The 2021 Portuguese Society of Ophthalmology joint guidelines with Paediatric Rheumatology on the screening, monitoring and medical treatment of juvenile idiopathic arthritis-associated uveitis
Authors
Inês Leal; Vasco Miranda; Cristina Fonseca; João Barbosa-Breda; David Cordeiro Sousa; Paulo Mesquita-Marques; Joana Araújo; Marta Inês Silva; Ana Catarina Pedrosa; Jorge Palmares; Maria João Furtado; Mafalda Macedo; Vânia Lages; Sofia Fonseca; Rita Gonçalves; Miguel Ruão; Filipa Gomes Rodrigues; Miguel Ribeiro; Rui Proença; Mariana Almeida; Marco Liverani; Susana Morais Pina; Manuela Bernardo; Vanda Nogueira; Rita Guerra Pinto; Fernando Pinto Ferreira; Rita Pinto Proença; Isabel Domingues; Marta Guedes; Miguel Cordeiro; Filipe Fraga; Olga Berens; Tatiana Gregório; Iva Brito; Filipa Oliveira-Ramos; João Eurico Fonseca; Luís Figueira;
Aim: To develop the first Ophthalmology joint guidelines with Paediatric Rheumatology with recommendations on the screening, monitoring and medical treatment of juvenile idiopathic arthritis-associated uveitis (JIA-U), endorsed by the Portuguese Society of Ophthalmology (SPO).
Methods: A systematic literature review was conducted to include publications up to July 14th 2020, with no language restrictions, in order to include all the international position papers/guidelines concerning the medical management of JIA-U and randomised clinical trials assessing the efficacy and safety of medical treatment in this field. We searched through MEDLINE (PubMed), Scopus, Web of Science and Cochrane Library. The Delphi modified technique to generate consensus was used. Preliminary evidence statements were subject to an anonymous agreement assessment and discussion process using an online survey, followed by further discussion and update at a national meeting. A draft of the manuscript with all recommendations was then circulated among all participants and suggestions were incorporated. The final version was again circulated before publication.
Results: Twenty-six recommendations were developed focusing on the following topics: general management (3), screening and follow-up of uveitis (4), treatment (17) and health education in JIA-U among patients and families (2).
Conclusion: These guidelines were designed to support the shared medical management of patients with JIA-U and emphasize the need for a multidisciplinary approach between Ophthalmology and Paediatric Rheumatology regarding the comprehensive care of JIA-U. We acknowledge that updating these recommendations will be warranted in the future, as more evidence becomes available.
Key-words: juvenile idiopathic arthritis, uveitis, biological treatment, conventional immunosuppressive treatment, multidisciplinary management, guidelines, consensus, review, Delphi Technique
Inês Leal
Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Portugal; Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, FMUL, Portugal
Vasco Miranda
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
Cristina Fonseca
Centro de Responsabilidade Integrado de Oftalmologia, Centro Hospitalar e Universitário de Coimbra
João Barbosa-Breda
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal; UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal; KULeuven, Research Group Ophthalmology, Department of Neurosciences,
David Cordeiro Sousa
Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Portugal; Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina,
Paulo Mesquita-Marques
Ophthalmology Department, Hospital de Braga, Braga, Portugal; Ophthalmology Department, Instituto CUF Porto, Porto, Portugal
Joana Araújo
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
Marta Inês Silva
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
Ana Catarina Pedrosa
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Jorge Palmares
Hospital Lusíadas Porto, Porto Portugal
Maria João Furtado
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
Mafalda Macedo
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
Vânia Lages
Ophthalmology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
Sofia Fonseca
Ophthalmology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
Rita Gonçalves
Ophthalmology Department, Hospital Pedro Hispano, ULS Matosinhos, Portugal
Miguel Ruão
Ophthalmology Department, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
Filipa Gomes Rodrigues
Ophthalmology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
Miguel Ribeiro
Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Portugal
Rui Proença
Centro de Responsabilidade Integrado de Oftalmologia, Centro Hospitalar e Universitário de Coimbra; Faculdade de Medicina, Universidade de Coimbra, Centro Académico Clínico de Coimbra, Portugal
Mariana Almeida
Ophthalmology Department, Centro Hospitalar do Oeste, Caldas da Rainha, Portugal
Marco Liverani
Ophthalmology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
Susana Morais Pina
Ophthalmology Department, Hospital Beatriz Ângelo, Loures, Portugal
Manuela Bernardo
Ophthalmology Department, Hospital Prof Dr Fernando Fonseca EPE, Portugal
