Elsevier

Ophthalmology

Volume 113, Issue 10, October 2006, Pages 1874-1877
Ophthalmology

Original Article
Visual Outcomes in Children with Juvenile Idiopathic Arthritis–Associated Uveitis

Presented as a poster at: American Academy of Ophthalmology meeting, October 16, 2005, Chicago, Illinois.
https://doi.org/10.1016/j.ophtha.2006.05.016Get rights and content

Purpose

To analyze visual outcomes in children affected by juvenile idiopathic arthritis (JIA)–associated uveitis.

Design

Retrospective interventional case series.

Participants

Eighty-nine children with JIA-associated uveitis.

Methods

Charts of children with JIA-associated uveitis were reviewed.

Main Outcome Measure

Change in patients’ visual acuities (VAs).

Results

Of 269 children with uveitic syndromes referred, 89 (33%) had JIA–associated uveitis. The process was bilateral in 76 children. Seventy-three patients were female, and 84% of patients were Caucasian. Mean age of onset of uveitis was 5.7 years. Mean follow-up was 2.96 years. Antinuclear antibody positivity was detected in 56 patients, 44 of them female. Patients with JIA-associated uveitis developed numerous complications in the course of their disease: of 165 affected eyes, 105 (64%) developed cataracts, 33 (20%) developed increased intraocular pressure, and 76 (46%) developed band keratopathy; posterior synechiae were present in 96 (58%). Of 89 children, 73% were treated with immunomodulators, 40% were treated with nonsteroidal antiinflammatory agents alone or in combination with immunomodulators, and 21% were treated with topical and/or systemic steroids. Of 65 children who required immunomodulation, only one chemotherapeutic agent was used in 30, two agents in 21, and ≥3 in 14. Visual acuities of 65 children (122 eyes) were documented and compared at standard intervals. By mixed-models linear regression, improvement in VA of 0.03 logarithm of the minimum angle of resolution units per year was not found to be statistically significant (standard error, 0.02, P = 0.089).

Conclusions

Juvenile idiopathic arthritis–associated uveitis is a sight-threatening disease. However, much of the children’s vision can be preserved if patients are treated appropriately.

Section snippets

Materials and Methods

The records of 269 patients, ages 1 to 17 years, who were examined and treated from 1985 through 2003 were reviewed. We identified 89 children with JIA-associated uveitis. Inclusion criteria for the study were ages 1 to 17, diagnosis of JIA by a pediatric rheumatologist, and presence of intraocular inflammation consistent with the signs and symptoms of JIA-associated uveitis. Patients who did not meet these criteria were excluded from the study. Variables assessed and analyzed included date of

Results

Of 269 children with uveitic syndromes referred to a tertiary eye center, 89 (33%) had JIA-associated uveitis. The process was bilateral in 76 children. Seventy-three patients (82%) were girls; 84%, Caucasian; 8%, African American; and 8%, Hispanic. Mean age of onset of uveitis was 5.7 years (range, 1–14). Mean follow-up for all children was 2.96 years. Antinuclear antibody positivity was detected in 56 patients, 44 of them female. Arthritis was oligoarticular in 88% of all patients, with a

Discussion

Reports have begun to appear in the literature reporting better visual outcomes of patients with JIA-associated uveitis.9, 12, 13, 14 Edelstein et al found in their study that only 6% of eyes of 163 patients ended with blindness.9 None of 63 patients in a Finnish study went blind from JIA-associated uveitis.12 Oren et al reported on 10 children, all of whom had final VA of 20/30 or better.13 Paroli et al found that 64.5% of their patients maintained VA of 20/33 or better at final follow-up.14

References (20)

There are more references available in the full text version of this article.

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    In our study, 38.8% of the patients with JIA-U developed at least 1 ocular complication during the 18 years of observation. The rate of complications is lower than in previous reports 2 or more decades ago.15,16,40 However, complications are more prevalent in our study compared with other recent studies from Europe.37-39

  • Risk of Hypotony in Juvenile Idiopathic Arthritis–Associated Uveitis

    2016, American Journal of Ophthalmology
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    In our study, hypotony was present in 9.3% of patients at presentation. This is comparable to the 1.7%–19% range reported in other cohorts.10,14,15,20 Over a median follow-up period of 5.3 years, 26 of 137 at-risk eyes in this series developed hypotony at the rate of 0.04/EY, which is similar to the rate reported for pediatric uveitis patients (0.03/EY)21 and the rate reported for JIA-associated uveitis patients within the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) study (0.028/EY).15

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Manuscript no. 2005-1053.

The authors have no financial interest related to the subject of the article.

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