1
|
Maleki A, Patel PD, Foster CS. Juvenile idiopathic arthritis and its associated uveitis. Expert Rev Clin Immunol 2023; 19:1157-1169. [PMID: 37401872 DOI: 10.1080/1744666x.2023.2231154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Juvenile idiopathic arthritis is the most common chronic rheumatologic disease in children. Uveitis is the most common extra-articular manifestation of JIA, and it can be a sight-threatening condition. AREAS COVERED In this review article, we discussed epidemiology, risk factors, clinical presentation, supportive laboratory tests, treatment options, and complications of Juvenile idiopathic arthritis and Juvenile idiopathic arthritis associated uveitis. We covered conventional immunomodulatory therapy and biologic response modifiers agents for different types of Juvenile idiopathic arthritis and their associated uveitis. Finally, we discussed the course of disease, functional outcome, and the quality of life of Juvenile idiopathic arthritis and Juvenile idiopathic arthritis-associated uveitis. EXPERT OPINION Although clinical outcomes of Juvenile idiopathic arthritis and its associated uveitis have been improved over the past three decades by biologic response modifier agents, a significant proportion of patients require active treatment into adult life therefore screening and monitoring of these patients is required during the patient's entire life. The limited number of food and drug administration approved biologic response modifier agents for the treatment of Juvenile idiopathic arthritis associated uveitis justify more randomized clinical trials with new medications in this field.
Collapse
Affiliation(s)
- Arash Maleki
- Department of Ophthalmology, University of Florida, Gainesville, FL, USA
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Priya D Patel
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - C Steven Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Elnahry AG, Hassan LM, Abdelrahman W, Abd Elmohsen MN. Optical coherence tomography angiography (OCTA) findings in juvenile idiopathic arthritis. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
3
|
Psychological Effects and Quality of Life in Parents and Children with Jia-Associated Uveitis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121864. [PMID: 36553308 PMCID: PMC9777304 DOI: 10.3390/children9121864] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease common in children and young adults. Uveitis is the most frequent serious extra-articular JIA manifestation and can lead to severe ocular complications, vision loss, and permanent blindness. This study aims to evaluate the psychological condition and the quality of life of children affected by JIA associated with uveitis (JIA-U) and the repercussion of this condition on parents. Thirty children and adolescents with active uveitis (Uveitis group) and comorbid joint symptoms of JIA were referred to the Unit of Ophthalmology, Giovanni XXIII Hospital of Bari, and 30 age-matched healthy controls (Healthy group) were enrolled with their parents. Four questionnaires were administered: Child Behaviour Checklist (CBCL), Parent Stress Index in Short Form (PSI), Pediatric Quality of Life Inventory (PedsQL), and Coping Inventory for Stressful Situations (CISS). The data were collected from February 2021 to December 2021. No significant differences between the two groups in CBCL, PSI, or CISS tests were shown (p > 0.05). Conversely, significant differences between the two groups were observed in the PedsQL (p < 0.05). This study shows how several ocular complications, recurrent eye examinations, and the rigor of long-term treatment may negatively influence health-related quality of life in children with JIA-U.
Collapse
|
4
|
Wennink RA, Kalinina Ayuso V, Pameijer EM, Dekkers CC, Bozkir I, de Boer JH. Improved clinical outcomes in patients with juvenile idiopathic arthritis associated uveitis in the last decade. Acta Ophthalmol 2022; 100:781-787. [PMID: 35076174 PMCID: PMC9786763 DOI: 10.1111/aos.15097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/24/2021] [Accepted: 12/29/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of the study was to analyse the development of ocular complications and visual prognosis in juvenile idiopathic arthritis associated uveitis (JIA-uveitis) compared to the previous decade in the light of new treatment guidelines. METHODS In this retrospective cohort, 143 patients with JIA-uveitis were stratified into two cohorts based on the year of diagnosis of uveitis, <2010 (n = 61) and ≥2010 (n = 82). Development of ocular complications and visual outcomes were analysed by univariate and multivariate methods. Treatment with systemic corticosteroids and immunomodifying medication (IMT) were documented. RESULTS In total, 109 and 133 affected eyes, respectively, for cohort 1 (<2010) and cohort 2 (≥2010) were included for analysis. In the multivariate analysis with correction for paired eyes, patients in cohort 1 were at higher risk for cataract surgery (p = 0.03) and secondary glaucoma (p = 5.15 × 10-3 ). Also, the number of eyes that were legally blind and visually impaired at 5 years of follow-up was significantly higher in cohort 1 (7% versus 2% and 8% versus 0%, p = 0.01 respectively). The number of patients that started IMT was significantly higher in cohort 2 (57% versus 98%, p = 2.17 × 10-6 ). In cohort 2, both methotrexate and anti-TNF-α therapy were prescribed earlier in the disease course (1.41 versus 0.05 years, p = 8.31 × 10-6 and 6.07 versus 1.84 years, p = 5.14 × 10-5 respectively). CONCLUSIONS The prognosis of JIA-uveitis has improved during the last decade. There is a reduction in the number of cataract surgeries and secondary glaucoma and fewer patients lose their vision parallel with earlier access to tertiary care and earlier introduction of IMT.
