Monitoring of juvenile idiopathic arthritis associated uveitis in long-term disease remission: consensus based recommendations from MIWGUC.

Abstract

Objectives: We aimed to develop consensus-based recommendations for the monitoring of children with Juvenile Idiopathic Arthritis-associated uveitis (JIAU) in long-term remission, addressing the absence of international guidance on monitoring schedules for these children and young people.

Methods: The Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC) convened experts from ten countries, including paediatric rheumatologists and ophthalmologists, alongside parents of affected children. A review of key longitudinal cohort studies informed a structured consensus process comprising discussion, recommendation development, and voting for adoption, with a consensus threshold of ≥80% needed for adoption. Recommendation development focused on three principal questions: stratification of the risk of poor outcomes, the natural history of JIAU post-remission, and the impact of delayed examination.

Results: The group established several key recommendations including: a standard monitoring frequency of every 4 months for the first four years following medication cessation; ongoing assessments for patients with structural complications; and low-frequency monitoring every 6 months for those in stable, drug-free remission for over four years. There was unanimous agreement on these recommendations.

Conclusions: These consensus-based recommendations provide a framework for monitoring children with JIAU in remission, enhancing the quality of care and optimizing resource use in eye health services. Ongoing research is essential to refine these guidelines as new evidence emerges regarding biomarkers and imaging techniques for disease recurrence.