The evaluation of uveitis in JIA patients: are current ophthalmologic screening guidelines adequate?

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The evaluation of uveitis in juvenile idiopathic arthritis (JIA) patients:

are current ophthalmologic screening guidelines adequate?

Pediatric rheumatology

http://www.clinexprheumatol.org/pdf/vol26/26-2/ab25.htm

J.K. Reininga1,3, L.I. Los1, N.M. Wulffraat2, W. Armbrust3

1Department of Ophthalmology, University Medical Centre Groningen (UMCG),

University of Groningen, the Netherlands; 2Department of Children's

Immunology, Wilhelmina Children's Hospital, University Medical Centre

Utrecht (UMCU), the Netherlands; 3Department of Children's Rheumatology,

Beatrix Children's Hospital (UMCG), Groningen, the Netherlands.

ABSTRACT

Objective

The aims of this study are to examine in our juvenile idiopathic arthritis

(JIA) population: 1) the prevalence and characteristics of uveitis, 2) the

complications and outcome of uveitis, 3) prognostic factors, and 4) the

adequacy of the current ophthalmologic screening guidelines.

Methods

Retrospective analysis of medical records.

Results

1) Of the 153 JIA patients included, 27 developed asymptomatic anterior

uveitis (17.6%) - 7 unilateral and 20 bilateral. The 27 uveitis patients

were significantly younger at JIA presentation than the 126 JIA patients

without uveitis.

2) The following uveitis complications were noticed: glaucoma, cataract,

posterior synechiae, cystoid macular oedema and papillitis. A visual outcome

was acquired in 25 patients - 21 patients had a known visual acuity of ?

0.1. Four patients had a visual acuity of <0.05 - 3 unilateral and 1

bilateral.

3) Female gender could not be confirmed as an independent risk factor for

uveitis, neither was Anti Nuclear Antibody (ANA) positivity. We did not find

a significant relationship between the moment of clinical remission of

arthritis and of uveitis.

4) When applying current uveitis screening guidelines to our JIA population,

we found that the optimum screening regimen would consist of a combination

of the higher screening frequency of Southwood (1) and the longer screening

period of the American Academy of Pediatrics (2) (AAP) screening guidelines.

Conclusions

Uveitis is often encountered in JIA patients. It is a serious cause of

morbidity. The use of disease-modifying antirheumatic drugs (DMARDs)

probably has a positive effect on the preservation of visual function. We

recommend a uveitis screening regimen which combines the AAP and Southwood

guidelines and which includes rheumatoid factor positivity (RF+) and

systemic onset patients in the quarterly screening.

Key words

Juvenile idiopathic arthritis, uveitis, children, blindness.