Predictive factors and biomarkers for the 2-year outcome of uveitis in juvenile idiopathic arthritis: data from the Inception Cohort of Newly diagnosed patients with Juvenile Idiopathic Arthritis (ICON-JIA) study

Abstract

Objective To define predictors for the 2-year outcome in terms of achieving inactivity, subsequent uveitis reactivation and occurrence of uveitis-related complications of JIA-associated uveitis. Methods Demographic and clinical parameters and serum samples of JIA-associated uveitis patients enrolled in ICON at ⩽1 year of JIA diagnosis were collected at study enrolment, every 3 months during the first year and subsequently every 6 months. Predictors for the 2-year outcome were evaluated by linear mixed models. Results Of 954 JIA patients included, uveitis occurred in 106 up to the first 2-year follow-up, with 98 of them having complete ophthalmological documentation. In 81.8% and 80.0% of patients, uveitis inactivity was achieved at the 1- and 2-year follow-up after uveitis onset, respectively. JIA onset after the age of 5 years, no use of topical corticosteroids, and adalimumab treatment were significantly associated with an inactive uveitis for at least 6 months ( n = 57). Correlates for subsequent uveitis reactivation ( n = 16, 30.2%) were age at uveitis onset ⩽5 years and active disease (clinical Juvenile Arthritis Disease Activity Score >4.5). Uveitis-related complications were present in 29.8% of patients at first uveitis documentation and in 30.7% and 32.8% at 1- and 2-year follow-up, respectively. Older age at JIA onset, short duration between JIA and uveitis onset, high anterior chamber (AC) cell grades, poor visual acuity, and topical steroid use at first uveitis documentation correlated with uveitis-related complications. Conclusion In addition to demographic risk factors, JIA disease and uveitis activity scores and adalimumab are significant predictors for the 2-year outcome of JIA-associated uveitis patients.

Temporal Relationship Between Juvenile Idiopathic Arthritis Disease Activity and Uveitis Disease Activity

“…Our findings are consistent with previous studies that have alluded to a nonrandom association between arthritis and uveitis disease activity in JIA-U. The Inception Cohort of Newly diagnosed patients with Juvenile Idiopathic Arthritis identified moderate-tohigh JIA disease activity as a predictor of uveitis reactivation over a 2-year follow-up period, after achieving sustained uveitis quiescence ≥6 months (18). Along the same lines, in an investigation of young adults with JIA evaluated at an average of 16 years after JIA diagnosis, patients with a history of uveitis ever in their disease course exhibited active arthritis at follow-up more often than those without a history of uveitis (risk ratio 1.38 [95% CI 1.06-1.78], P < 0.044); in fact, 4 of 5 individuals with extended oligoarticular JIA had ongoing active uveitis and active arthritis at follow-up (19).…”

Occurrence and Risk Factors for Macular Edema in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis

“…In 9-25% of children, uveitis manifests during the course of disease [3][4][5][6][7]. As uveitis may lead to potentially irreversible vision-threatening complications [4,[8][9][10][11][12], identifying patients at risk for such complications is crucial for improving final disease outcome.…”

Similarities in clinical course and outcome between juvenile idiopathic arthritis (JIA)-associated and ANA-positive idiopathic anterior uveitis: data from a population-based nationwide study in Germany

“…Treatment for uveitis is mostly instituted with topical corticosteroids, and an escalation of therapy to diseasemodifying anti-rheumatic drugs (DMARDs) is required in patients not responding properly or who present a particularly severe disease course [15,16]. Populationbased studies recently determined that changes in treatment patterns, i.e., more frequent use of DMARDs, reduced uveitis prevalence [17], and improved outcome of uveitis [8,18]. Most recently, adalimumab has received approval for the treatment of chronic, noninfectious anterior uveitis in children aged ≥ 2 years either inadequately responding or not tolerating conventional therapy [19].…”