Frequency and Identification of Risk Factors of Uveitis in Juvenile Idiopathic Arthritis

Abstract

Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. The JIA–associated uveitis represents the most common extra-articular manifestation. Objectives The main aim of this study was to evaluate frequency and risk factors of uveitis in a pediatric population affected by JIA. Methods One hundred eight Italian children with JIA were followed during a follow-up period of 13 years. Association between uveitis, antinuclear antibodies (ANAs), and subtype of arthritis has been estimated, and Kaplan-Meier curves were generated to assess the probability of ocular complications during the follow-up period. Results Twenty-one patients developed uveitis, after 96.5 ± 50.4 months from the enrollment. According to JIA subtypes, the oligoarthritis subtype was characterized by the highest prevalence (39%) of uveitis. The greatest risk of uveitis has been detected in oligoarthritis patients associated to ANA positivity (risk ratio, 8.6; 95% confidence interval, 2.27–32.9; χ2 = 20.4), whereas the worst evolution was revealed in patients with oligoarthritis and high levels of ANAs, with a progression time of 36 months (log-rank χ2 = 16.39; p < 0.0001; risk ratio, 18; 95% confidence interval, 7.3–44.2). Conclusions Patients with early-onset ANA-positive oligoarticular JIA have the highest risk of developing uveitis. A routine ophthalmological follow-up is required at regular intervals, even though the joint disease is clinically quiescent.

Costs of medication use among patients with juvenile idiopathic arthritis in the Dutch healthcare system

“…When only considering patients from the moment at which a biological was prescribed onwards, patients with oligoarticular ANA+ JIA and polyarticular RF+ JIA were found to have the highest mean annual duration of biological use. However, as biologicals are currently not registered for oligoarticular ANA+ JIA, the high duration of biological use in this subgroup (n = 22) is likely attributable to treating JIA-related uveitis, as this JIA subgroup has the highest risk of developing uveitis [28]. When considering this subgroup in detail it is observed that the mean duration of follow-up is 4.8 years, of which they receive a biological for on average 2.2 years.…”

“…Patients were classified into JIA subtype according to the ILAR criteria [17]. As persistent oligoarticular JIA was the most common subtype, and because the risk of developing JIArelated uveitis depends on a patient's antinuclear antibody (ANA) status [28], this subtype was further subdivided into ANA-oligoarthritis and ANA+ oligoarthritis. The duration of medication use and accompanying costs were calculated for all JIA patients in general and by JIA subtype.…”

Juvenile idiopathic arthritis-associated uveitis in the era of biological therapy: how the disease changed in 14 years of observation in a tertiary referral center in Rome (Italy)

“…A signi cant higher frequency of ANA positive patients was observed in the JIA-U group (72.2%) (p = 0.0157). Moreover, in 83.3% of our cases, the diagnosis of JIA preceded the ocular involvement, and we observed a signi cant correlation between uveitis onset and younger age at JIA diagnosis [13,[22][23][24][23][24][25]. Calandra et.…”

Overview of Juvenile Idiopathic Arthritis

“…In regards to risk stratification of JIA, autoantibodies are useful. A positive ANA has clinical implications as it is a risk factor for the development of uveitis [35,36,39]. As previously mentioned, frequent ophthalmologic screening is needed to detect asymptomatic uveitis [38].…”

“…Regular ophthalmological screening is recommended for all children with JIA [38]. Children with risk factors for uveitis, including female gender, oligoarthritis, younger age of JIA onset and Anti-Nuclear Antibody (ANA) positivity, should undergo more frequent ophthalmological screening [35,36,39]. Beyond arthritis and uveitis, psoriatic arthritis can also present with psoriasis, as its name suggests.…”