Occurrence of uveitis in recently diagnosed juvenile chronic arthritis: A prospective study

doi:10.1016/S0161-6420(01)00773-4

Ophthalmology

Volume 108, Issue 11, November 2001, Pages 2071-2075

https://doi.org/10.1016/S0161-6420(01)00773-4 Get rights and content

Abstract

Objective

To examine the occurrence and characteristics of uveitis in patients with recently diagnosed juvenile chronic arthritis (JCA).

Design

A prospective observational case series.

Participants/methods

The study covered the new cases detected with JCA (426 children), all of whom were referred to an ophthalmologic consultation during 1989 to 1996 at the Pediatric Department of the Rheumatism Foundation Hospital, Heinola, Finland.

Main outcome measures

The children with JCA were followed by ophthalmologic and pediatric examinations two to four times a year. The type and course of arthritis and presentation and characteristics of uveitis were examined prospectively.

Results

Uveitis was detected in 104 of 426 children (24%). Two thirds of all patients and the same proportion of those with uveitis were girls. Proportionally, uveitis was found to be as common among children with oligoarthritis (27%) as among those with seronegative polyarthritis (25%). Antinuclear antibodies (ANA) were detected significantly more frequently in patients with uveitis (66%) than among those without uveitis (37%) (P < 0.001). The uveitis was asymptomatic in 99 cases; only 5 children had episodes of acute anterior symptomatic uveitis. Uveitis was found before or within 3 months from the onset of recent arthritis in 51 of 104 children (49%) and later on in 53 of 104 children (51%). The mean age at diagnosis of uveitis was 5.9 years (range, 1.1–17.7; median, 4.9 years). The mean period from the diagnosis of JCA to the diagnosis of uveitis was 1.1 years (range, −2.4–6.5; median, 0.3 years). The mean age at diagnosis of JCA was 4.8 years (range, 0.6–15; median, 3.2 years) among those with uveitis and 7.3 years (range, 0.9–16; median, 6.7 years) among those who did not have it (P < 0.001). Uveitis was ongoing in 63 children at the end of the follow-up period. The mean follow-up time was 4.5 years (range, 0–9.7) for all children and 5.6 years (range, 1.3–9.6) for those with uveitis. In most instances, the visual prognosis was good. In 25 of 104 patients (24%) one or more complications of uveitis were found, but in only three children did the visual acuity decrease to 20/60 or less, and none became blind. All the other patients had visual acuity ≥ 20/40.

Conclusions

In this patient group, uveitis in JCA frequently appeared very early after the onset of arthritis. The uveitis was significantly more common in patients with an early onset of arthritis combined with ANA positivity. The proportion of children with uveitis was as large in those with polyarthritis as in those with oligoarthritis, with no predilection to girls.

Section snippets

Patients and methods

The patients in this study were collected at the Rheumatism Foundation Hospital, a semiprivate institution, that receives patients from university hospitals, other central hospitals, and directly from primary care, especially if the patient lives in the vicinity of the hospital. The hospital provides inpatient and outpatient care.

The diagnosis of JCA was made by pediatric rheumatologists according to the European League Against Rheumatism criteria.9 The subtype of arthritis was defined after 6

Results

Uveitis was diagnosed in 104 of the 426 children (24% [95% CI, 21–29]) with JCA. Proportionally, uveitis was found as often among girls (69 of 276, 25% [95% CI, 20–30]) as among boys (35 of 150, 23% [95% CI, 17–31]), as well as in patients with oligoarthritis (76 of 283, 27% [95% CI, 22–32]) as with rheumatoid factor negative polyarthritis (25 of 102, 25%[95% CI, 17–34]). Very rarely, uveitis occurred in patients with rheumatoid factor–positive polyarthritis and with systemic onset arthritis.

Discussion

Previously, chronic uveitis has been reported to occur in 10% to 20% of patients with JCA, even if somewhat lower and higher figures have been reported.5, 6 Recent reports from the United States have shown a lower frequency of uveitis than series from Europe.8, 14, 15, 16, 17, 18 For instance, in a large group of patients with juvenile rheumatoid arthritis collected from four pediatric rheumatology centers in the United States, uveitis occurred in only 9% of the patients.14 The underlying

Acknowledgements

The authors thank the personnel of the Pediatric Department of the Rheumatism Foundation Hospital for their collaboration during this study.

