Background/Purpose:

Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA), often entirely asymptomatic but could be sight-threatening. The most often prescribed biologics in JIA patients without eye involvement is etanercept, which has not effective the uveitis control. Due to known information about new onset of uveitis during etanercept treatment the question about the role of etanercept in new onset of uveitis is still open.The aim of our study was to evaluate the risk of new onset of uveitis in JIA during different types of treatment.

Methods: The clinical charts of all consecutive patients (n=413) who had received a stable management for at least 2 years with or without MTX or etanercept were reviewed. Patients who were given systemic corticosteroids were excluded. Patients with systemic arthritis, rheumatoid factor-positive arthritis, or enthesitis-related arthritis were also excluded. In each patient, the al least 2-year follow-up period after first visit was examined to establish whether uveitis had occurred. All patients according the treatment were divided in 3 groups: i) patients, who received only NSAID and/or intraarticular corticosteroids (IAC) – “no MTX” group; ii) patients who treated with MTX (NASID and IAC were allowed) – “MTX” group; iii) patients, who treated with etenercept (with or without MTX) – “etanercept” group. For statistical analysis we utilized Cox’s regression models, Log-Rank test, x2 test and Mann-Whitny test. Data are presented by median and interquartile range.

Results: data of comparison three lines of treatment are presented in the table. In the comparison of treatment curves there was a differences in probability of new onset of uveitis (p=0.00001). There were no differences in the time before uveitis in three groups (p=0.45). After paired comparison of the treatment arms, there were no difference between “MTX” and “Etanercept” groups RR=1.47 (0.54-4.0), p=0.46 and were differences between “No MTX” vs “MTX” RR=4.0 (2.4;6.7), p=0.00001 and “No MTX” vs “Eta” RR=2.0 (1,2;3.3), p=0.002. After adjustment on ANA status, oligoarthicular disease course and JIA onset age<5 years we found out differences. For ANA positive patients RR=3.2 (2.0; 5.3), p=0.000001, LogRank test p=0.048 compare to ANA-negative persons. In the regression models “No MTX” vs “MTX” RR=3.8 (2.1; 6.7), p=0.000006, “No MTX” vs “Eta” RR=2.3 (1.2;4.2), p=0.01; “MTX” vs “Eta” RR=2.2 (0.6;7.8), p=0.206. For patients with oligoarthicular disease course RR=2.9 (1.9;4.6), p=0.000002, LogRank test p=0.005. In the regression models “No MTX” vs “MTX” RR=3.7 (2.2;6.4), p=0.000001, “No MTX” vs “Eta” RR=1.9 (1.1;3.2), p=0.02; “MTX” vs “Eta” RR=1.3 (0.46;3.5), p=0.65. For JIA patients less than 5 years RR = 2.8 (1.9;4.4); p=0.000002, LogRank test, p=0.18. In the regression models “No MTX” vs “MTX” RR=3.6 (2.1;6.0), p=0.000002, “No MTX” vs “Eta” RR=2.0 (1.2;3.3), p=0.006; “MTX” vs “Eta” RR=1.4 (0.5;3.9), p=0.5.

Conclusion: the incidence of new onset of uveitis in the etanercept group is the lowest and compare to JIA patients treated with MTX. More likely new onset of uveitis is related to JIA pathogenesis rather etanercept treatment. Firther investigation and randomized controlled trials required.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/new-onset-of-uveitis-in-non-methotrexate-group-methotrexate-group-and-etanercept-group-in-juvenile-idiopathic-arthritis/