Collapse
Affiliation(s)
- Roos A.W. Wennink
- Department of OphthalmologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Viera Kalinina Ayuso
- Department of OphthalmologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Els M. Pameijer
- Department of OphthalmologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Coco C. Dekkers
- Department of OphthalmologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Irem Bozkir
- Department of OphthalmologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Joke H. de Boer
- Department of OphthalmologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| |
Collapse
|
5
|
Mahendradas P, Mishra SB, Mangla R, Sanjay S, Kawali A, Shetty R, Dharmanand B. Reactivation of juvenile idiopathic arthritis associated uveitis with posterior segment manifestations following anti-SARS-CoV-2 vaccination. J Ophthalmic Inflamm Infect 2022; 12:15. [PMID: 35476156 PMCID: PMC9043884 DOI: 10.1186/s12348-022-00294-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background/purpose Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in the pediatric population and anterior uveitis is its commonest extra-articular manifestation. Typically the uveitis presents as chronic anterior uveitis and there is limited literature of the posterior segment manifestations of the disease. Similar to other vaccines, anti-SARS-CoV-2 vaccination that began as an urgent measure to control the spread of the SARS-CoV-2 pandemic has not been without adverse events. We are reporting a 19-year-old Asian Indian female who was diagnosed and treated for JIA associated anterior uveitis that was unilateral and was under anti-inflammatory control but showed worsening of uveitis with posterior segment inflammation in both eyes following anti-SARS-CoV-2 vaccination. Case report A 19-year-old Asian Indian female with a history of juvenile idiopathic arthritis on treatment with methotrexate, presented with right eye chronic anterior uveitis with peripheral subclinical retinal vasculitis and macular edema which was brought under control following administration of adalimumab. She was inflammation free for 6 months until she received anti-SARS-CoV-2 vaccination and developed new onset floaters in both eyes that were initially noted after the first dose and increased after the second dose. Clinical examination revealed presence of keratic precipitates and grade 1+ anterior chamber inflammation along with vitiritis in both eyes. Fundus fluorescein angiography revealed angiographically active retinal vasculitis without the presence of macular edema in both eyes. This was managed with a short course of topical difluprednate and continuation of systemic immunosuppressive therapy with adalimumab and methotrexate. Conclusion JIA associated uveitis results from an autoimmune process which can be controlled with timely immunosuppressive treatment. It is important to be aware of the potential risk of flare up of uveitis with posterior segment manifestations following anti- SARS-CoV-2 vaccination.
Collapse
Affiliation(s)
| | - Sai Bhakti Mishra
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Rubble Mangla
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | | |
Collapse
|
6
|
Carlsson E, Beresford MW, Ramanan AV, Dick AD, Hedrich CM. Juvenile Idiopathic Arthritis Associated Uveitis. CHILDREN-BASEL 2021; 8:children8080646. [PMID: 34438537 PMCID: PMC8393258 DOI: 10.3390/children8080646] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 01/31/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. The development of associated uveitis represents a significant risk for serious complications, including permanent loss of vision. Initiation of early treatment is important for controlling JIA-uveitis, but the disease can appear asymptomatically, making frequent screening procedures necessary for patients at risk. As our understanding of pathogenic drivers is currently incomplete, it is difficult to assess which JIA patients are at risk of developing uveitis. Identification of specific risk factors for JIA-associated uveitis is an important field of research, and in this review, we highlight the genomic, transcriptomic, and proteomic factors identified as potential uveitis risk factors in JIA, and discuss therapeutic strategies.
