背景:在发达国家,幼年特发性关节炎相关葡萄膜炎(JIA-U)是其最常见的关节外表现,也是儿童葡萄膜炎的主要原因。所使用的各种结果指标使疾病进程的比较,并发症的风险,视觉功能受损,对治疗的反应相当困难。我们的目的是总结有关JIA-U中目前可获得的结果指标的证据。
方法:在2000年1月至2018年12月之间进行了系统评价,以确定调查JIA-U中使用的结局指标的研究。
结果:最初的搜索确定了8254篇文章,其中89篇可能符合条件。全文修订后,共27项研究,包括2个RCT,包括在内。在这些研究中,已经确定了12种使用JIA-U的结果指标(AC中的细胞等级,交流中耀斑的等级,VA,弱视,结构性并发症,使用和保留口服皮质类固醇和免疫抑制药物,手术要求,生物标志物,双侧疾病,JIA坚持,生活质量评估,葡萄膜炎亚型)。关于主要成果指标,44%的研究包括一个或多个与疾病活动相关的变量(即耀斑等级,细胞分级);56%包括视觉功能表现(即视敏度);68%(17/25)包括与疾病相关的组织损伤或并发症的一个或多个变量(即白内障,弱视);24%包括疾病特征(即双侧疾病;葡萄膜炎亚型);44%包括实验室特征(即生物标志物);8%包括JIA特征(即疾病的持久性);12%包括生活质量(即EYE-Q);44%包括管理(即口服皮质类固醇和其他免疫抑制药物的使用和保留;手术要求)。
结论:我们的系统评价调查了与儿童JIA-U相关的结局指标的异质性,即使在RCT中。它不能提供克服葡萄膜炎研究中异质性的解决方案,但它确实提供了对问题规模的估计,并提供数据来为这一重要的辩论提供信息;强调需要就JIA-U中确定合适和有效的结果衡量标准的共同方法达成新的共识。
BACKGROUND: Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) represents its most frequent extra-articular manifestation and the main cause of childhood uveitis in in developed countries. The broad variety of outcome measures utilized makes the comparison of the disease course, risk for complications, impairment in visual function, and responses to treatment quite difficult. Our aim was to summarize evidence regarding the current availability of outcome measures in JIA-U.
METHODS: A systematic review between January 2000 and December 2018 was performed to identify studies investigating outcome measures used in JIA-U.
RESULTS: The initial search identified 8254 articles of which 89 were potentially eligible. After the full text revision, a total of 27 studies, including 2 RCTs, were included. Among these studies 12 outcome measures for JIA-U use have been identified (grade of cells in the AC, grade of flare in the AC, VA, amblyopia, structural complications, use and sparing of oral corticosteroids and immunosuppressive drugs, surgery requirement, biomarkers, bilateral disease, JIA persistence, quality of life assessments, uveitis subtype). As regards primary outcome measures, 44% among studies included one or more variables related to disease activity (i.e. grade of flare, grade of cells); 56% included visual function performance (i.e. visual acuity); 68% (17/25) included one or more variables of disease-associated tissue damage or complications (i.e. cataract, amblyopia); 24% included disease features (i.e. bilateral disease; uveitis subtype); 44% included laboratory features (i.e. biomarkers); 8% included JIA features (i.e. persistence of disease); 12% included quality of life (i.e. EYE-Q); 44% included management (i.e. use and sparing of oral corticosteroids and other immunosuppressive drugs; surgery requirement).
CONCLUSIONS: Our systematic review surveys the heterogeneity around outcome measures related to JIA-U in children, even in RCTs. It does not provide the solution to overcome the heterogeneity in uveitis studies, but it does provide an estimate of the scale of the problems and provides data to inform this important debate; highlighting the requirement to obtain a new
consensus regarding a common approach to identify suitable and efficient outcome measures in JIA-U.