Elsevier

The Journal of Pediatrics

Volume 149, Issue 6, December 2006, Pages 833-836
The Journal of Pediatrics

Original article
Risk of new-onset uveitis in patients with juvenile idiopathic arthritis treated with anti-TNFα agents

https://doi.org/10.1016/j.jpeds.2006.08.044Get rights and content

Objective

To determine whether treatment with tumor necrosis factor alpha (TNFα)–blocking agents alters the incidence of new-onset uveitis in patients with juvenile idiopathic arthritis (JIA).

Study design

Cohort study based on retrospective chart review. The charts of all 1109 patients with a diagnosis of JIA seen between January 1, 1996, and June 30, 2003, at our clinic were reviewed for diagnosis of uveitis and treatment with TNFα inhibitors. Cox regression analysis was performed with anti-TNFα treatment as a time-dependent covariate for risk of development of uveitis.

Results

We identified 70 patients treated with anti-TNFα without a prior diagnosis of uveitis. Two of these 70 patients (2.9%), both treated with etanercept, had development of new-onset uveitis during anti-TNFα therapy. One had juvenile psoriatic arthritis diagnosed 4.1 years before onset of uveitis. The other had extended oligoarticular JIA diagnosed 6.4 years before onset of uveitis. We found no statistically significant difference in the risk for development of uveitis between patients with or without anti-TNFα treatment.

Conclusions

In our patients with JIA, anti-TNFα treatment did not alter the risk for development of new-onset uveitis. However, anti-TNFα therapy with etanercept did not prevent the development of uveitis in 2 patients.

Section snippets

Methods

The charts of all 1109 children with a diagnosis of JIA seen in the Rheumatology Clinic at The Hospital for Sick Children (HSC) in Toronto, Ontario, Canada, between January 1, 1996, and June 30, 2003, were reviewed for diagnosis of noninfectious uveitis and for treatment with an anti-TNFα agent (etanercept or infliximab).

We used the 1997 ILAR criteria for JIA subgroups to describe type of juvenile arthritis.2 Patients with a diagnosis before the use of the ILAR criteria were assigned to a

Results

The total cohort of patients consisted of 1109 patients, of whom 145 patients (13.1%) had development of uveitis and 87 patients (7.8%) received anti-TNFα therapy. Seventy patients were treated with an anti-TNFα agent without a prior diagnosis of uveitis (Table I). Forty-eight of the 70 patients (68.6%) were treated with etanercept, 13 of 70 (18.6%) with infliximab, and 9 of 70 (12.9%) with both etanercept and infliximab consecutively (6 with etanercept followed by infliximab and 3 with

Discussion

TNFα-blocking agents are increasingly used to treat children with JIA refractory to conventional therapy. Although most reports have demonstrated resolution of refractory uveitis with anti-TNFα, cases of new-onset uveitis or uveitis flares after initiation of anti-TNFα therapy have been reported.5, 6, 7, 8 This has led to the concern that treatment with TNFα inhibitors may lead to an increased risk for the development of uveitis in patients with JIA. In our study of a large cohort of patients

References (9)

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Cited by (0)

Supported by the Swiss arthritis society (Schweizerische Rheumaliga), Stiftung Sanitas (Switzerland) and Brandan’s Eye Research Fund.

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