Collapse
Affiliation(s)
- Emil Carlsson
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, UK;
- Correspondence: (E.C.); (C.M.H.); Tel.: +44-151-228-4811 (ext. 2690) (E.C.); +44-151-252-5849 (C.M.H.)
| | - Michael W. Beresford
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, UK;
- Department of Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
- National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
| | - Athimalaipet V. Ramanan
- Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol BS2 8DZ, UK;
| | - Andrew D. Dick
- Translational Health Sciences, University of Bristol, Bristol BS2 8DZ, UK;
- UCL Institute of Ophthalmology, London EC1V 9EL, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Christian M. Hedrich
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, UK;
- Department of Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
- National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
- Correspondence: (E.C.); (C.M.H.); Tel.: +44-151-228-4811 (ext. 2690) (E.C.); +44-151-252-5849 (C.M.H.)
| |
Collapse
|
7
|
Neves LM, Haefeli LM, Hopker LM, Ejzenbaum F, Moraes do Nascimento H, Aikawa N, Hilario MO, Magalhães CS, Terreri MT, Sztajnbok F, Silva C, Rossetto JD. Monitoring and Treatment of Juvenile Idiopathic Arthritis-associated Uveitis: Brazilian Evidence-based Practice Guidelines. Ocul Immunol Inflamm 2021; 30:1384-1398. [PMID: 33826468 DOI: 10.1080/09273948.2021.1876886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To present a national guideline for ophthalmologic care and surveillance of juvenile idiopathic arthritis-associated uveitis (JIA-uveitis).Methods: Review article based on medical literature and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology/Brazilian Council of Ophthalmology and the Brazilian Society of Pediatrics/Brazilian Society of Rheumatology. Studies with a high level of evidence were selected by searching the PubMed/Medline database. The final document was approved by the experts.Results: The main recommendations are that children/adolescents with JIA should undergo screening according to their risk factors. Ophthalmological checkups should also consider ocular inflammation and therapy. Topical glucocorticoids should be the first line of therapy, with systemic glucocorticoids acting as bridge treatments in severe uveitis. Methotrexate should be the first-line systemic therapy and anti-tumor necrosis factor (anti-TNF alpha) the second for uncontrolled uveitis.Conclusions: This evidence-based guideline for JIA-uveitis will be useful for both ophthalmology and rheumatology practice.
Collapse
Affiliation(s)
- L M Neves
- Ophthalmology Department, Instituto Nacional De Saúde Da Mulher, Da Criança E Do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio De Janeiro, RJ, Brazil.,Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil
| | - L M Haefeli
- Ophthalmology Department, Instituto Nacional De Saúde Da Mulher, Da Criança E Do Adolescente Fernandes Figueira- Fundação Oswaldo Cruz, Rio De Janeiro, RJ, Brazil.,Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil
| | - L M Hopker
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Ophthalmology Department, Hospital De Olhos Do Paraná, Curitiba/PR, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil
| | - F Ejzenbaum
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Ophthalmology Department, Santa Casa De Misericórdia De São Paulo Sao Paulo/SP, Brazil
| | - H Moraes do Nascimento
- Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Ophthalmology and Visual Science Department, Federal University of Sao Paulo - UNIFESP, São Paulo, SP, Brazil
| | - N Aikawa
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, SP, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil
| | - M O Hilario
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Department, Santa Casa De Misericórdia De Porto Alegre, Porto Alegre/RS, Brazil
| | - C S Magalhães
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Rheumatology Division, São Paulo State University (UNESP), Botucatu/SP, Brazil
| | - M T Terreri
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Rheumatology Unit, Federal University of São Paulo - UNIFESP, São Paulo/SP, Brazil
| | - F Sztajnbok
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil.,Pediatric Department, Instituto De Puericultura E Pediatria Martagão Gesteira - IPPMG/Federal University of Rio De Janeiro - UFRJ - Rio De Janeiro/RJ, Brazil
