Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis

Objective: To evaluate the efficacy of anti- tumour necrosis factor ( anti- TNF) treatment in juvenile idiopathic arthritis ( JIA)associated uveitis. Methods: 24 patients with uveitis taking etanercept and 21 taking infliximab were studied. The endpoint ophthalmological evaluation was at 24 months or at the termination of the first biological agent. The ocular inflammatory activity was graded on the basis of the number of anterior chamber cells. Results: Of the 45 patients, uveitis improved in 14 ( 31%), no change was observed in 14 ( 31%) and the activity of uveitis increased in 17 ( 38%). Inflammatory activity improved more frequently ( p = 0.047) in the patients taking infliximab than in those taking etanercept. The number of uveitis flares/ year was higher ( p = 0.015) in the patients taking etanercept ( mean 1.4, range 0 - 3.2) than in those taking infliximab ( mean 0.7, range 0 - 2). Uveitis developed for the first time while taking anti- TNF treatment in five patients - 4 taking etanercept ( 2.2/ 100 patient- years) and 1 taking infliximab ( 1.1/ 100 patient- years). Conclusions: During anti- TNF treatment, the ophthalmological condition improved in one- third of the patients with uveitis. In chronic anterior uveitis, associated with refractory JIA, infliximab may be more effective than etanercept.