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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">vsp</journal-id><journal-title-group><journal-title xml:lang="ru">Вопросы современной педиатрии</journal-title><trans-title-group xml:lang="en"><trans-title>Current Pediatrics</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1682-5527</issn><issn pub-type="epub">1682-5535</issn><publisher><publisher-name>Издательство «ПедиатрЪ»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15690/vsp.v11i5.426</article-id><article-id custom-type="elpub" pub-id-type="custom">vsp-425</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ ЛИТЕРАТУРЫ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>LITERATURE REVIEW</subject></subj-group></article-categories><title-group><article-title>ПРИНЦИПЫ ЛЕЧЕНИЯ УВЕИТА ПРИ ЮВЕНИЛЬНОМ ИДИОПАТИЧЕСКОМ АРТРИТЕ: СОСТОЯНИЕ ВОПРОСА НА 2012 г.</article-title><trans-title-group xml:lang="en"><trans-title>TREATMENT APPROACH FOR JUVENILE IDIOPATHIC ARTHRITIS-RELATED UVEITIS: 2012 UPDATE</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Зулиан</surname><given-names>Ф.</given-names></name><name name-style="western" xml:lang="en"><surname>Zulian</surname><given-names>Francesco</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кафедра детских болезней</p></bio><bio xml:lang="en"><p>Francesco Zulian, MD, Department of Pediatrics University of Padova</p></bio><email xlink:type="simple">zulian@pediatria.unipd.it</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бироло</surname><given-names>Ц.</given-names></name><name name-style="western" xml:lang="en"><surname>Birolo</surname><given-names>C.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кафедра детских болезней</p></bio><bio xml:lang="en"><p>Department of Pediatrics</p></bio><email xlink:type="simple">zulian@pediatria.unipd.it</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Заннин</surname><given-names>М. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Zannin</surname><given-names>M. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кафедра детских болезней</p></bio><bio xml:lang="en"><p>Department of Pediatrics</p></bio><email xlink:type="simple">zulian@pediatria.unipd.it</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Падуанский университет</institution><country>Италия</country></aff><aff xml:lang="en"><institution>University of Padova</institution><country>Italy</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub"><day>19</day><month>09</month><year>2012</year></pub-date><volume>11</volume><issue>5</issue><issue-title>Вопросы современной педиатрии</issue-title><fpage>36</fpage><lpage>44</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Зулиан Ф., Бироло Ц., Заннин М.Е., 2012</copyright-statement><copyright-year>2012</copyright-year><copyright-holder xml:lang="ru">Зулиан Ф., Бироло Ц., Заннин М.Е.</copyright-holder><copyright-holder xml:lang="en">Zulian F., Birolo C., Zannin M.E.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://vsp.spr-journal.ru/jour/article/view/425">https://vsp.spr-journal.ru/jour/article/view/425</self-uri><abstract><p>Хронический передний увеит представляет собой наиболее частое экстраартикулярное осложнение ювенильного идиопатического артрита. Частота его выше при формах заболевания, характеризующихся ранним развитием. В частности, более высокую распространенность регистрируют при олигоартикулярном варианте ювенильного идиопатического артрита (40%), нежели при других вариантах заболевания (5–14%). Риск тяжелых нарушений зрения при данном осложнении остается высоким вследствие развития угрожающих потерей зрения осложнений (синехий, лентовидной кератопатии, катаракты, глаукомы, цистоидного отека желтого пятна). Принципы лечения данного состояния не стандартизованы и требуют принятия сложных решений, а также тесного взаимодействия между детским офтальмологом и ревматологом. Местная терапия часто не обеспечивает адекватного контроля воспаления глаза, а внутриглазные инъекции — слишком инвазивная процедура для выполнения детям, в связи с чем часто назначают иммуносупрессивную терапию. Метотрексат в низких дозах преимущественно используют в качестве терапии второй линии, хотя контролируемых исследований, в которых сравнивали бы эффективность раннего и отсроченного назначения метотрексата, не проводилось. Микофенолата мофетил эффективно купирует воспаление у пациентов, рефрактерных к метотрексату, однако обладает лишь умеренной эффективностью при промежуточном и заднем увеите по сравнению с обусловленными ювенильным идиопатическим артритом увеитом и склеритом. Ингибиторы фактора некроза опухолей α, в частности, инфликсимаб и адалимумаб, продемонстрировали эффективность в рамках открытых исследований, однако крупных контролируемых исследований их использования при данной патологии до настоящего времени также не проводилось. Адалимумаб и инфликсимаб одинаковы по эффективности, однако адалимумаб характеризуется большей простотой в использовании и более хорошей переносимостью. Абатацепт следует назначать больным увеитом, который обусловлен ювенильным идиопатическим артритом, рефрактерным к ингибиторам фактора некроза опухолей.</p></abstract><trans-abstract xml:lang="en"><p>Chronic anterior uveitis is the most common extra-articular complication of juvenile idiopathic arthritis. It is more frequent in the early onset forms with a higher prevalence in the oligoarticular (40%) than in other juvenile idiopathic arthritis subtypes (5–14%). The risk for severe visual impairment is still high due to the development of sight-threatening complications (synechiae, band keratopathy, cataract, glaucoma, cystoid macular oedema. Treatment is not standardized and requires a complex decision-making process, involving a close collaboration between paediatric ophthalmologist and rheumatologist. Topical therapy alone is often inadequate to control ocular inflammation and bulbar injections are too invasive to perform in children therefore immunosuppressive treatment is often advocated. Low dose methotrexate is the second-line agent mostly used although no controlled studies comparing effects of early to late methotrexate treatment have been reported. Mycophenolate mofetil is effective in controlling inflammation in methotrexate -refractory patients. Its efficacy, however, seems to be more relevant in intermediate or posterior uveitis, than in juvenile idiopathic arthritis uveitis and scleritis. Anti-TNFα agents, namely infliximab and adalimimab showed effectiveness in open-label studies but no wide controlled trials have been reported so far. Adalimimab is as effective as infliximab but has an easier way of administration and a better drug tolerance. Abatacept should be used in anti-TNF refractory patients with juvenile idiopathic arthritis uveitis.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>увеит</kwd><kwd>лечение</kwd><kwd>генно-инженерные биологические препараты</kwd><kwd>ювенильный идиопатический артрит</kwd><kwd>исход</kwd></kwd-group><kwd-group xml:lang="en"><kwd>uveitis</kwd><kwd>treatment</kwd><kwd>biological agents</kwd><kwd>juvenile idiopathic arthritis</kwd><kwd>outcome</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Saurenmann R. K., Levin A. V., Feldman B. M., Rose J. B., Laxer R. M., Schneider R., Silverman E. D. Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: a long-term follow up study. Arthritis Rheum. 2007; 56 (2): 647–657.</mixed-citation><mixed-citation xml:lang="en">Saurenmann R. K., Levin A. V., Feldman B. M., Rose J. B., Laxer R. 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