| | - Caa Silva
- Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital Das Clinicas HCFMUSP, Faculdade De Medicina, Universidade De Sao Paulo, SP, Brazil.,Brazilian Society of Rheumatology (SBR), Sao Paulo/SP, Brazil
| | - J D Rossetto
- Brazilian Society of Pediatric Ophthalmology (SBOP), Sao Paulo/SP, Brazil.,Brazilian Council of Ophthalmology (CBO), Sao Paulo/SP, Brazil.,Brazilian Society of Pediatrics (SBP), Rio de Janeiro/RJ, Brazil.,Ophthalmology and Visual Science Department, Federal University of Sao Paulo - UNIFESP, São Paulo, SP, Brazil.,Pediatric Department, Instituto De Puericultura E Pediatria Martagão Gesteira - IPPMG/Federal University of Rio De Janeiro - UFRJ - Rio De Janeiro/RJ, Brazil
| |
Collapse
|
8
|
Slamang W, Tinley C, Brice N, Scott C. Paediatric non-infectious uveitis in Cape Town, South Africa: a retrospective review of disease characteristics and outcomes on immunomodulating treatment. Pediatr Rheumatol Online J 2021; 19:50. [PMID: 33794930 PMCID: PMC8017656 DOI: 10.1186/s12969-021-00537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Non-infectious uveitis is a well-reported cause of blindness in more developed countries, however data from sub-Saharan Africa is lacking. Here we aim to describe the diseases associated with paediatric non-infectious uveitis and the effect of currently available treatment in this setting. METHODS A retrospective observational analysis of children with non-infectious uveitis from January 2010 to December 2017, attending the tertiary paediatric rheumatology and ophthalmology referral units in Cape Town was conducted. Statistical analysis utilising STATA13 software was performed with p < 0.05 considered significant. RESULTS Twenty-nine children were identified: median age at first visit of 74 months (IQR 49-86 months), female to male ratio of 0.9:1, predominantly of mixed ancestry (72.4%). Juvenile idiopathic arthritis associated uveitis (JIAU) (48.3%), idiopathic uveitis (41.4%), sarcoidosis (6.9%) and Behcet's disease (3.5%) were diagnosed. Chronic anterior uveitis (72.4%) was the most frequent finding. Fifty-five percent had complications at presentation and all children with idiopathic uveitis presented with cataracts. Only 6.5% of the JIA cohort had JIAU. All JIA children had chronic anterior uveitis. There were no differences between JIA children with uveitis and those without uveitis, for sex (p = 0.68) and race (p = 0.58). Significantly, children with uveitis presented at an overall younger age (p = 0.008), had oligo-articular JIA (p = 0.01) and were antinuclear antibody positive (p < 0.001). Children with idiopathic uveitis were predominantly male (66.6%) with chronic anterior uveitis (41.7%). Nineteen children (65.5%) in the cohort had inactive disease on treatment at 12 months from diagnosis, which included 10 on topical corticosteroid therapy. At the last clinical visit 17 (58.6%) on standard initial therapy, 8 (27.6%) on tumour necrosis factor inhibitors and 2 on additional DMARDs were in remission. Five of these children still required topical corticosteroids. Surgery was performed in 41.4%, primarily in the idiopathic group. Visual acuity improved or was maintained on treatment. CONCLUSION Current practice seems to detect children with potentially sight-threatening disease but the high rate of complications and the low percentage of children with JIAU raises concerns of delayed healthcare intervention. Tumour necrosis factor inhibitors have improved outcomes in refractory cases in this cohort, however further studies are needed.
Collapse
Affiliation(s)
- Waheba Slamang
- Department of Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Cape Town, 7700, South Africa.
- University of Cape Town South Africa, Rondebosch, Cape Town, South Africa.
| | - Christopher Tinley
- University of Cape Town South Africa, Rondebosch, Cape Town, South Africa
- Department of Paediatric Ophthalmology, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Cape Town, 7700, South Africa
| | - Nicola Brice
- Department of Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Cape Town, 7700, South Africa
- University of Cape Town South Africa, Rondebosch, Cape Town, South Africa
| | - Christiaan Scott
- Department of Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, Klipfontein Rd, Cape Town, 7700, South Africa.
- University of Cape Town South Africa, Rondebosch, Cape Town, South Africa.
