Literature Review

Pathogenesis and treatments of juvenile idiopathic arthritis-associated uveitis

  • ZHAO Fulin ,
  • JIANG Li
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  • The First Hospital of Lanzhou University, Lanzhou 730000, Gansu, China

Received date: 2024-09-23

  Accepted date: 2024-11-19

  Online published: 2025-05-09

Abstract

Juvenile idiopathic arthritis-associated uveitis (JIA-U) is a prevalent non-infectious autoimmune uveitis among children under the age of 16. The principal pathogenesis lies in the interaction between genetic and environmental factors, resulting in autoimmune dysregulation within the body. Under the collective influence of these factors, the autoimmune response in JIA patients may disrupt peripheral immune tolerance and the blood-retinal barrier, leading to the infiltration of T and B cells and their subsets into the ocular tissues of patients. Through reacting to specific retinal antigens, the production of highly specific autoantibodies, and secreting cytokines such as tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), it promotes the occurrence and progression of ocular tissue inflammation, and in severe cases, poses a threat to the patient's vision. The initial treatment for JIA-U is based on a stepwise strategy, with corticosteroids as the first-line drug, combined with methotrexate (MTX) for steroid-reduced systemic therapy. For patients intolerant to MTX or with suboptimal therapeutic responses, or those presenting with severe vision-threatening complications, biological disease-modifying antirheumatic drugs (bDMARDs) can be added or substituted. TNF-α inhibitors, IL-6 receptor inhibitors, and Janus kinase inhibitors are commonly utilized bDMARDs for refractory JIA-U or patients unresponsive to MTX. Additionally, T-cell co-stimulation modulators and anti-CD20 monoclonal antibodies may also prove effective for refractory JIA-U or patients unresponsive to MTX. Future studies are requisite to further investigate the mechanism of action, safety, and efficacy of these biological agents in JIA-U, in order to provide more effective therapeutic references.

Cite this article

ZHAO Fulin , JIANG Li . Pathogenesis and treatments of juvenile idiopathic arthritis-associated uveitis[J]. Journal of Clinical Pediatrics, 2025 , 43(5) : 376 -382 . DOI: 10.12372/jcp.2025.24e1008

