RESUMEN
PURPOSE OF REVIEW: The review provides updates on novel risk markers for the development of pediatric inflammatory uveitis and a severe disease course, on treatment of refractory disease, and on the measurement of visual outcomes. RECENT FINDINGS: There are several new genetic markers, biomarkers, and clinical factors that may influence a child's uveitis disease course. It is important to identify children at risk for poor visual outcomes and who are refractory to traditional therapy. Racial disparities have recently been reported. We describe agents of potential benefit. In addition, we discuss the importance of patient reported outcomes in this population. SUMMARY: Uveitis can lead to vision-threatening complications. Timely and aggressive treatment of children identified to be at risk for a severe uveitis course may lead to improved outcomes.
Asunto(s)
Corticoesteroides/uso terapéutico , Antirreumáticos/uso terapéutico , Enfermedades Autoinmunes/tratamiento farmacológico , Uveítis/tratamiento farmacológico , Adolescente , Negro o Afroamericano , Humor Acuoso/química , Artritis Juvenil/epidemiología , Enfermedades Autoinmunes/epidemiología , Enfermedades Autoinmunes/genética , Enfermedades Autoinmunes/inmunología , Sedimentación Sanguínea , Niño , Antígeno HLA-B27/genética , Antígeno HLA-DR1/genética , Cadenas HLA-DRB1/genética , Humanos , Metotrexato/uso terapéutico , Recurrencia , Factores de Riesgo , Proteínas S100/inmunología , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Uveítis/epidemiología , Uveítis/genética , Uveítis/inmunología , Agudeza VisualRESUMEN
OBJECTIVE: To evaluate relationships among vitamin D, proteinuria, and disease activity in pediatric systemic lupus erythematosus (SLE) and juvenile dermatomyositis (JDM). STUDY DESIGN: Multiple linear regression was used to associate subject-reported race, sunscreen use, and vitamin D intake with physician-assessed disease activity and serum 25-hydroxyvitamin D (25[OH]D) in 58 subjects with pediatric SLE (n=37) or JDM (n=21). Serum 25(OH)D was correlated with urinary vitamin D binding protein/creatinine ratio (DBP/C) and other indicators of proteinuria. RESULTS: Serum 25(OH)D levels in subjects with SLE were inversely associated with the natural log of urinary DBP/C (r=-0.63, P<.001) and urine protein to creatinine ratio (r=-0.60, P<.001), with an adjusted mean 10.9-ng/mL (95% CI, 5.1-16.8) decrease in 25(OH)D for those with proteinuria. Excluding subjects with proteinuria, serum 25(OH)D levels were inversely associated with disease activity in JDM, but not in SLE. Overall, 66% of all subjects were taking concurrent corticosteroids, but this was not associated with 25(OH)D levels. CONCLUSIONS: Low serum 25(OH)D in patients with SLE is associated with proteinuria and urinary DBP. Vitamin D deficiency is associated with disease activity in patients with JDM and SLE; this relationship in SLE may be confounded by proteinuria.