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW To give an overview of recently published articles covering risk factors, novel biomarkers and treatment for noninfectious uveitis in children. RECENT FINDINGS In the last few years, several genetic markers, serum biomarkers, aqueous humor markers, tear biomarkers and clinical factors have been identified, which are associated with childhood noninfectious uveitis. We describe the most important reports in this field that may help to tailor the screening and monitoring of this population in the future and might become the target of novel therapies. The advances in the biologic therapy of paediatric uveitis, thanks to evidence provided by the SYCAMORE, ADJUVITE and APTITUDE trials, offer new possibilities for the treatment of patients who fail methotrexate with adalimumab and tocilizumab. We discuss the importance of comprehensive outcome measures as proposed by the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC). SUMMARY Paediatric noninfectious uveitis is a sight-threatening condition and the identification of risk factors and novel biomarkers is critical for tailored management. Biologic therapies are revolutionizing the outcomes of patients resistant to conventional therapy. Increasing our knowledge of disease pathogenesis is crucial to improve targeting of screening to those at highest risk and stratification of treatments.
Collapse
|
10
|
Chen JL, Abiri P, Tsui E. Recent advances in the treatment of juvenile idiopathic arthritis-associated uveitis. Ther Adv Ophthalmol 2021; 13:2515841420984572. [PMID: 33681703 PMCID: PMC7897841 DOI: 10.1177/2515841420984572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022] Open
Abstract
Juvenile idiopathic arthritis-associated uveitis has an estimated prevalence of 10-20% in patients with juvenile idiopathic arthritis, making it the most common cause of chronic anterior uveitis in children. Prompt treatment is important to prevent development of ocular complications and permanent vision loss. In this review, we will discuss the use of immunosuppression in treatment of juvenile idiopathic arthritis-associated uveitis. This will include the use of conventional immunosuppressants, such as methotrexate, biologic anti-tumor necrosis factor agents, such as adalimumab, as well as other anti-tumor necrosis factor agents, including infliximab and golimumab. In addition, we will discuss medications currently in clinical trials or under consideration for juvenile idiopathic arthritis-associated uveitis, including interleukin-6 inhibitors (tocilizumab) and Janus kinase inhibitors (tofacitinib, baricitinib).
Collapse
Affiliation(s)
- Judy L Chen
- Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Parinaz Abiri
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Edmund Tsui
- Assistant Professor of Ophthalmology, Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, 200 Stein Plaza, Los Angeles, CA 90095-7003, USA
| |
Collapse
|
11
|
Rodriguez-Smith J, Yeh S, Angeles-Han S. Improving quick and accurate diagnosis of childhood JIA-uveitis from a pediatric rheumatology perspective. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 15:101-109. [PMID: 32313548 PMCID: PMC7170263 DOI: 10.1080/17469899.2020.1739521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/04/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease associated with uveitis. JIA-associated uveitis (JIA-U) is typically asymptomatic, chronic, and can lead to sight-threatening complications. This review will provide approaches to improve the diagnosis and outcomes of children with JIA-U. AREAS COVERED We will provide updates on risk factors for uveitis onset and ocular complications, improvements in the ophthalmic screening schedule for uveitis detection, and potential strategies to advance the diagnosis and monitoring of JIA-U using advanced ophthalmic imaging and diagnostic equipment and laboratory biomarkers. EXPERT OPINION There is a lack of high-quality research in JIA-U and few randomized controlled trials, underscoring the urgent need for further studies in this population. Early uveitis diagnosis combined with timely and appropriate treatment can improve visual outcomes. Improved knowledge of uveitis pathogenesis, risk factors for uveitis onset, measurement of uveitis outcomes, and optimal treatment are crucial.
Collapse
Affiliation(s)
- Jackeline Rodriguez-Smith
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, 3333 Burnett Avenue, Cincinnati, Ohio 45229-3026, United States
| | - Steven Yeh
- Emory Eye Center, Department of Ophthalmology, Atlanta, Georgia 30322-1013, United States
| | - Sheila Angeles-Han
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, 3333 Burnett Avenue, Cincinnati, Ohio 45229-3026, United States
| |
Collapse
|
12
|
Castagna I, Roszkowska AM, Alessandrello F, Oliverio GW, Tumminello G, Gallizzi R, Conti G, Aragona P. Juvenile idiopathic arthritis-associated uveitis: a retrospective analysis from a centre of South Italy. Int Ophthalmol 2019; 40:335-342. [PMID: 31586268 DOI: 10.1007/s10792-019-01184-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the clinical and laboratory characteristics of the children affected by juvenile idiopathic arthritis (JIA) who developed uveitis. METHODS In this retrospective study, we have examined data of 109 patients aged from 3 to 16 years, affected by JIA and followed at Paediatrics Rheumatology Clinic and Ophthalmology Clinic of University Hospital of Messina in the period from 2007 to 2017. The main outcome measures were clinical and laboratory findings related to JIA and ocular involvement. The prevalence of ocular signs and symptoms was determined and correlated with age. RESULTS Twenty-one (19.3%) subjects developed uveitis. Two different peaks of age with ocular involvement were registered. The first occurred between 4 and 6 years and the second between 10 and 12 years. All subjects in the first group resulted to be female, presented oligoarticular arthritis and chronic anterior uveitis. In the second group, the 84% of patients were male with different types of JIA and acute anterior uveitis. The prevalence of ocular complications was higher in the first group. CONCLUSIONS Two peaks of age emerged and were characterized by different clinical outcomes of arthritis and ocular involvement. The first occurred between 4 and 6 years and interested females affected by oligoarticular JIA who develop chronic anterior uveitis. The second appeared at 10-12 years and interested older males affected by different types of JIA with acute anterior uveitis. Early diagnosis and cooperation between paediatric rheumatologist and ophthalmologist are of great importance in the proper management of JIA children with uveitis.
