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A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial)

Ramanan, A. and Dick, A.D. and Benton, D. and Compeyrot-Lacassagne, S. and Dawoud, D. and Hardwick, B. and Hickey, H. and Hughes, D.A. and Jones, A. and Woo, P. and Edelsten, C. and Beresford, M.W. and The SYCAMORE Trail Management Group, (2014) A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). Trials, 15 (14). DOI: 10.1186/1745-6215-15-14

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Abstract

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Children with JIA are at risk of inflammation of the uvea in the eye (uveitis). Overall, 20% to 25% of paediatric uveitis is associated with JIA. Major risk factors for development of uveitis in JIA are oligoarticular pattern of arthritis, an age at onset of arthritis of less than seven years of age, and antinuclear antibody positivity. In the initial stages of mild to moderate inflammation the uveitis is asymptomatic. This has led to current practice of screening all children with JIA for uveitis. Approximately 12% to 38% of patients with JIA develop uveitis in seven years following onset of arthritis. In 30% to 50% of children with JIA-associated uveitis structural complications are present at diagnosis. Furthermore about 50% to 75% of those with severe uveitis will eventually develop visual impairment secondary to ocular complications such as cataract and glaucoma. Defining the severity of inflammation and structural complications in uveitis patients is now possible following Standardised Uveitis Nomenclature (SUN) guidelines, and modified to incorporate the consensus of end point and outcome criteria into the design of randomised trials. Despite current screening and therapeutic options (pre-biologics) 10% to 15% of children with JIA-associated uveitis may develop bilateral visual impairment and certified legally blind. To date, there remains no controlled trial evidence of benefits of biologic therapy.

Item Type: Article
Subjects: Research Publications
Departments: College of Health and Behavioural Sciences > Institute of Medical & Social Care Research
Date Deposited: 13 Dec 2014 03:47
Last Modified: 13 Apr 2016 02:18
ISSN: 1745-6215
URI: http://e.bangor.ac.uk/id/eprint/3289
Identification Number: DOI: 10.1186/1745-6215-15-14
Publisher: Springer
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