Session Type: Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: To determine the association between the occurrence of uveitis flares in patients with Juvenile Idiopathic Arthritis (JIA) and the de-intensification of immunosuppressive treatment.
Methods: We conducted a retrospective longitudinal cohort study, including a single-centre consecutive cohort of patients diagnosed with oligoarticular JIA antinuclear antibody (ANA) positive, who had had at least one uveitis flare during their follow-up up to 19.5 years. Patiens with the same JIA category, ANA positive, with no history of uveitis flare were considered controls. Epidemiological data, age of first uveitis flare, number of previous episodes, treatments prescribed at the time of the flare and time since the last treatment modification were recorded. Treatment tapering was defined as a reduction in dose or increase in the inter-doses period, according to datasheet of the corresponding treatment. The relative risk (RR) for the development of uveitis flare and treatment tapering were determined by contingency tables.
Results: We included 68 patients of which 22 had had uveitis flares during their follow-up, and 46 controls. The mean age of patients at JIA diagnosis was3.56 ± 2.17 years. A total of 107 uveitis flares were recorded with an average of 4.54 ± 4.70 episodes per patient. The first uveitis flare was registered at an average age of 6.57 ± 5.79 years. Four patients (18.1%) had had only one episode. Among patients with more than one flare, the inter-flare period was 17.84 ± 21.8 months. Thirty flares (27%) were registered in patients without immunosuppressive treatment. Twenty patients (90%) required the initiation of biological therapy specific for uveitis. Adalimumab (ADA) was chosen in 19 (86.3%) patienst and avoided further uveitis flares in 15 (68%) cases. Treatment with Tocilizumab (TCZ) was used in 6 (27.7%) cases and avoided further uveitis flares in 5 (27.3%). Thirty-three episodes (33.1%) were registered in patients with Methotrexate (MTX) of which, 8 (7.5%) were receiving doses below datasheet (< 10mg/m2). Forty-four uveitis flares (41%) took place in patients on biological treatment, of which 27 were receiving ADA (25.3%), 2 (1.9%) TCZ and 15 (14%) other therapies. Thirty-seven flares (32.1%) took place in patients on tapered treatments and 11 (10.3%) after non scheduled withdrawal. In terms of risk of developing a new uveitis flare, tapering had a RR of 2.79 (CI 2.01-3.7; P< 0.05) while therapy withdrawal had a RR of 5.91 (CI 3.23-10.8; P< 0.05). MTX tapering had a RR of 12.5 (CI 6.4-24.5 P< 0.05). Patients with ADA had a RR of 0.88 (CI 0.4-1.6; P=0.84) of developing uveitis flares, with TCZ a RR of 4,65 (CI 1.2-17.8; P< 0.05) and with other biological therapy (Etanercept, Infliximab, Abatacept) a RR of 3.56 (CI 2.05-6.2; P< 0.05).
Conclusion: Tapering immunosuppressive treatment in oligoarticular JIA ANA positive patients, increases the risk of developing uveitis flares.
To cite this abstract in AMA style:Teran M, Boteanu A, Guillen C, Pijoan C, Quinones J, Garcia V, Del Bosque-Granero I, Calvo-Sanz L, Vázquez M. To Taper or Not to Taper in Juvenile Idiopathic Arthritis: Is There a Risk of Development of Uveitis Flares? [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/to-taper-or-not-to-taper-in-juvenile-idiopathic-arthritis-is-there-a-risk-of-development-of-uveitis-flares/. Accessed November 23, 2020.
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