Collapse
Affiliation(s)
- I Castagna
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| | - A M Roszkowska
- Ophthalmology Section, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland. .,A.O.U. Policlinico G. Martino Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - F Alessandrello
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| | - G W Oliverio
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| | - G Tumminello
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| | - R Gallizzi
- Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - G Conti
- Pediatric Nephrology and Rheumatology Unit, University Hospital of Messina, Messina, Italy
| | - P Aragona
- Ophthalmology Unit, Department of Biomedical Sciences, University Hospital of Messina, Messina, Italy
| |
Collapse
|
13
|
Oligoarticular onset juvenile idiopathic arthritis as the most common cause of disability of children and young adults. Reumatologia 2019; 57:189-191. [PMID: 31548744 PMCID: PMC6753598 DOI: 10.5114/reum.2019.87607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/29/2019] [Indexed: 01/31/2023] Open
|
14
|
Mastrangelo G, Foeldvari I, Anton J, Simonini G. Defining outcome measures in juvenile idiopathic arthritis associated uveitis by a systematic review analysis: do we need a consensus? Pediatr Rheumatol Online J 2019; 17:40. [PMID: 31296236 PMCID: PMC6625008 DOI: 10.1186/s12969-019-0330-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/17/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis associated Uveitis (JIA-U) represents its most frequent extra-articular manifestation and the main cause of childhood uveitis in in developed countries. The broad variety of outcome measures utilized makes the comparison of the disease course, risk for complications, impairment in visual function, and responses to treatment quite difficult. Our aim was to summarize evidence regarding the current availability of outcome measures in JIA-U. METHODS A systematic review between January 2000 and December 2018 was performed to identify studies investigating outcome measures used in JIA-U. RESULTS The initial search identified 8254 articles of which 89 were potentially eligible. After the full text revision, a total of 27 studies, including 2 RCTs, were included. Among these studies 12 outcome measures for JIA-U use have been identified (grade of cells in the AC, grade of flare in the AC, VA, amblyopia, structural complications, use and sparing of oral corticosteroids and immunosuppressive drugs, surgery requirement, biomarkers, bilateral disease, JIA persistence, quality of life assessments, uveitis subtype). As regards primary outcome measures, 44% among studies included one or more variables related to disease activity (i.e. grade of flare, grade of cells); 56% included visual function performance (i.e. visual acuity); 68% (17/25) included one or more variables of disease-associated tissue damage or complications (i.e. cataract, amblyopia); 24% included disease features (i.e. bilateral disease; uveitis subtype); 44% included laboratory features (i.e. biomarkers); 8% included JIA features (i.e. persistence of disease); 12% included quality of life (i.e. EYE-Q); 44% included management (i.e. use and sparing of oral corticosteroids and other immunosuppressive drugs; surgery requirement). CONCLUSIONS Our systematic review surveys the heterogeneity around outcome measures related to JIA-U in children, even in RCTs. It does not provide the solution to overcome the heterogeneity in uveitis studies, but it does provide an estimate of the scale of the problems and provides data to inform this important debate; highlighting the requirement to obtain a new consensus regarding a common approach to identify suitable and efficient outcome measures in JIA-U.
