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To the Editors:

We appreciate the comments by Elhai et al regarding our study of abatacept for the treatment of refractory JIA-related uveitis. The authors reported on 2 new patients with disease refractory to immunosuppressive treatments and at least 2 anti-TNF agents, who successfully responded to abatacept treatment. Indeed, the followup of these 2 patients was longer than in our previous report, confirming the sustained efficacy of this biologic agent in uveitis, which is one of the worse extraarticular complications of JIA.

To this respect, we would like to briefly update the clinical status of the 6 patients in our series who continued the abatacept treatment. After a mean followup period of 21 months (range 19–23), 5 patients are maintaining a good control of both uveitis and arthritis. Three of the patients are on low-dose MTX, while 2 patients have even stopped steroids and DMARDS. Unfortunately, one patient, who initially responded to abatacept treatment, relapsed after 12 months with flares of both arthritis and uveitis. An increase of prednisone and the MTX dose was needed to control the disease.

An interesting and quite innovative aspect of the report by Elhai et al is the maintenance of a good response to treatment with an abatacept infusion regimen every 6 and 7 weeks, respectively. This opens new insights on how to manage the abatacept tapering once a sustained clinical response has been reached. In conclusion, this study further supports the indication for the administration of abatacept in patients with JIA-related uveitis and for planning future prospective studies.

Francesco Zulian MD*, Maria Elisabetta Zannin MD, PhD*, * University of Padua, Padua, Italy.

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