Experience of switching biological therapy in a patient with juvenile idiopathic arthritis and uveitis. Case report

Uveitis associated with juvenile arthritis can be complicated by cataracts, retinal edema, and glaucoma, which carries a potential risk of disability in the child's organ of vision. Approximately 25–40% of patients demonstrate insufficient effectiveness of the ongoing standard antirheumatic therapy, which requires the inclusion of genetically engineered biological therapy. According to the protocols, the drug of choice for juvenile arthritis associated with uveitis is adalimumab, which has shown high efficacy in many studies. However, some patients stop “responding” to therapy over time, which raises the question of “switching” to another genetically engineered biological drug (GЕBD). Our article presents a case of severe course with an early onset of juvenile idiopathic arthritis associated with uveitis. Due to the insufficient effectiveness of basic monotherapy with methorexate, as well as topical glucocorticoids, adilimumab was added to therapy a year after the onset of the disease. Over the next 5 years, the child was on this therapy with exacerbations of uveitis about 1–2 episodes per year. Subsequently, uveitis began to continuously recur, which raised the question of the development of probable resistance to adalimumab and the change of GEBD. The girl was switched to golimumab, which is a human monoclonal antibody that can bind to tumor necrosis factor-α. This drug has been used for the treatment of juvenile idiopathic arthritis since 2017 for children weighing 40 kg and above, and after the completion of the multicenter GO-KIDS study, it is registered for children from 2 years of age. According to a number of studies, golimumab has shown its effectiveness in relation to the activity of uveitis in patients with arthritis, including those in childhood. In general, the issues of switching GEBD in cases of ineffective therapy with first-line drugs are a very urgent problem in pediatric rheumatology. In our case, switching to the GIBP golimumab resulted in a positive effect on the activity of rheumatoid uveitis and induction of remission of the articular syndrome.