Vanda Nogueira
Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
Rita Guerra Pinto
Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
Fernando Pinto Ferreira
Ophthalmology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
Rita Pinto Proença
Ophthalmology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
Isabel Domingues
Ophthalmology Department, Hospital Lusíadas Lisboa, Portugal
Marta Guedes
Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
Miguel Cordeiro
Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
Filipe Fraga
Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
Olga Berens
Ophthalmology Department, Hospital do Espírito Santo, Évora, Portugal
Tatiana Gregório
Ophthalmology Department, Hospital Dr. Nélio Mendonça, SESARAM, Funchal, Portugal
Iva Brito
Paediatric Rheumatology and Young Adult Unit,Centro Hospitalar Universitário S. João, Porto, Portugal; 11Faculdade de Medicina da Universidade do Porto, Portugal
Filipa Oliveira-Ramos
Paediatric Rheumatology Unit, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade Lisboa
João Eurico Fonseca
Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa; Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Portugal
Luís Figueira
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Center for Drug Discovery and Innovative Medicines (MedInUP) of the University of Porto, Portugal
Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Portugal; Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, FMUL, Portugal
Vasco Miranda
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
Cristina Fonseca
Centro de Responsabilidade Integrado de Oftalmologia, Centro Hospitalar e Universitário de Coimbra
João Barbosa-Breda
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal; UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal; KULeuven, Research Group Ophthalmology, Department of Neurosciences,
David Cordeiro Sousa
Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Portugal; Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina,
Paulo Mesquita-Marques
Ophthalmology Department, Hospital de Braga, Braga, Portugal; Ophthalmology Department, Instituto CUF Porto, Porto, Portugal
Joana Araújo
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
Marta Inês Silva
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal
Ana Catarina Pedrosa
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Jorge Palmares
Hospital Lusíadas Porto, Porto Portugal
Maria João Furtado
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
Mafalda Macedo
Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
Vânia Lages
Ophthalmology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
Sofia Fonseca
Ophthalmology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
Rita Gonçalves
Ophthalmology Department, Hospital Pedro Hispano, ULS Matosinhos, Portugal
Miguel Ruão
Ophthalmology Department, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
Filipa Gomes Rodrigues
Ophthalmology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
Miguel Ribeiro
Ophthalmology Department, Centro Hospitalar Tondela-Viseu, Portugal
Rui Proença
Centro de Responsabilidade Integrado de Oftalmologia, Centro Hospitalar e Universitário de Coimbra; Faculdade de Medicina, Universidade de Coimbra, Centro Académico Clínico de Coimbra, Portugal
Mariana Almeida
Ophthalmology Department, Centro Hospitalar do Oeste, Caldas da Rainha, Portugal
Marco Liverani
Ophthalmology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
Susana Morais Pina
Ophthalmology Department, Hospital Beatriz Ângelo, Loures, Portugal
Manuela Bernardo
Ophthalmology Department, Hospital Prof Dr Fernando Fonseca EPE, Portugal
Vanda Nogueira
Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
Rita Guerra Pinto
Instituto de Oftalmologia Dr. Gama Pinto, Lisbon, Portugal
Fernando Pinto Ferreira
Ophthalmology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
Rita Pinto Proença
Ophthalmology Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
Isabel Domingues
Ophthalmology Department, Hospital Lusíadas Lisboa, Portugal
Marta Guedes
Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
Miguel Cordeiro
Ophthalmology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
Filipe Fraga
Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
Olga Berens
Ophthalmology Department, Hospital do Espírito Santo, Évora, Portugal
Tatiana Gregório
Ophthalmology Department, Hospital Dr. Nélio Mendonça, SESARAM, Funchal, Portugal
Iva Brito
Paediatric Rheumatology and Young Adult Unit,Centro Hospitalar Universitário S. João, Porto, Portugal; 11Faculdade de Medicina da Universidade do Porto, Portugal
Filipa Oliveira-Ramos
Paediatric Rheumatology Unit, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade Lisboa
João Eurico Fonseca
Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa; Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Portugal
Luís Figueira
Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, Portugal; Center for Drug Discovery and Innovative Medicines (MedInUP) of the University of Porto, Portugal
