engleski

The impact of selecting different outcome measure on the results of juvenile idiopathic arthritis associated uveitis treatment - the longitudinal observational study

The number of patients with juvenile idiopathic arthritis associated uveitis (JIA-U) on systemic immunomodulatory treatment (IMT) is relatively small, especially those who need IMT for disease control. Variabilities in the way patients are selected and the results presented in different studies on the effectiveness of IMT make it very difficult to compare studies with each other. Objectives: The aim of this study was to show on the same sample of JIA-U patients how different the obtained levels of therapy efficacy are depending on the selected definitions of outcomes in the long-term management with IMT. Methods: The longitudinal observational study with JIA-U patients treated with IMT was conducted at University Hospital Centre Zagreb in the period from 2011 to 2017. Results: We included 38 JIA-U patients aged 2 to 15 years and 69 eyes respectively, since 7 patients had unilateral JIA- U. Median (range) time of follow up was 209 (19- 381) weeks. At the first examination 46 (66.7%) eyes had grade ≤1+ of inflammation in anterior chamber (AC) according to Standardization of Uveitis Nomenclature (SUN) Working Group criteria, 11 (15.9%) had grade 2+, while 3 (4.4%) eyes had grade 3+ of inflammation. At baseline, 23 children (60.5%) had already received methotrexate (MTX) therapy and 8 (21.0%) biologics, while 4 (10.5%) children were treated with systemic glucocorticoids (GC). Topical glucocorticoids (TGC) in the form of drops were used to treat JIA- U in 61 (88.4%) eyes with a median of 4 daily doses. Most patients were treated concomitantly with GC ointment (75.4% of the eyes) with a median of 1 daily dose. Until the end of the follow-up, all children received MTX at least for some period, and 40% of patients were treated with biologics. The results of the effectiveness of IMT are presented according to the reduction of the need for TGC therapy and according to the achieved level of inflammation in AC. In the first 12 months of follow-up, among JIA-U patients treated with both biologics and MTX, in 65% of eyes there was no need for TGC therapy. Overall, in the 48th month of follow-up, in 50% of eyes there was no need for TGC therapy, and the rest required 1-2 daily doses of TGC. At the end of the first year, with MTX and biological therapy 75% of eyes had grade 0 of inflammation in AC and in 48th month 61.1% of eyes achieved grade 0 of inflammation. In the 12th month of application of biological therapy, in addition to MTX, in our study in 75% of eyes a grade 0 of inflammation was achieved with ≤2 doses of TGC, and in the 48th month in 61.1% of eyes. If the results are presented according to milder criteria, then in the 12th month of follow-up 90% of the eyes have a degree of inflammation ≤0.5+ with ≤2 doses of TGC, and in the 48th month all patients achieved a degree of inflammation ≤0.5+ with ≤2 doses of TGC. Conclusion: It was shown that the results of treatment outcomes during follow-up largely depend on the selected outcome measures, i.e. the criteria for the effectiveness of therapy. This will be important for future research because it suggests caution that in the pursuit of better results, setting different limits can lead to a more favorable outcome.

juvenile idiopathic arthritis ; uveitis ; efficacy, treatment ; outcome

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