Early methotrexate treatment in JIA-related uveitis

Purpose: The treatment of chronic uveitis in Juvenile Idiopathic Arthritis (JIA) is still a challenge for ophthalmologists. Methotrexate (MTX), widely used in JIA, has been recently introduced as a second–line agent for the treatment of sight–threatening uveitis. We report the preliminary results of a prospective study on the early MTX treatment of uveitis in children with oligoarticular JIA. Methods: Patients with severe course uveitis lasting less than 6 months have been treated with MTX at a standard dose of 10 mg/m2/week orally (group 1). The control group consisted in patients with severe long–standing eye involvement treated with MTX at the same dosage (group 2). Data on demographics, number of relapses, ocular complications and drug–related side effects were reported. Results: Nine patients (6F, 3M) entered the study. In all but one uveitis was detected before or at onset of arthritis. The age at onset of uveitis was comparable in both groups and ranged between 21 and 93 months. The follow–up period ranged between 10 and 128 months. In Group 1, including 6 patients, mean disease duration was 1.5 months, mean age was 49 months and mean follow–up was 16.8 months. Group 2, including 3 patients, received MTX treatment between 72 and 108 months after the onset of uveitis, mean age 120–192 months and follow–up 38.6 months. In Group 1, only one patient experienced no relapse during the study period; the remaining patients had 1 to 4 relapses. In the second group, 2 patients presented 1 and 2 relapses, respectively and one patient had 5 relapses. Two cases in each group developed synechiae. One case, included in Group 2, progressed towards a panuveitis despite of treatment. No major side effects during the MTX treatment have been reported in both groups. Conclusions: To our knowledge this represents the first prospective study on the early MTX treatment for JIA–related uveitis. Our preliminary data suggest that MTX does not significantly influence the course of uveitis in JIA even if introduced earlier. Further randomized studies on larger series are needed to confirm this observation.