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Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis

¹ Department of Opthalmology, Rheumatism Foundation Hospital, Heinola, Finland
² Department of Pediatric Rheumatology, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
³ Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland

Correspondence to:
Correspondence to:
Dr P Tynjälä
Research Unit, Hospital for Children and Adolescents, Biomedicum 2 Helsinki, 5th Floor, PO Box 448 (Tukholmankatu 8A) Helinski, 00029 HUS, Finland; pirjo.tynjala{at}hus.fi

ABSTRACT
Objective: To evaluate the efficacy of anti-tumour necrosis factor (anti-TNF) treatment in juvenile idiopathic arthritis (JIA)-associated uveitis.

Methods: 24 patients with uveitis taking etanercept and 21 taking infliximab were studied. The endpoint ophthalmological evaluation was at 24 months or at the termination of the first biological agent. The ocular inflammatory activity was graded on the basis of the number of anterior chamber cells.

Results: Of the 45 patients, uveitis improved in 14 (31%), no change was observed in 14 (31%) and the activity of uveitis increased in 17 (38%). Inflammatory activity improved more frequently (p = 0.047) in the patients taking infliximab than in those taking etanercept. The number of uveitis flares/year was higher (p = 0.015) in the patients taking etanercept (mean 1.4, range 0–3.2) than in those taking infliximab (mean 0.7, range 0–2). Uveitis developed for the first time while taking anti-TNF treatment in five patients—4 taking etanercept (2.2/100 patient-years) and 1 taking infliximab (1.1/100 patient-years).

Conclusions: During anti-TNF treatment, the ophthalmological condition improved in one-third of the patients with uveitis. In chronic anterior uveitis, associated with refractory JIA, infliximab may be more effective than etanercept.

Abbreviations: ANA, antinuclear antibody; DMARD, disease-modifying antirheumatic drug; JIA, juvenile idiopathic arthritis; MTX, methotrexate; TNF, tumour necrosis factor

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