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Classification Criteria for Juvenile Idiopathic Arthritis–Associated Chronic Anterior Uveitis
2021, American Journal of Ophthalmology
To determine classification criteria for juvenile idiopathic arthritis (JIA)-associated chronic anterior uveitis (CAU).
Machine learning of cases with JIA CAU and 8 other anterior uveitides.
Cases of anterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the anterior uveitides. The resulting criteria were evaluated on the validation set.
One thousand eighty-three cases of anterior uveitides, including 202 cases of JIA CAU, were evaluated by machine learning. The overall accuracy for anterior uveitides was 97.5% in the training set and 96.7% in the validation set (95% confidence interval 92.4, 98.6). Key criteria for JIA CAU included (1) chronic anterior uveitis (or, if newly diagnosed, insidious onset) and (2) JIA, except for the systemic, rheumatoid factor–positive polyarthritis, and enthesitis-related arthritis variants. The misclassification rates for JIA CAU were 2.4% in the training set and 0% in the validation set.
The criteria for JIA CAU had a low misclassification rate and seemed to perform well enough for use in clinical and translational research.
Uveitis in Juvenile Idiopathic Arthritis: 18-Year Outcome in the Population-based Nordic Cohort Study
2021, Ophthalmology
Citation Excerpt :
Other reasons for the variability in reported uveitis prevalence are differences in what is actually reported, such as point prevalence or period prevalence, study design, cohort compositions such as referral cohorts from which the patients are recruited, and genetic differences between populations. Some of the highest prevalence is reported from the Nordic countries,3,4,20 and it has been suggested that children with European descent, especially with Nordic descent, have a higher risk of uveitis in JIA.3,36 In other population-based studies from Spain, Czech Republic, Germany, and Estonia, the cumulative incidence of uveitis varied between 4.0% and 12.0%, but the follow-up period in these studies were shorter than in our study.31-35
To assess the long-term outcome of uveitis in juvenile idiopathic arthritis (JIA).
Population-based, multicenter, prospective JIA cohort, with a cross-sectional assessment of JIA-associated uveitis (JIA-U) 18 years after the onset of JIA.
A total of 434 patients with JIA, of whom 96 had uveitis, from defined geographic areas of Denmark, Finland, Norway, and Sweden.
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.
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.
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], 1.1–1.8). 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, 3.6–274). Presence of antinuclear antibodies (ANAs) was also a risk factor for developing 1 or more ocular complications (OR, 3.0; 95% CI, 1.2–7.7). 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.
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.
Occurrence of uveitis in patients with chronic juvenile arthritis
2020, Revue du Rhumatisme (Edition Francaise)
Cette méta-analyse a étudié la fréquence et le type des atteintes oculaires dans les arthrites inflammatoires et d’autres maladies rhumatismales juvéniles. Nous avons recherché les publications relatives aux arthrites et maladies rhumatismales juvéniles décrivant la fréquence de l’uvéite dans un contexte de rhumatisme juvénile et incluant au moins 20 patients dans les bases de données Medline, Web of Science et Cochrane, entre leur date de création et septembre 2018. La prévalence et le type des complications oculaires ont été extraits et leur fréquence a été estimée par des modèles à effets aléatoires. L’hétérogénéité a été évaluée au moyen du test I². Un total de 59 articles résultant de 7132 citations uniques ont été inclus. La fréquence compilée de l’uvéite était de 24 % dans l’AJI oligoarticulaire, 12 % dans l’AJI polyarticulaire, 1 % dans l’AJI systémique, 50 % dans la maladie de Behçet (MB) juvénile, 9 % dans le rhumatisme psoriasique (RPso) juvénile, 24 % dans la spondyloarthropathie (SpA) juvénile et 5 % dans le lupus érythémateux systémique (LES) juvénile. Le type d’uvéite le plus fréquent dans l’AJI était l’uvéite antérieure, observée dans 14 % des cas et décrite comme une iridocyclite chez 10 % des patients. Le biais de publication était négligeable pour toutes les affections à l’exception de celles ayant été peu étudiées (LES juvénile et AJI systémique). L’uvéite dans l’AJI était plus fréquente en Europe (14 %), en Amérique du Nord (11 %) et au Moyen-Orient (12 %) qu’en Asie de l’Est (7 %) et en Océanie (3 %). L’atteinte oculaire (essentiellement uvéite) dans l’arthrite inflammatoire juvénile et d’autres rhumatismes pédiatriques variait de 3 à 50 % selon l’affection sous-jacente et était la plus fréquente dans la maladie de Behçet de l’enfant. Parmi les AJI, la fréquence de l’uvéite la plus élevée a été constatée dans l’AJI oligoarticulaire et l’uvéite antérieure était le type le plus fréquent. Des variations géographiques ont été observées pour l’uvéite dans l’AJI.
Juvenile uveitis
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^☆: Supported by De Blindas Vänner-Sokeain Ystävätry, Helsinki, Finland.

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Occurrence of uveitis in recently diagnosed juvenile chronic arthritis: A prospective study☆

Abstract

Objective

Design

Participants/methods

Main outcome measures

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Acknowledgements

Bandföermige Hornhauttrübung bei einem neunjähringen Mädchen und ihre Behandlung mit subkonjunktivalen Jodaliumeinspritzungen

Klin Monatsbl Augenheilkd

Iridocyclitis and disease of the joints in children

Acta Ophthalmol (Kbh)

Iridocyclitis in Still’s disease

Trans Ophthalmol Soc UK

Uveitis associated with juvenile rheumatoid arthritis

Semin Arthritis Rheum

Uveitis in juvenile chronic arthritisincidence, clinical features and prognosis

Eye

Uveitis in juvenile chronic arthritis

Clin Exp Rheumatol

Changing patterns in uveitis of childhood

Ophthalmology

Visual prognosis in children with chronic anterior uveitis and arthritis

J Rheumatol

Nomenclature and classification of arthritis in children

Current proposed revision of JRA criteria

Arthritis Rheum

International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease

Am J Ophthalmol