BACKGROUND: The purpose of this study was to investigate the long-term effects 
of adalimumab, a tumor necrosis factor alpha antagonist, in the treatment of 
uveitis associated with juvenile idiopathic arthritis.
METHODS: Adalimumab was initiated in 94 patients with juvenile idiopathic 
arthritis to treat active arthritis and/or active associated uveitis. In 18 
patients, therapy was discontinued after a short period because of inefficacy or 
side effects. The activity of uveitis (using Standardized Uveitis Nomenclature 
[SUN] criteria and clinical examination) and arthritis (number of swollen or 
active joints) was evaluated at the start and at end of the study.
RESULTS: At the end of the study, uveitis was under good clinical control in two 
thirds of 54 patients (31% did not need any local treatment and 35% used only 
1-2 corticosteroid drops a day), and one third had active uveitis (at least 
three corticosteroid drops a day). According to SUN criteria, adalimumab 
treatment for uveitis showed improved activity (a two-fold decrease in uveitis 
activity) in 28% of patients, with a moderate response in 16 patients, no change 
in a further 16 patients, and worsening activity (a two-fold increase in uveitis 
activity) in 13% of patients. The overall proportion of patients with active 
arthritis decreased. At the beginning of the study, 69% of patients with uveitis 
had more than two active joints, and at the end of the study only 27% had active 
joint disease. In 27 patients with juvenile idiopathic arthritis without uveitis 
on adalimumab, the number of active joints decreased from 93% to 59%. Systemic 
corticosteroid treatment could be stopped in 22% of patients with uveitis and in 
11% of those without uveitis. Most of the patients had received methotrexate, 
other immunosuppressive therapy, or other biological drugs before initiating 
adalimumab.
CONCLUSION: Adalimumab is a valuable option in the treatment of uveitis 
associated with active juvenile idiopathic arthritis.