Comparison of uveitis in the course of juvenile idiopathic arthritis with isolated uveitis in children – own experiences

Abstract

ObjectivesUveitis and juvenile idiopathic arthritis (JIA) relatively often coexist. Inflammatory changes in the anterior segment of the eye are the most common extra-articular symptom in children with JIA, and JIA is, in turn, the main systemic cause of anterior uveitis in children. The aim of our study was to compare the course of anterior uveitis accompanying JIA and isolated uveitis.Material and methodsWe analyzed 25 children with JIA and uveitis (group I) and 28 children with isolated uveitis (group II). The study population was retrospectively selected from the patients treated in our center in the years 1998–2016 through a search of the hospital database. All data were presented as descriptive statistics.ResultsIn group I there was a higher percentage of girls than in group II (64% vs. 50%) and uveitis occurred at a significantly younger age (8.7 years vs. 11.6). Patients from group I more often presented with immunological abnormalities (positive antinuclear antibodies or HLA-B27 antigen). The majority of children from group I developed uveitis prior to (44%) or simultaneously with (20%) arthritis. In patients who first presented with uveitis, arthritis appeared on average after 28 months (median 12 months). In children in whom arthritis developed first, uveitis appeared on average after 51 months (median 36 months). In some patients the time interval between the involvement of these two organs was as long as 9–10 years. Four children from group I and three from group II were qualified for biological treatment.ConclusionsThe results of our analysis indicate the need for constant cooperation between the pediatric rheumatologist and the ophthalmologist. Although the risk of uveitis in JIA decreases with the disease duration, in some cases this complication can develop after many years. Children with present antinuclear antibodies, at younger age and of female gender should be subject to particularly close observation.

Juvenile idiopathic arthritis-associated uveitis: a retrospective analysis from a centre of South Italy

“…JIA-associated uveitis commonly manifest as chronic anterior uveitis, which is often clinically silent, but can lead to serious sight-threatening complications. This form of uveitis is typically associated with oligoarticular and RF-negative polyarticular arthritis with particular risk for girls who develop JIA within 3 years of age with ANA positivity [1,3,[8][9][10]. In contrast, boys with ERA HLA-B27 positivity develop most frequently acute anterior uveitis, which is symptomatic, unilateral and episodic [3,8,10,11].…”

Recomendaciones pediátricas para el manejo de la uveítis no infecciosa en Costa Rica

“…3 El diagnóstico amerita un abordaje multidisciplinario entre oftalmología especializada y reumatología o inmunología pediátrica. 5 La prevalencia varía según: raza, localización geográfica, edad de la población en estudio, estado socioeconómico, centro académico y fecha del estudio. 7 Las mujeres están ligeramente más afectadas.…”

“…10,21 Es necesaria la cooperación constante entre el reumatólogo o inmunólogo pediatra y el oftalmólogo. 5 Muchas de las recomendaciones se extrapolan de los adultos; 20 hay algunas recomendaciones específicas de UI en niños, porque definitivamente existen diferencias entre las dos poblaciones. 20,29 La meta del tratamiento es resolver la inflamación ocular, lograr remisión, prevenir las recurrencias y las complicaciones oculares, y preservar la visión, 21 todo en un contexto de la menor cantidad de efectos secundarios asociados a los El tratamiento inicial es con esteroides tópicos y solo en aquellos casos de mayor inflamación se usan los esteroides sistémicos.…”