References

[1] Maleki A, Patel PD, Foster CS. Juvenile idiopathic arthritis and its associated uveitis[J]. Expert Rev Clin Immunol, 2023, 19(9): 1157-1169.
[2] M Bani Khalaf I, Jain H, Vora NM, et al. A clearer vision: insights into juvenile idiopathic arthritis-associated uveitis[J]. Proc (Bayl Univ Med Cent), 2024, 37(2): 303-311.
[3] 曹兰芳, 李会珍. 幼年特发性关节炎相关葡萄膜炎临床实践相关指南解读[J]. 中华实用儿科临床杂志, 2024, 39(8): 576-578.
  Cao LF, Li HZ. Interpretation of clinical practice-related guidelines for uveitis associated with juvenile idiopathic arthritis[J]. Zhonghua Shiyong Erke Linchuang Zazhi, 2024, 39(8): 576-578.
[4] Maleki A, Anesi SD, Look-Why S, et al. Pediatric uveitis: a comprehensive review[J]. Surv Ophthalmol, 2022, 67(2): 510-529.
[5] ElMohsen MNA, Hassan LM, Youssef MM, et al. The efficacy of anti-TNF-α agents in the treatment of juvenile idiopathic arthritis-associated uveitis in a pediatric cohort[J]. Indian J Ophthalmol, 2023, 71(5): 2168-2174.
[6] Skarin A, Berthold E, Rauer O, et al. Uveitis associated with juvenile arthritis: a continued cohort study 40 years after uveitis onset[J]. Pediatr Rheumatol Online J, 2022, 20(1): 47.
[7] Van Meerwijk C, Kuiper J, van Straalen J, et al. Uveitis associated with juvenile idiopathic arthritis[J]. Ocul Immunol Inflamm, 2023, 31(10): 1906-1914.
[8] Leinonen S. A Nordic screening guideline for juvenile idiopathic arthritis-related uveitis[J]. Acta Ophthalmol, 2023, 101(4): 465-468.
[9] Van Straalen JW, Kearsley-Fleet L, Klotsche J, et al. Development and external validation of a model predicting new-onset chronic uveitis at different disease durations in juvenile Idiopathic arthritis[J]. Arthritis Rheumatol, 2023, 75(2): 318-327.
[10] 曹雨金, 方旺, 梁芳芳, 等. 幼年特发性关节炎相关葡萄膜炎42例临床特征及视力预后因素分析[J]. 中国实用儿科杂志, 2022, 37(7): 512-515.
  Cao YJ, Fang W, Liang FF, et al. Analysis of clinical characteristics and visual outcome factors in 42 cases of uveitis associated with juvenile idiopathic arthritis[J]. Zhongguo Shiyong Erke Zazhi, 2022, 37(7): 512-515.
[11] Liebling EJ, Faig W, Chang JC, et al. Temporal relationship between juvenile idiopathic arthritis disease activity and uveitis disease activity[J]. Arthritis Care Res (Hoboken), 2022, 74(3): 349-354.
[12] Maccora I, Land P, Miraldi Utz V, et al. Therapeutic potential of JAK inhibitors in juvenile idiopathic arthritis-associated uveitis[J]. Expert Rev Clin Immunol, 2023, 19(7): 689-692.
[13] Bolletta E, Coassin M, Iannetta D, et al. Cataract surgery with intraocular lens implantation in juvenile idiopathic arthritis-associated uveitis: outcomes in the era of biological therapy[J]. J Clin Med, 2021, 10(11): 2437.
[14] 尹光年. 在实验性自身免疫性葡萄膜炎(EAU)模型中亲代葡萄膜炎对子代发育和患葡萄膜炎易感性的影响[D]. 重庆: 重庆医科大学, 2020.
  Yin GN. Effect of parental uveitis on offspring development and susceptibility to developing uveitis in an experimental autoimmune uveitis (EAU) model[D]. Chongqing: Chongqing Medical University, 2020.
[15] Iannone C, Marelli L, Costi S, et al. Tocilizumab in juvenile idiopathic arthritis associated uveitis, a narrative review[J]. Children (Basel), 2023, 10(3): 434.
[16] Wennink RAW, De Boer JH, Hiddingh S, et al. Next-generation HLA sequence analysis uncovers shared risk alleles between clinically distinct forms of childhood uveitis[J]. Invest Ophthalmol Vis Sci, 2021, 62(9): 19.
[17] Wennink RAW, Pandit A, Haasnoot AJW, et al. Whole transcriptome analysis reveals heterogeneity in B cell memory populations in patients with juvenile idiopathic arthritis-associated uveitis[J]. Front Immunol, 2020, 11: 2170.
[18] 陈亮, 吕翼. 外周免疫耐受机制的研究进展及其应用[J]. 生物学教学, 2023, 48(6): 4-7.
  Chen L, Lyu Y. Progress in the mechanism of peripheral immune tolerance and its application[J]. Shengwuxue Jiaoxue, 2023, 48(6): 4-7.
[19] 袁晨, 张梅, 谢学军. 血-视网膜内屏障体外模型构建研究进展[J]. 国际眼科杂志, 2021, 21(6): 991-995.
  Yuan C, Zhang M, Xie XJ. Progress in in vitro model construction of blood-endoreetinal barrier[J]. Guoji Yanke Zazhi, 2021, 21(6): 5.
[20] Walscheid K, Neekamp L, Heiligenhaus A, et al. Increased circulating proinflammatory T lymphocytes in children with different forms of anterior uveitis: results from a pilot study[J]. Ocul Immunol Inflamm, 2019, 27(5): 788-797.
[21] Busch M, Wefelmeyer KL, Walscheid K, et al. Identification of ocular autoantigens associated with juvenile idiopathic arthritis-associated uveitis[J]. Front Immunol, 2019, 10: 1793.
