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An Update on Treatment of Pediatric Chronic Non-infectious Uveitis

  • Pediatric Rheumatology (M Becker and J Harris, Section Editors)
  • Published:
Current Treatment Options in Rheumatology Aims and scope Submit manuscript

Opinion statement

There are no standardized treatment protocols for pediatric non-infectious uveitis. Topical corticosteroids are the typical first-line agent, although systemic corticosteroids are used in intermediate, posterior, and panuveitic uveitis. Corticosteroids are not considered to be long-term therapy due to potential ocular and systemic side effects. In children with severe and/or refractory uveitis, timely management with higher dose disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents is important. Increased doses earlier in the disease course may lead to improved disease control and better visual outcomes. In general, methotrexate is the usual first-line steroid-sparing agent and given as a subcutaneous weekly injection at >0.5 mg/kg/dose or 10–15 mg/m2 due to better bioavailability. Other DMARDs, for instance mycophenolate, azathioprine, and cyclosporine, are less common treatments for pediatric uveitis. Anti-tumor necrosis factor-alpha agents, primarily infliximab and adalimumab, are used as second-line agents in children refractory to methotrexate or as first-line treatment in those with severe complicated disease at presentation. Infliximab may be given at a minimum of 7.5 mg/kg/dose every 4 weeks after loading doses, and up to 20 mg/kg/dose. Adalimumab may be given up to 20 or 40 mg weekly. In children who fail anti-tumor necrosis factor-alpha agents, develop anti-tumor necrosis factor-alpha antibodies, experience adverse effects, or have difficulty with tolerance, there is less data available regarding subsequent treatment. Promising results have been noted with tocilizumab infusions every 2–4 weeks, abatacept monthly infusions, and rituximab.

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Authors and Affiliations

  1. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, US

    Arjun B. Sood MD

  2. Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 4010, Cincinnati, OH, 45229, USA

    Sheila T. Angeles-Han MD, MSc

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  1. Arjun B. Sood MD
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Correspondence to Sheila T. Angeles-Han MD, MSc.

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Arjun B. Sood, MD, and Sheila T. Angeles-Han, MD, MSc, declare that they have no conflict of interest.

Dr. Angeles-Han was supported by Award Number K23EY021760 from the National Eye Institute and also by a grant from the American College of Rheumatology Research and Education Foundation Career Development Bridge Funding Award. However, these did not support this study.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Sood, A.B., Angeles-Han, S.T. An Update on Treatment of Pediatric Chronic Non-infectious Uveitis. Curr Treat Options in Rheum 3, 1–16 (2017). https://doi.org/10.1007/s40674-017-0057-z

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