Chronic iridocyclitis in juvenile rheumatoid arthritis

181

Objective. To describe the long-term outcome and determine predictors of severity among patients with oligoarticular-onset juvenile idiopathic arthritis (JIA).Methods. In a longitudinal study, 207 patients with oligoarticular-onset JIA who were referred between 1988 and 1998 were evaluated. At disease onset, selected clinical and laboratory data were collected as independent variables. A polyarticular disease course, joint erosion, uveitis, and remission were assessed as dependent variables. Longitudinal analyses were performed with the Kaplan-Meier method, and multivariate analysis with the Cox model.Results. After 6 years of followup, the probability of a polyarticular course of disease was 50%, joint erosion was 35%, uveitis was 30%, and remission was 23% in these patients. Joint erosion was strongly associated with a polyarticular course. A high erythrocyte sedimentation rate (ESR) as well as involvement of more than 1 joint or involvement of an upper limb at disease onset were predictors of disease extension. A high ESR was also a strong predictor of a destructive course, and a family history of psoriasis was predictive of uveitis occurrence. No predictive factor for remission could be identified.Conclusion. Oligoarticular-onset JIA is a severe disease with frequent complications. Factors predictive of severity in oligoarticular-onset JIA were identified. This could allow early identification of high-risk patient subgroups, warranting a more aggressive therapeutic approach.

Section: Discussioncontrasting

confidence: 99%

Long-term outcome and prognosis in oligoarticular-onset juvenile idiopathic arthritis

Guillaume¹,

Prieur²,

Coste³

et al. 2000

181

“…Our results support the opinions expressed by authors of earlier reports, that the activity of eye and joint inflammation in children with JRA and associated uveitis tends to be discordant (1,4,5). In 6 of 7 patients described by Schaller et a1 (4), the onset time of uveitis and arthritis differed; 4 patients had the onset of uveitis when arthritis was inactive.…”

supporting

confidence: 91%

The relationship between ocular and articular disease activity in children with juvenile rheumatoid arthritis and associated uveitis

Rosenberg

Oen

1986

“…In most patients with JRA iridocyclitis, the arthritis begins months or a few years before the iridocyclitis (1)(2)(3)(4)(5). Most patients in this series were not tested for ANA prior to the onset of iridocyclitis.…”

Section: Resultsmentioning

confidence: 99%

“…Iridocyclitis, inflammation of the iris and ciliary body, affects about 10% of children with juvenile rheumatoid arthritis (JRA, Still's disease) and is a major cause of morbidity in the disease (1)(2)(3)(4). Two types of iridocyclitis occur: acute and chronic.…”

mentioning

confidence: 99%

The association of antinuclear antibodies with the chronic iridocyclitis of juvenile rheumatoid arthritis (Still's disease)

Schaller

Johnson

Holborow

et al. 1974

134

Positive tests for antinuclear antibodies (ANA) were found in 51 of 58 (88%) patients with chronic iridocyclitis and juvenile rheumatoid arthritis (Still's disease). Antinuclear antibodies were predominantly of the IgG class of immunoglobulins and were generally present in titers of 1 5 0 (six ANA units) or more. They were unassociated with disease activity, severity or duration, age of patient at onset or testing, or sex. Neither other autoantibodies nor antibodies reactive with DNA or RNA were associated. In 8 patients tested early in disease, ANA were found prior to the onset of iridocyclitis. The presence of ANA should prove useful in identifying patients with JRA at risk for chronic iridocyclitis. In contrast, negative tests for ANA in patients with childhood-onset arthritis and iridocyclitis were found to be associated with acute iridocyclitis and subsequent ankylosing spondylitis.Iridocyclitis, inflammation of the iris and ciliary body, affects about 10% of children with juvenile rheumatoid arthritis (JRA,