossRef
16.
Kump LI, Castañeda RA, Androudi SN, Reed GF, Foster CS. Visual outcomes in children with juvenile idiopathic arthritis-associated uveitis. Ophthalmology. 2006;113(10):1874–7.PubMedCrossRef
17.
Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS. Visual outcomes prognosticators in juvenile rheumatoid arthritis-associated uveitis. Ophthalmology. 1997;104(2):236–44.PubMedCrossRef
18.
Gregory AC 2nd, Kempen JH, Daniel E, Kaçmaz RO, Foster CS, Jabs DA, et al. Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group. Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the systemic immunosuppressive therapy for eye diseases study. Ophthalmology. 2013;120(1):186–92.PubMedCrossRef
19.
Edelsten C, Lee V, Bentley CR, Kanski JJ, Graham EM. An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. Br J Ophthalmol. 2002;86(1):51–6.PubMedPubMedCentralCrossRef
20.
Sabri K, Saurenmann RK, Silverman ED, Levin AV. Course, complications, and outcome of juvenile arthritis-related uveitis. J AAPOS. 2008;12(6):539–45.PubMedCrossRef
21.
Saurenmann RK, Levin AV, Feldman BM, Rose JB, Laxer RM, Schneider R, et al. Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term followup study. Arthritis Rheum. 2007;56(2):647–57.PubMedCrossRef
22.
Denniston AK, Keane PA, Srivastava SK. Biomarkers and surrogate endpoints in uveitis: the impact of quantitative imaging. Invest Ophthalmol Vis Sci. 2017;58(6):BIO131-BIO140.CrossRef
23.
Campanilho-Marques R, Bogas M, Ramos F, Santos MJ, Fonseca JE. Prognostic value of antinuclear antibodies in juvenile idiopathic arthritis and anterior uveitis. Results from a systematic literature review. Acta Reumatol Port. 2014;39:116–22.PubMed
24.
Zulian F, Martini G, Falcini F, Gerloni V, Zannin ME, Pinello L, et al. Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. J Rheumatol. 2002;29(11):2446–53.PubMed
25.
Jawad S, Liu B, Agron E, Nussenblatt RB, Sen HN. Elevated serum levels of interleukin-17A in uveitis patients. Ocul. Immunol. Inflamm. 2013;21(6):434–9.PubMedPubMedCentralCrossRef
26.
Ayuso VK, de Boer JH, Byers HL, Coulton GR, Dekkers J, de Visser L, et al. Intraocular biomarker identification in uveitis associated with juvenile idiopathic arthritis. Invest Ophthalmol Vis Sci. 2013;54(5):3709–20.CrossRef
27.
Angeles-Han ST, Griffin KW, Harrison MJ, Lehman TJ, Leong T, Robb RR, et al. Development of a vision-related quality of life instrument for children ages 8-18 years for use in juvenile idiopathic arthritis-associated uveitis. Arthritis Care Res (Hoboken). 2011;63(9):1254–61.PubMedPubMedCentralCrossRef
28.
Angeles-Han ST, Yeh S, McCracken C, Jenkins K, Stryker D, Myoung E, et al. Measuring visual outcomes in children with uveitis using the “effects of youngsters’ eyesight on quality of life” questionnaire. Arthritis Care Res (Hoboken). 2015;67(11):1513–20.PubMedPubMedCentralCrossRef
29.
Sen ES, Morgan MJ, MacLeod R, Strike H, Hinchcliffe A, Dick AD, et al. Cross sectional, qualitative thematic analysis of patient perspectives of disease impact in juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J. 2017;15(1):58.PubMedPubMedCentralCrossRef
30.
Holland GN, Denove CS, Yu F. Chronic anterior uveitis in children: clinical characteristics and complications. Am J Ophthalmol. 2009;147(4):667–78.PubMedCrossRef
31.
Holland GN. A reconsideration of anterior chamber flare and its clinical relevance for children with chronic anterior uveitis: an American ophthalmological society thesis. Trans Am Ophthalmol Soc. 2007;105:344–64.PubMedPubMedCentral
32.
Taylor SR, Lightman SL, Sugar EA, Jaffe GJ, Freeman WR, Altaweel MM. The impact of macular edema on visual function in intermediate, posterior, and panuveitis. Ocul Immunol Inflamm. 2012;20:171–81.PubMedPubMedCentralCrossRef
33.
Sugar EA, Jabs DA, Altaweel MM, Lightman SL, Acharya N, Vitale AT, et al. For the multicenter uveitis steroid treatment (MUST) trial research group. Identifying a clinically meaningful threshold for change in uveitic macular edema evaluated by optical coherence tomography. Am J Ophthalmol. 2011;152:1044–52.PubMedPubMedCentralCrossRef
34.
Kiss CG, Barisani-Asenbauer T, Maca S, Richter-Mueksch S, Radner W. Reading performance of patients with uveitis- associated cystoid macular edema. Am J Ophthalmol. 2006;142:620–4.PubMedCrossRef
35.
Munk M, Kiss C, Huf W, Sulzbacher F, Bolz M, Sayegh R, et al. Therapeutic interventions for macular diseases show characteristic effects on near and distance visual function. Retina. 2013;33:1915–22.PubMedCrossRef
36.
Sharma S, Lowder CY, Vasanji A, Baynes K, Kaiser PK, Srivastava SK. Automated analysis of anterior chamber inflammation by spectral-domain optical coherence tomogra- phy. Ophthalmology. 2015;122:1464–70.PubMedCrossRef
37.
Agarwal A, Ashokkumar D, Jacob S, Saravanan Y. High-speed optical coherence tomography for imaging anterior chamber inflammatory reaction in uveitis: clinical correlation and grading. Am J Ophthalmol. 2009;147:413–6.PubMedCrossRef
38.
39.
Igbre AO, Rico MC, Garg SJ. High-speed optical coherence tomography as a reliable adjuvant tool to grade ocular anterior chamber inflammation. Retina. 2014;34:504–8.PubMedCrossRef
40.
Ramanan AV, Dick AD, Jones AP, et al. For the SYCAMORE study group, adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis. N Engl J Med. 2017;376:1637–46.PubMedCrossRef
41.
Quartier P, Baptiste A, Despert V, et al. ADJUVITE: a double-blind, randomised, placebo controlled trial of adalimumab in early onset, chronic, juvenile idiopathic arthritis-associated anterior uveitis. Ann Rheum Dis. 2018;77:1003–11.PubMedCrossRef
42.
Sinha I, Jones L, Smyth RL, Williamson PR. A systemic review of studies that aim to determine which outcomes to measure in clinical trials in children. PLoS Med. 2008;5:e96.PubMedPubMedCentralCrossRef
43.
Williamson PR, Altman DG, Blazeby JM, Clarke M, Devane D, Gargon E, et al. Developing core outcome sets for clinical trials: issues to consider. Trials. 2012;13:132.PubMedPubMedCentralCrossRef
44.
45.
de Wit M, Kirwan JR, Tugwell P, Beaton D, Boers M, Brooks P, et al. Successful stepwise development of patient research partnership: 14 Years' experience of actions and consequences in outcome measures in rheumatology (OMERACT). Patient. 2017;10(2):141–52.PubMedCrossRef
Metadata
Title
Defining outcome measures in juvenile idiopathic arthritis associated uveitis by a systematic review analysis: do we need a consensus?
Authors
Greta Mastrangelo
Ivan Foeldvari
Jordi Anton
Gabriele Simonini
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Pediatric Rheumatology / Issue 1/2019
Electronic ISSN: 1546-0096
DOI
https://doi.org/10.1186/s12969-019-0330-9

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