[22] 杨园缘, 王芷若, 陈功, 等. B细胞在非感染性葡萄膜炎中的研究进展[J]. 国际眼科杂志, 2024, 24(5): 718-722.
  Yang YY, Wang ZR, Chen G, et al. B cells in noninfectious uveitis[J]. Guoji Yanke Zazhi, 2024, 24(5): 718-722.
[23] Wildschütz L, Ackermann D, Witten A, et al. Transcriptomic and proteomic analysis of iris tissue and aqueous humor in juvenile idiopathic arthritis-associated uveitis[J]. J Autoimmun, 2019, 100: 75-83.
[24] 赵文燕, 佘磊. 幼年特发性关节炎相关性葡萄膜炎患儿外周血CDld(hi)CD5+CD19+调节性B细胞的变化及意义[J]. 国际眼科杂志, 2022, 22(1): 34-38.
  Zhao WY, She L. Changes and significance of CD5+ CD19+ regulatory B cells in children with juvenile idiopathic arthritis-related uveitis[J]. Guoji Yanke Zazhi, 2022, 22(1): 34-38.
[25] Wang J, Wu H, Liu X, et al. Effect of LPS on cytokine secretion from peripheral blood monocytes in juvenile idiopathic arthritis-associated uveitis patients with positive antinuclear antibody[J]. J Immunol Res, 2021: 6691681.
[26] Arve-Butler S, Mossberg A, Kahn F, et al. Identification of novel autoantigens as potential biomarkers in juvenile idiopathic arthritis associated uveitis[J]. Front Pediatr, 2022, 10: 1091308.
[27] Angeles-Han ST, Utz VM, Thornton S, et al. S100 proteins, cytokines, and chemokines as tear biomarkers in children with juvenile idiopathic arthritis-associated uveitis[J]. Ocul Immunol Inflamm, 2021, 29(7-8): 1616-1620.
[28] Wu CY, Yang HY, Huang JL, et al. Signals and mechanisms regulating monocyte and macrophage activation in the pathogenesis of juvenile idiopathic arthritis[J]. Int J Mol Sci, 2021, 22(15): 7960.
[29] Mapelli C, Miserocchi E, Nassisi M, et al. Predictors of lack of response to methotrexate in juvenile idiopathic arthritis associated uveitis[J]. Rheumatology (Oxford), 2025, 64(2): 798-804..
[30] 沈志军, 沈琳, 曹绪胜, 等. 阿达木单抗治疗难治性幼年特发性关节炎相关葡萄膜炎12个月效果观察[J]. 眼科, 2023, 32(4): 320-325.
  Shen ZJ, Shen L, Cao XS, et al. Effect of adalimumab on refractory juvenile idiopathic arthritis associated with uveitis[J]. Yanke, 2023, 32(4): 320-325.
[31] Horton S, Jones AP, Guly CM, et al. Adalimumab in juvenile idiopathic arthritis-associated uveitis: 5-year follow-up of the bristol participants of the SYCAMORE trial[J]. Am J Ophthalmol, 2019, 207: 170-174.
[32] 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[J]. Ann Rheum Dis, 2018, 77(7): 1003-1011.
[33] Al-Julandani DA, Bagri NK, Tsang N, et al. Outcome of adalimumab monotherapy in paediatric non-infectious uveitis[J]. Pediatr Rheumatol Online J, 2023, 21(1): 21.
[34] Dini G, Dell'Isola GB, Beccasio A, et al. Biologic therapies for juvenile idiopathic arthritis-associated uveitis[J]. Front Ophthalmol (Lausanne), 2022, 2: 954901.
[35] Ramanan AV, Dick AD, Guly C, et al. Tocilizumab in patients with anti-TNF refractory juvenile idiopathic arthritis-associated uveitis (APTITUDE): a multicentre, single-arm, phase 2 trial[J]. Lancet Rheumatol, 2020, 2(3): e135-e141.
[36] Maleki A, Manhapra A, Asgari S, et al. Tocilizumab employment in the treatment of resistant juvenile idiopathic arthritis associated uveitis[J]. Ocul Immunol Inflamm, 2021, 29(1): 14-20.
[37] Schwartz DM, Kanno Y, Villarino A, et al. JAK inhibition as a therapeutic strategy for immune and inflammatory diseases[J]. Nat Rev Drug Discov, 2017, 16(12): 843-862.
[38] 佘重阳, 卢弘. Janus激酶抑制剂在幼年特发性关节炎相关葡萄膜炎治疗中的研究进展[J]. 中华眼科医学杂志(电子版), 2023, 13(2): 104-108.
  She CY, Lu H. Progress of Janus kinase inhibitors in the treatment of uveitis associated with juvenile idiopathic arthritis[J]. Zhonghua Yanke Yixue Zazhi (electronic form), 2023, 13(2): 104-108.
[39] Miserocchi E, Giuffrè C, Cornalba M, et al. JAK inhibitors in refractory juvenile idiopathic arthritis-associated uveitis[J]. Clin Rheumatol, 2020, 39(3): 847-851.
[40] Keam S, Turner N, Kugeratski FG, et al. Toxicity in the era of immune checkpoint inhibitor therapy[J]. Front Immunol, 2024, 15: 1447021.
[41] Quiruz L, Yavari N, Kikani B, et al. Ophthalmic immune-related adverse events and association with survival: results from a real-world database[J]. Am J Ophthalmol, 2024, 268: 348-359.
[42] Chong AS, Habal MV. From bench to bedside: reversing established antibody responses and desensitization[J]. Curr Opin Organ Transplant, 2022, 27(5): 376-384.
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