Coordinated Care Improves Anterior Uveitis in Children

TOPLINE:

Coordinated care in a combined rheumatology and ophthalmology clinic for managing pediatric anterior uveitis resulted in better outcomes, quicker initiation of biologic disease-modifying antirheumatic drugs (DMARDs), reduced corticosteroid use, and fewer complications than traditional care approaches.

METHODOLOGY:

• This retrospective cohort study aimed to evaluate whether receiving care in an ophthalmology/rheumatology multidisciplinary clinic benefits pediatric patients with anterior uveitis.
• It included 215 children aged ≤ 19 years with anterior uveitis (65% girls) seen in a pediatric tertiary care center between 2013 and 2022, with 170 in the traditional care cohort and 45 in the coordinated care cohort.
• Patients in the traditional care cohort saw rheumatologists and ophthalmologists in separate visits, whereas those in the coordinated care cohort saw both specialists in one visit.
• The outcome measures included time to disease control, time to initiation of biologic DMARDs, use of corticosteroids, and rate of visits.
• Disease control was defined as two consecutive visits when the patient had ≤ 0.5+ anterior chamber cells and needed at least two topical steroid drops daily.

TAKEAWAY:

• Patients in the coordinated care cohort had a 46% greater likelihood of achieving disease control than those in the traditional care cohort (hazard ratio [HR], 1.46; P = .02).
• Moreover, healthcare providers were able to monitor a patient’s condition better under coordinated care than under traditional care, leading to quicker initiation of biologic DMARDs when needed (HR, 2.46; P
• Coordinated care was associated with 96% lower corticosteroid use per appointment within the first year (rate ratio [RR], 0.04; P
• Patients in the coordinated care cohort had a 68% lower risk of developing complications such as band keratopathy (odds ratio, 0.32; P = .02) and had to make fewer visits to the clinic for receiving uveitis care (RR, 0.33; P

IN PRACTICE:

“The greatest impact of multidisciplinary care was the acceleration of initiation of a biologic when needed,” the authors wrote.

SOURCE:

This study was led by Catherine Lavallee, MD, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, and was published online on September 15, 2024, in Arthritis Care & Research.

LIMITATIONS:

The retrospective design of the study may have limited its ability to establish causality. The small proportion of patients in the coordinated care cohort was another major limitation. Different start times for the two cohorts and the absence of defined criteria for coordinated care referral may have introduced selection bias. 

DISCLOSURES:

This study was funded by the Rheumatology Research Foundation Medical Student Preceptorship, and additional funding was provided by the Department of Rheumatology, Children’s Hospital of Philadelphia. Some authors reported receiving funding, serving leadership roles, holding patents, or having other ties with some funding agencies and various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.