The purpose of this study was to evaluate whether cost, prior insurance authorisation concerns and subspecialty practice influence therapeutic decisions in the treatment of uveitis associated with JIA. The authors developed an email questionnaire that included a brief vignette of uveitis associated with JIA and sent this out to ophthalmologists; 132/2965 physicians returned the questionnaire – return rate of 4.5%. First choice treatment for uveitis associated with juvenile idiopathic arthritis (JIA) was non-biologic immunosuppression medications most commonly. Biologic medications as first line treatments were most likely selected by rheumatologists. Local impacts as first line treatment were most likely chosen by retinal specialists. Inter-specialty comparisons showed that Methotrexate was preferred as first line treatment by 92% of uveitis specialists, 56% of retinal specialists, 75% of paediatric ophthalmologists and 71% of rheumatologists. For second choice treatment, the large majority of uveitis specialists, paediatric ophthalmologists and rheumatologists chose biologic agents. The authors conclude general agreement on Methotrexate as a first line treatment and biologic immunosuppression medications as a second choice. However, significant differences were found between specialists in the use of these treatments. Cost and insurance considerations did not affect treatment selection. 

Specialty practice and cost considerations in the management of uveitis associated with juvenile idiopathic arthritis.
Palestine AG, Singh JK, Kolfenbach JR, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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