Options in Tough-To-Treat Uveitis

Last week's articles on rheumatology topics in the major non-rheumatology journals.

Adalimumab therapy for refractory childhood uveitisJournal of the American Association for Pediatric Ophthalmology and Strabismus, October 2013

Treatment of chronic noninfectious uveitis in children-the trend toward tumor necrosis factor-alpha inhibitionJournal of the American Association for Pediatric Ophthalmology and Strabismus, October 2013

More than half of children with refractory uveitis responded to treatment with adalimumab (Humira), according to a small study. Most of the patients had juvenile idiopathic arthritis (JIA).

The drug controlled initial acute inflammatory activity in 60% of the 15 patients, according to the Standardization of Uveitis Nomenclature (SUN) Working group criteria. However, the drug was less effective long-term.

These patients had failed to respond to systemic steroids, methotrexate, cyclosporine, azathioprine, etanercept (Enbrel), and infliximab (Remicade).

Risk factors associated with the relapse of uveitis in patients with juvenile idiopathic arthritis: a preliminary reportJournal of the American Association for Pediatric Ophthalmology and Strabismus, October 2013

Immunomodulatory therapy (IMT) at an earlier age was associated with longer remission of uveitis in JIA.

This study reviewed the records of 30 patients with JIA who were successfully treated with IMT during 1990-2011, with corticosteroid-free remission of uveitis for at least one year.

A little more than half (57%) of the patients remained in remission, and almost half (43%) relapsed. Patients who had received IMT at an earlier age were more likely to go into remission.

Methotrexate monotherapy was sufficient to induce remission in 13 of 30 patients. Other drugs included mycophenolate mofetil, azathioprine, etanercept, infliximab, and chlorambucil.

Also new last week:

The Spectrum of Paraneoplastic Cutaneous Vasculitis in a Defined Population: Incidence and Clinical FeaturesMedicine, October 18, 2013

Among 766 patients with cutaneous vasculitis, 16 had an underlying malignancy in this case review. There were nine hematologic and seven solid underlying malignancies.

Skin cells were the initial presentation, usually palpable purpura. Hematologic cytopenias and immature peripheral blood cells were frequently observed in the full blood count.


High Prevalence of Prothrombotic Abnormalities in Multifocal Osteonecrosis: Description of a Series and Review of the LiteratureMedicine, October 18, 2013

Three to ten percent of patients with osteonecrosis have involvement of ≥3 anatomic sites.
In a retrospective study of 29 patients, 24% had high factor VIII levels, and 20% were positive for antiphospholipid antibody.