Collapse
Affiliation(s)
- Greta Mastrangelo
- Rheumatology Unit, Anna Meyer Children's Hospital, Pediatric Section-NEUROFARBA Department, University of Florence, Florence, Italy.
| | - Ivan Foeldvari
- 0000 0004 0581 2913grid.491620.8Centre for Pediatric and Adolescence Rheumatology, An der Schön Klinik, Hamburg, Eilbek Germany
| | - Jordi Anton
- 0000 0001 0663 8628grid.411160.3Pediatric Rheumatology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Gabriele Simonini
- 0000 0004 1757 2304grid.8404.8Rheumatology Unit, Anna Meyer Children’s Hospital, Pediatric Section-NEUROFARBA Department, University of Florence, Florence, Italy
| |
Collapse
|
15
|
Comparison of uveitis in the course of juvenile idiopathic arthritis with isolated uveitis in children - own experiences. Reumatologia 2018; 56:149-154. [PMID: 30042602 PMCID: PMC6052371 DOI: 10.5114/reum.2018.76902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/07/2018] [Indexed: 12/05/2022] Open
Abstract
Objectives Uveitis and juvenile idiopathic arthritis (JIA) relatively often coexist. Inflammatory changes in the anterior segment of the eye are the most common extra-articular symptom in children with JIA, and JIA is, in turn, the main systemic cause of anterior uveitis in children. The aim of our study was to compare the course of anterior uveitis accompanying JIA and isolated uveitis. Material and methods We analyzed 25 children with JIA and uveitis (group I) and 28 children with isolated uveitis (group II). The study population was retrospectively selected from the patients treated in our center in the years 1998–2016 through a search of the hospital database. All data were presented as descriptive statistics. Results In group I there was a higher percentage of girls than in group II (64% vs. 50%) and uveitis occurred at a significantly younger age (8.7 years vs. 11.6). Patients from group I more often presented with immunological abnormalities (positive antinuclear antibodies or HLA-B27 antigen). The majority of children from group I developed uveitis prior to (44%) or simultaneously with (20%) arthritis. In patients who first presented with uveitis, arthritis appeared on average after 28 months (median 12 months). In children in whom arthritis developed first, uveitis appeared on average after 51 months (median 36 months). In some patients the time interval between the involvement of these two organs was as long as 9–10 years. Four children from group I and three from group II were qualified for biological treatment. Conclusions The results of our analysis indicate the need for constant cooperation between the pediatric rheumatologist and the ophthalmologist. Although the risk of uveitis in JIA decreases with the disease duration, in some cases this complication can develop after many years. Children with present antinuclear antibodies, at younger age and of female gender should be subject to particularly close observation.
Collapse
|
16
|
Chronic Anterior Uveitis in Children: Psychosocial Challenges for Patients and Their Families. Am J Ophthalmol 2018; 191:xvi-xxiv. [PMID: 29601821 DOI: 10.1016/j.ajo.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe issues of concern to children with chronic anterior uveitis; to consider the psychological impact of chronic anterior uveitis on children's lives; and to understand the effect of a child's chronic illness on other family members. DESIGN Expert commentary. METHODS Author experiences were supplemented by a review of pertinent medical literature and by consideration of content from semi-structured, separate patient and parent interviews. RESULTS Vision loss and the fear of blindness are not the only stressors for children with chronic anterior uveitis and their families; of additional concern are the burdens of examinations and treatment regimens, as well as drug toxicities. Children with chronic anterior uveitis experience medical, academic, interpersonal, psychological, and developmental challenges. The impact of disease extends to other members of a patient's family as well; parents experience challenges in similar domains. Problems with adherence to medical regimens are common. Both the disease and its treatment affect quality of life, and can interfere with successful management of disease and transition to autonomy in adulthood, as reported for other chronic conditions. Coping processes vary greatly between different families. CONCLUSIONS Eye examinations and the rigors of long-term treatment often influence the psychosocial health of patients and families; physicians who are aware of these issues can help patients and families cope with chronic illness and may improve outcomes. Further psychosocial research to understand the experiences of children dealing with chronic anterior uveitis is warranted; this commentary can serve as a foundation for development of age- and disease-specific research questions.
