Uveitis in Juvenile Idiopathic Arthritis

Abstract

Purpose: To assess the long-term outcome of uveitis in juvenile idiopathic arthritis (JIA). Design: Population-based, multicenter, prospective JIA cohort, with a cross-sectional assessment of JIAassociated uveitis (JIA-U) 18 years after the onset of JIA.Participants: A total of 434 patients with JIA, of whom 96 had uveitis, from defined geographic areas of Denmark, Finland, Norway, and Sweden.Methods: Patients with onset of JIA between January 1997 and June 2000 were prospectively followed for 18 years. Pediatric rheumatologists and ophthalmologists collected clinical and laboratory data.Main Outcome Measures: Cumulative incidence of uveitis and clinical characteristics, JIA and uveitis disease activity, ocular complications, visual outcome, and risk factors associated with the development of uveitis-related complications.Results: Uveitis developed in 96 (22.1%) of 434 patients with JIA. In 12 patients (2.8%), uveitis was diagnosed between 8 and 18 years of follow-up. Systemic immunosuppressive medication was more common among patients with uveitis (47/96 [49.0%]) compared with patients without uveitis (78/338 [23.1%]). Active uveitis was present in 19 of 78 patients (24.4%) at the 18-year visit. Ocular complications occurred in 31 of 80 patients (38.8%). Short duration between the onset of JIA and the diagnosis of uveitis was a risk factor for developing ocular complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1e1.8). Patients with a diagnosis of uveitis before the onset of JIA all developed cataract and had an OR for development of glaucoma of 31.5 (95% CI, 3.6e274). Presence of antinuclear antibodies (ANAs) was also a risk factor for developing 1 or more ocular complications (OR, 3.0; 95% CI, 1.2e7.7). Decreased visual acuity (VA) <6/12 was found in 12 of 135 eyes (8.9%) with uveitis, and 4 of 80 patients (5.0%) with JIA-U had binocular decreased VA <6/12.Conclusions: Our results suggest that uveitis screening should start immediately when the diagnosis of JIA is suspected or confirmed and be continued for more than 8 years after the diagnosis of JIA. Timely systemic immunosuppressive treatment in patients with a high risk of developing ocular complications must be considered early in the disease course to gain rapid control of ocular inflammation.

Fatigue in young adults with juvenile idiopathic arthritis 18 years after disease onset: data from the prospective Nordic JIA cohort

“…The 18-year follow-up was composed of a study visit with clinical examination, including a full joint examination performed by experienced pediatric rheumatologists to explore whether the participants had active joints and/or restricted joints. In addition, a temporomandibular joint (TMJ) examination by a dentist, and an eye examination by an ophthalmologist were performed [22,23]. We also registered ongoing and previous medication, disease status and damage, blood tests, selfreported questionnaires on health and HRQoL, including fatigue and sleep questionnaires and participation in school/work.…”

Temporal Trends in Childhood Uveitis: Using Administrative Health Data to Investigate the Impact of Health Policy and Clinical Practice

“…The most recent major change in the management of childhood uveitis is the increasing use of systemic immunosuppression in children with and without JIA, and in particular the use of the antitumor necrosis factor alpha (TNF-alpha) monoclonal inhibitor, adalimumab, in refractory or severe disease. 9,10,14,15 The 2014 commencement of the multi-centre SYCAMORE (randomized controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis) trial, and the premature halt of the trial in March 2015 due to superior outcomes in the treatment group (adalimumab and methotrexate) brought increased attention to the use of systemic immunosuppressive agents in childhood uveitis. [8][9][10]16,17 A move away from infused anti-TNF agents (such as infliximab) to subcutaneous delivery of adalimumab may explain part of the early fall in hospitalizations post 2015, but not the ongoing year on year reductions in admissions.…”

A Nordic screening guideline for juvenile idiopathic arthritis‐related uveitis

“…The Nordic Study Group of Paediatric Rheumatology suggested that systematic screening for JIA-uveitis should be extended. In the Nordic JIA cohort, 12 of 434 patients had a late-onset uveitis at a mean age of 23 years, 8-18 years after the onset of JIA (Rypdal et al, 2020). Considering the additional 10 years of follow-up and that ≥5 of these 12 patients had ocular symptoms, it is not reasonable to provide systematic JIA-uveitis screening for asymptomatic adults.…”

“…Uveitis occurs most commonly (82-90%) during the first 4 years after the onset of arthritis (Heiligenhaus et al, 2007;Kotaniemi et al, 2001;Nordal et al, 2017;Rypdal et al, 2020). Therefore, screening guidelines…”