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 clinical features and visual outcomes in children with either idiopathic uveitis (IU) or juvenile idiopathic arthritis associated uveitis (JIA-U). The effect of medication on uveitis activity is also analyzed. Methods:A retrospective, 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 IU in 23% and associated with JIA in 77% of cases. 37% of the patients in IU 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 IU and 5.5 (SD 3.3) years in JIA-U (p<0.001). Anterior location of uveitis was noted in 74% in IU and 99% in JIA-U (p<0.001). Mostly, uveitis was chronic (59% in IU and 75% in JIA-U) and bilateral (56% in IU and 64% in JIA-U). Topical corticosteroids were used by 89% and 100%, systemic corticosteroids by 30% and 27%, disease-modifying antirheumatic drugs (DMARDs) by 33% and 85% (p<0.001) of the patients in IU and JIA-U, respectively. Biologic disease-modifying antirheumatic drugs (bDMARDs) were more common in JIA-U (55% vs. 15% in IU, respectively, p<0.001). Most of the patients had long-term bilateral and worse eye Snellen visual actuity >0.8 (84% and 70%, respectively). Only 5 patients (4%) had visual impairment in one, but none in both eyes. Uveitis activity by SUN classification was 0+ in 59% and 58%, 0.5+ in 37% and 28%, and 1+ in 4% and 14% in the IU and JIA-U, respectively (p=0.014). 92% of the patients treated with DMARDs and bDMARDs and with 1+ uveitis activity was in the JIA-U group. Conclusions: Children with uveitis have good visual acuity and a low rate for visual impairment. In addition, modern treatment with DMARDs and biologic therapy seems to save vision.