Table 1 Synthetic DMARDs used in treatment of chronic anterior uveitis associated with JIA

Methotrexate

Cellular adenosine release [95]

10–15 mg/m²(or 0.3–0.6 mg/kg) po or sc once weekly

GI discomfort, nausea, elevated liver enzymes

Systematic review and meta-analysis of retrospective case series (n = 135): improvement in 73 %

[49]

Azathioprine

Purine nucleoside analogue, inhibits DNA replication

1 mg/kg od, increasing to maximum 3 mg/kg od

GI discomfort, bone marrow suppression, liver impairment

Retrospective case series (n = 41): uveitis inactivity in 61.5 % as initial monotherapy; 66.7 % as combination therapy

[96]

Mycophenolate mofetil

Inhibitor of inosine-5-monophosphate dehydrogenase

300 mg/m² bd, increasing to 600 mg/m² bd

GI discomfort, leukopenia, hair loss

Several retrospective case series (n = 17, 52 and 85; not all with JIA, variable outcome measures): response in 55–88 %

[97–99]

Ciclosporin

Calcineurin inhibitor blocking T cell proliferation

2.5–5 mg/kg/day in 2 doses

GI disturbance, hypertension, renal and liver dysfunction, lipid abnormalities

Retrospective case series (n = 82 and 14): uveitis inactivity in 24 % as monotherapy, 48.6 % as combination therapy

[100, 101]

Tacrolimus

Calcineurin inhibitor blocking T cell proliferation

50–150 microgram/kg bd

GI disturbance, hypertension, renal and liver dysfunction, lipid abnormalities, blood disorders

Retrospective case series (n = 62, mostly adults with idiopathic uveitis): permitted glucocorticoid tapering and improved visual acuity

[102]