Encouraging visual outcomes in children with idiopathic and JIA associated uveitis: a population-based study

Abstract

Background Pediatric uveitis is typically asymptomatic and may become chronic affecting ocular structures and vision. We evaluated visual outcomes, clinical features, medication, and uveitis activity in children with either idiopathic uveitis (idio-U) or juvenile idiopathic arthritis associated uveitis (JIA-U). Methods A longitudinal, population-based cohort study of children with uveitis in 2008–2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution, etiology, systemic association, uveitis activity, medication, and visual outcomes. Results A total of 119 patients aged < 16 years with uveitis were included. Uveitis was idio-U in 23% and associated with JIA in 77% of cases. 37% of the patients in the idio-U group and 65% in the JIA-U were girls (p = 0.014). The mean age at first uveitis was 10.0 (SD 3.4) years in idio-U and 5.5 (SD 3.3) years in JIA-U (p < 0.001). Anterior location of uveitis was noted in 74% in idio-U and 99% in JIA-U (p < 0.001). Mostly, uveitis was chronic (59% in idio-U and 75% in JIA-U) and bilateral (56% in idio-U and 64% in JIA-U). Topical corticosteroids were initially used by 89% and 100%, systemic corticosteroids by 30% and 27% in some extent during the follow-up, disease-modifying antirheumatic drugs (DMARDs) by 33% and 85% (p < 0.001) of the patients in idio-U and JIA-U, respectively. Biologic disease-modifying antirheumatic drugs (bDMARDs) were more common in JIA-U (55% vs. 15% in idio-U, respectively, p < 0.001). Most patients had normal visual acuity (Snellen > 0.8, [6/7.5]) in the affected eye and bilaterally in 85% idio-U and 70% JIA-U. Only 5 patients (4%) had visual impairment in one, but none in both eyes. Uveitis activity by SUN classification was 0 + in 81% and 72%, 0.5 + in 19% and 25%, and 1 + in 0% and 3% in the idio-U and JIA-U, respectively. Conclusions Children with uveitis have good visual acuity and a low rate for visual impairment. In addition, modern treatment with DMARDs and bDMARDs seems to save vision.

Inflammatory arthritis and eye diseases: a Mendelian randomization study

“…Notably, DSCIC greatly increases the risk of JIA, which was consistent with the clinical observation of uveitis with JIA concomitant ( 14 , 55 , 56 ). Siiskone found in a cohort study that 99% of JIA-associated uveitis was concentrated in the anterior ( 14 ). JIA and childhood uveitis are very difficult to diagnose and may have serious clinical consequences.…”

“…Reports have suggested that 33.2% of people with AS, 7% of those with PsA, and 25%–39% of RA patients might develop corresponding eye disorders, which would further lead to serious consequences such as loss of vision or even blindness ( 10 – 13 ). Furthermore, it is worth noting that a substantial portion of pediatric uveitis cases are linked to JIA ( 14 – 16 ). A strong relationship between inflammatory arthritis and eye diseases has been investigated in several observational studies, encompassing multiple sites like the uvea, retina, sclera, and cornea ( 10 , 17 – 19 ).…”

Ocular complications in pediatric non-infectious anterior uveitis in long-term follow-up

“…These numbers are much bigger than noted in our population-based cohort. One explanation for this discrepancy might be the implementation of modern and more e cient treatment of uveitis especially for children with JIA-U in Finland during the last two decades (9). Female gender was over-represented in ocular complications among the participants of the present study: 73% of patients with glaucoma, 71% with ocular hypertension, and 52% of those with cataract were girls.…”

“…JIA onset after the age of 5 years, no use of corticosteroids, and use of adalimumab treatment has been shown to be associated with uveitis inactivity for at least 6 months (8). Modern treatment modalities of uveitis have improved the visual prognosis of pediatric uveitis (9,10). The long-term impact of modern medications including diseasemodifying antirheumatic drugs (DMARDs) and biologic therapy (bDMARDs) on frequency and severity of uveitis complications in children is not fully established.…”

Sociodemographic and Visual Outcomes of Juvenile Idiopathic Arthritis Uveitis: IRIS® Registry Study

“…4,21,22 Treatment with long-term immunosuppressive medications has improved visual outcomes over time. 5,[23][24][25] More recent population-based cohort studies of JIA uveitis children from the Nordic region and the Netherlands demonstrate blindness rates as low as 2% to 3.8%, as measured by visual acuity at last follow-up. 5,25 The earlier introduction of systemic immunomodulatory treatment is theorized to be a key factor for improved visual prognoses.…”