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Uveitis bei juveniler idiopathischer Arthritis

Uveitis in juvenile idiopathic arthritis

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Zusammenfassung

Im Rahmen einer juvenilen idiopathischen Arthritis (JIA) tritt bei etwa 10% der Fälle meist eine anteriore Uveitis auf. Die Häufigkeit ist vom jeweiligen Subtyp der JIA abhängig. Am häufigsten findet sie sich bei Patienten mit einer Oligoarthritis vom „Extended-Typ“ (bis zu 25%) und einem frühen Manifestationsalter der Arthritis. Da die Uveitis meist ohne äußerlich erkennbare Zeichen verläuft und zu Komplikationen führt, müssen alle JIA-Patienten regelmäßigen augenärztlichen Untersuchungen unterzogen werden, um eine möglichst schnelle Diagnose und Therapie zu erwirken. Etwa 25% der Uveitispatienten weisen einen problematischen Verlauf auf und bedürfen einer systemischen Immunsuppression. Eine immunsuppressive Therapie sollte möglichst kurzfristig begonnen werden, falls nach 12 Wochen die lokale Glukokortikoid-Gabe nicht auf weniger als 3 Tropfen/Tag und die systemische Glukokortikosteroid-Therapie nicht unter 0,1 mg/kg Körpergewicht reduziert werden konnte. Zuerst wird Methotrexat als Basistherapie begonnen, bei Therapieversagen wird eine Intensivierung durch eine Kombinationstherapie mit Ciclosporin A und Biologika durchgeführt. Therapieziel ist es, eine Remission zu erzielen. Besonders schwierig ist das Management der typischen visusgefährdenden Komplikationen Katarakt, Glaukom, okuläre Hypotonie und Makulaödem.

Abstract

Anterior uveitis usually occurs in the context of juvenile idiopathic arthritis in about 10% of patients. Frequency is dependent on JIA subtype. Uveitis is most commonly found in patients with extended oligoarthritis (up to 25%) and early-age onset of arthritis. As the uveitis is usually without externally recognisable signs and often leads to ocular complications, all JIA patients should undergo regular ophthalmological examinations to ensure the promptest possible diagnosis and therapy. About 25% of uveitis patients have a complicated clinical course and require systemic immunosuppression. Immunosuppressive therapy should be started as early as possible if the dosage of topical glucocorticoids is not less than 3 drops per day and systemic glucocorticoid therapy is not less than 0.1 mg / kg body weight after 12 weeks. Methotrexate is commonly started as a first line immunosuppressive therapy. In the case of treatment failure, additional therapy can consist of combination therapy with cyclosporine A and biologicals. The main therapeutic goal is to achieve remission. Management of the typical vision-threatening complications such as cataract, glaucoma, ocular hypotension, and macular edema is particularly challenging.

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Heinz, C., Heiligenhaus, A., Kümmerle-Deschner, J. et al. Uveitis bei juveniler idiopathischer Arthritis. Z. Rheumatol. 69, 411–418 (2010). https://doi.org/10.1007/s00393-010-0656-7

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