中国实用儿科杂志

中国实用儿科杂志

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幼年特发性关节炎相关葡萄膜炎诊断和治疗

  

  1. 国家儿童医学中心（上海）  复旦大学附属儿科医院风湿科，上海  201102
  • 出版日期:2021-01-06 发布日期:2021-02-18

Diagnosis and treatment of uveitis related to juvenile idiopathic arthritis

  1. National Children’s Medical Center（Shanghai）；Department of Rheumatology，Children’s Hospital of Fudan University， Shanghai  201102， China
  • Online:2021-01-06 Published:2021-02-18

摘要： 幼年特发性关节炎（JIA）相关葡萄膜炎（JIA-U）是JIA的常见关节外并发症，以前葡萄膜炎多见，即虹膜睫状体炎，症状多隐匿，有致盲风险。儿童风湿科医生应加强对患者的科普宣教，并与眼专科医生紧密沟通和交流，在早期筛查、定期监测和恰当治疗三方面下功夫，维持JIA患儿的最佳视力和眼部健康。（1）筛查：根据JIA患儿不同个体的风险评估，确定眼科筛查的频度。（2）监测：建议对患有葡萄膜炎的JIA儿童进行定期的眼科监测，其间隔时间应以眼部检查结果和治疗方案为基础。（3）治疗：局部治疗，糖皮质激素应作为初始治疗，以达到控制炎症的目的。全身治疗、甲氨蝶呤和单克隆抗体类肿瘤坏死因子拮抗剂被推荐用于葡萄膜炎的全身治疗。局部治疗失败或依赖者，建议及时添加传统、生物制剂改善风湿病情的药物（DMARD），使有视力丧失风险的葡萄膜炎患儿尽快得到病情控制，避免失明。

关键词: 幼年特发性关节炎, 葡萄膜炎, 筛查, 监测, 生物制剂

Abstract: Juvenile idiopathic arthritis-associated uveitis（JIA-U）is a common extra-articular complication of JIA. Anterior uveitis is common，i.e.iridocyclitis，with hidden symptoms and risk of blindness. In order to maintain the best visual acuity and eye health of JIA children，pediatric rheumatologists should strengthen the education of patients，communicate with ophthalmologists closely，and make efforts in early screening，regular monitoring and appropriate treatment.（1）Screening：according to the risk assessment of different individuals with JIA，the frequency of ophthalmic screening was determined. （2）Monitoring：it is suggested that regular ophthalmic monitoring should be carried out for JIA children with uveitis，and the interval should be based on the results of eye examination and treatment plan. （3）Treatment：A. Topical treatment：glucocorticoids should be used as initial treatment to control inflammation； B. Systemic therapy：methotrexate and monoclonal antibody tumor necrosis factor antagonists are recommended for systemic treatment of uveitis. For patients with local treatment failure or dependence，it is recommended to add traditional and/or biological agents DMARDs in time to control the condition of uveitis children at risk of vision loss as soon as possible to avoid blindness.

Key words: juvenile idiopathic arthritis, uveitis, screening, monitoring, biologital agents