AB0968 INTEGRATED RHEUMATOLOGY AND OPHTHALMOLOGY CARE IN PEDIATRIC AUTOIMUNE UVEITIS – OUTCOME AND EFFECTIVENESS
Authors: Milena Foizer Leite, Luana Coelho Benevides, Francisco Hugo Rogrigues Gomes, Rafael Estevão de Angelis, Virginia Ferriani, João Marcello Fortes Furtado, Luciana Martins de Carvalho
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Uveitis is an ocular inflammatory disease that may lead to irreversible blindness if not treated early and properly. May be induced by infectious and non-infectious diseases (autoimmune diseases, especially juvenile idiopathic arthritis), or "masquerade" causes. Some uveitis are termed "idiopathic" although autoinflammatory evidence. Treatment effectiveness depends on the accuracy of the ophthalmologic evaluation and the appropriate management, especially when immunosuppressive medications are necessary. <sup>(1, 2)</sup> <h3>Objectives</h3> To describe the first year experience of the Integrated Ophthalmology and Pediatric Rheumatology Outpatient Clinic in the management of pediatric patients with autoimmune uveitis. <h3>Methods</h3> Retrospective chart review study of twenty-four patients followed up from June 2017 to October 2018. The patients clinical evolution at 0, 3, 6, 9 and 12 months was analyzed. <h3>Results</h3> In this group, 62% were female, and mean age at first appointment and at symptoms onset were 11.7 (2.9 to 17. 5) and 7.3 (1.1 to 12.6) years, respectively. Anterior uveitis was present in 70.8% of the cases, and in 65.6% it was bilateral; cataract or glaucoma was observed in 20.5%. The identified diagnosis during follow-up were: idiopathic autoimmune uveitis in 45.8%, juvenile idiopathic arthritis in 41.6% (20.8% oligoarticular, 16.6% polyarticular, 4.1% associated with enthesitis) and juvenile systemic lupus erythematosus, Kawasaki Disease and Vogt-Koyanagi-Harada syndrome one case of each. Antinuclear antibodies were present in 41% and inflammatory markers in 28.7% patients. At first appointment, 20.5% presented ocular inflammatory activity and 53.3% had sequelae when examined in slit lamp or indirect ophthalmoscopy. Medications used were: topical corticosteroids (61.6%), topical mydriatic (49.2%), oral corticosteroid (41%), methotrexate (41%), etanercept (12.3%), adalimumab (28.7%) and periocular injections of triamcinolone, cyclosporin, tocilizumab, azathioprine (4.1% each). The comparison of the data at inclusion and during follow-up is reported in Table: At the end of 12 months, only 12.3% of the patients still had active uveitis. We have also observed a reducing in 66.6% of topical corticosteroids and 72.2% of oral corticosteroids use during the treatment of uveitis over 12 months <h3>Conclusion</h3> Considering that before the inclusion, patients were followed independently in each clinic, there was optimization of the treatment and reduction in number of medical appointments after the creation of the integrated outpatient clinic. The interprofessional management teams should be the standard of care for pediatric patients with autoimmune uveitis. <h3>References</h3> [1] Angeles-Han ST, Rabinovich CE. Uveitis in children. Curr Opin Rheumatol. 2016;28(5):544-9. [2] Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature Working G. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509-16. <h3>Disclosure of Interests</h3> None declared