Treating juvenile idiopathic arthritis (JIA)-related uveitis beyond TNF-α inhibition: a narrative review

Chronic anterior uveitis is the most frequent among extra-articular manifestations of juvenile idiopathic arthritis (JIA) and a\r\nrelevant cause of ocular morbidity in children. Asymmetric arthritis, early onset disease, female sex, and anti-nuclear antibody\r\n(ANA) positivity are counted among risk factors for developing this complication. It usually has insidious onset and asymptomatic\r\nchronic-relapsing course, but the persistence of low-grade chronic inflammation can lead to irreversible structural ocular\r\ndamage and to vision-threatening complications. For such reasons, achieving a complete absence of inflammation through early\r\ntargeted and aggressive treatments is a primary therapeutic goal in these patients. This review is aimed at summarizing scientific\r\nevidence about biologic rescue therapy of JIA-related uveitis in patients who fail to achieve clinical remission, in spite of being\r\ntreated with conventional disease-modifying anti-rheumatic drugs (cDMARDs) and at least one biologic tumor necrosis factor\r\n(TNF)-α inhibitor. Interleukin (IL)-6 inhibition appears a promising and safe option for refractory JIA-related uveitis. Abatacept\r\nand rituximab proved to be beneficial as well, but their efficacy together with some safety concerns needs to be more extensively\r\nevaluated.