Outcomes of treatment of juvenile idiopathic arthritis related uveitis with TNF-alpha inhibitors

The aim of the study was to evaluate the efficacy of two anti-TNF-alpha biological agents: Adalimumab (humanized monoclonal anti-TNF-alpha antibody) and Infliximab (chimeric monoclonal antibody that binds both circulating and membrane-bound TNF-alpha receptors) in treatment of Juvenile Idiopathic Arthritis related uveitis. 37 children (73 % girls) with uveitis associated with aggressive forms of JIA who failed Methotrexate and topical treatment; Methotrexate and other immunosuppressive agents and systemic corticosteroids were included in the study. The age of patients at the beginning of biological therapies ranged 5-17 years. In ADA group the remission was observed in 61 % of cases, in 18 % we saw the reduction of flare-ups and in 14 % of children we registered exacerbation of the disease which was caused in most cases by discontinuation of non-biological drug. In INF group we observed remission in 78 % of the cases, no improvement in 22 %. The speed of remission in JIA associated uveitis treated with ADA and INF depended on the severity of uveitis, the time between the beginning of the disease and administration of immunosuppressive therapy. Early administration of anti-TNF-alpha agents, when there is no results from standard immunosuppressive therapy, allowed us to achieve remission in a shorter period of time and also allowed as to decrease the severity of complications of uveitis, as well as reduce the side effects of immunosuppressive therapy, especially of corticosteroids. This study needs to be continued to enroll more patients and to increase the follow-up time to evaluate the long-term efficacy and safety of anti-TNF-alpha agents in JIA associated uveitis.