Characteristics of a cohort of children with Juvenile Idiopathic Arthritis and JIA-associated Uveitis

Abstract

BackgroundJuvenile idiopathic arthritis-associated uveitis (JIA-U) can lead to poor visual outcomes and impact a child’s quality of life (QOL) and function. Our aim is to identify risk markers of JIA-U and examine differences in the QOL of children with JIA and JIA-U.MethodsRheumatology and ophthalmology record reviews and questionnaires were completed every 4–6 months on 287 children with JIA. We collected arthritis, uveitis, and QOL data. We examined data through last study visit.ResultsThere were 52/287 (18 %) children with JIA-U who were younger at arthritis diagnosis, had oligoarticular persistent JIA, and ANA positive. Confirmed uveitis predictors were age at JIA diagnosis (OR = 0.86) and oligoarticular subtype (OR = 5.92). They had worse vision specific QOL and function, but similar general QOL. Blindness occurred in 17.5 % of children but was more common in African American children compared to non-Hispanic Caucasian children ((5/7 (71 %) vs. 2/29 (7 %), p <0.001) despite a similar uveitis prevalence (22 % vs. 16 %). Both races had similar complications, although band keratopathy was more frequent in African Americans (75 % vs. 15.6 %, p = 0.003).ConclusionsWe confirm young age at JIA diagnosis and the oligoarticular JIA subtype as predictors of uveitis development. Although we were unable to identify predictors of ocular complications or blindness, AA children appeared to have a more severe disease course manifested by increased ocular complications, vision loss and blindness. Potential causes that warrant additional study include underlying disease severity, access to medical care and referral bias. Further investigation of the risk factors for vision-compromising uveitis and its’ long-term effects should be conducted in a large racially diverse population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12969-015-0018-8) contains supplementary material, which is available to authorized users.

The Association of Race With Childhood Uveitis

“…However, Woreta et al found no associations between race and ocular complications, a VA or 20/50 or worse, or a VA of 20/200 or worse in their JIA cohort, although there were only 5 blacks and 64 white patients 23 . We recently demonstrated increased blindness in a small cohort of non-Hispanic African American children with JIA-associated uveitis ((5/7) 71% vs. (2/29) 7%) 36 . Thus, reports vary on the course of disease in children of African descent.…”

The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation

“…96 A US cohort study of children with JIA compared those with JIA-associated uveitis with those without JIA-associated uveitis. 170 It reported that vision-related HRQoL was worse in uveitis patients, but general HRQoL was similar to that of JIA patients without uveitis. 170 It can be assumed that biologic DMARD treatment in JIA-associated uveitis patients will result in bigger overall HRQoL improvement (including vision-related HRQoL) and therefore would be more cost-effective in this group than in JIA patients without uveitis.…”

“…170 As discussed in Chapter 1, persistent oligoarthritis accounts for up to 48% of JIA cases in the UK and is regarded as a milder form of JIA. In contrast, EO accounts for between 6% and 17% of JIA cases in the UK and results in more severe symptoms and disease progression.…”

Fluocinolone acetonide intravitreal implant (Retisert®) in the treatment of sight threatening macular oedema of juvenile idiopathic arthritis‐related uveitis

“…Macular oedema occurs in up to 15% of patients with juvenile idiopathic arthritis (JIA)‐related uveitis (Angeles‐Han et al. ; de Boer et al. ).…”

“…) and legal blindness (Angeles‐Han et al. ). Macular oedema is more common among patients with longer duration of uveitis (de Boer et al.…”