Collapse
|
17
|
Haasnoot AMJW, Schilham MW, Kamphuis S, Hissink Muller PCE, Heiligenhaus A, Foell D, Minden K, Ophoff RA, Radstake TRDJ, Den Hollander AI, Reinards THCM, Hiddingh S, Schalij-Delfos NE, Hoppenreijs EPAH, van Rossum MAJ, Wouters C, Saurenmann RK, van den Berg JM, Wulffraat NM, ten Cate R, de Boer JH, Pulit SL, Kuiper JJW. Identification of an Amino Acid Motif in HLA-DRβ1 That Distinguishes Uveitis in Patients With Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2018. [DOI: 10.1002/art.40484] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Sylvia Kamphuis
- Sophia Children's Hospital, Erasmus University Medical Center; Rotterdam The Netherlands
| | | | - Arnd Heiligenhaus
- St. Franziskus-Hospital, Muenster, Germany, and University of Duisburg; Essen Germany
| | - Dirk Foell
- University of Muenster; Muenster Germany
| | - Kirsten Minden
- German Rheumatism Research Center Berlin-Leibniz Institute and Charite University Medicine; Berlin Germany
| | - Roel A. Ophoff
- University Medical Center Utrecht, Utrecht, The Netherlands, and University of California; Los Angeles
| | | | | | | | - Sanne Hiddingh
- University Medical Center Utrecht, Utrecht University; Utrecht The Netherlands
| | | | | | - Marion A. J. van Rossum
- Emma Children's Hospital AMC and Amsterdam Rheumatology and Immunology Center Reade; Amsterdam The Netherlands
| | - Carine Wouters
- University of Leuven and University Hospitals Leuven; Leuven Belgium
| | | | | | - Nico M. Wulffraat
- University Medical Center Utrecht, Utrecht University; Utrecht The Netherlands
| | | | - Joke H. de Boer
- University Medical Center Utrecht, Utrecht University; Utrecht The Netherlands
| | - Sara L. Pulit
- University Medical Center Utrecht, Utrecht, The Netherlands, and Oxford University; Oxford UK
| | - Jonas J. W. Kuiper
- University Medical Center Utrecht, Utrecht University; Utrecht The Netherlands
| | | |
Collapse
|
18
|
Abstract
Pediatric uveitis differs from adult-onset uveitis and is a topic of special interest because of its diagnostic and therapeutic challenges. Children with uveitis are often asymptomatic and the uveitis is often chronic, persistent, recurrent, and resistant to conventional treatment. Anterior uveitis is the most common type of uveitis in children; the prevalence of intermediate, posterior, and panuveitis varies geographically and among ethnic groups. Regarding etiology, most cases of pediatric uveitis are idiopathic but can be due to systemic inflammatory disorders, infections, or a manifestation of masquerade syndrome. Ocular complications include cataracts, hypotony or glaucoma, band keratopathy, synechiae formation, macular edema, optic disc edema, choroidal neovascular membranes, and retinal detachment. These complications are often severe, leading to irreversible structural damage and significant visual disability due to delayed presentation and diagnosis, persistent chronic inflammation from suboptimal treatment, topical and systemic corticosteroid dependence, and delayed initiation of systemic disease‒modifying agents. Treatment for noninfectious uveitis is a stepwise approach starting with corticosteroids. Immunomodulatory therapy should be initiated in cases where quiescence cannot be achieved without steroid dependence. Patients should be monitored regularly for complications of uveitis along with systemic and ocular adverse effects from treatments. The goals are to achieve steroid-free durable remission, to reduce the risk of sight-threatening complications from the uncontrolled ocular inflammation, and to avoid the impact of lifelong burden of visual loss on the child and their family. Multidisciplinary management will ensure holistic care of affected children and improve the support for their families.
Collapse
Affiliation(s)
| | - Jessy Choi
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield Children NHS Foundation Trust, Sheffield, United Kingdom
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| |
Collapse
|
19
|
Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Best Pract Res Clin Rheumatol 2018; 31:517-534. [PMID: 29773271 DOI: 10.1016/j.berh.2018.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/14/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the commonest rheumatic disease in children and JIA-associated uveitis its most frequent extra-articular manifestation. The uveitis is potentially sight-threatening and thus carries a considerable risk of morbidity with associated reduction in quality of life. The commonest form of uveitis seen in association with JIA is chronic anterior uveitis, which is almost always asymptomatic in the initial stages. Therefore, screening for JIA-associated uveitis in at-risk patients is essential. The aim of early detection and treatment is to minimise intraocular inflammation and to avoid complications that lead to visual loss, which can result from both disease activity and medications. The sight-threatening complications of JIA-associated uveitis include cataracts, glaucoma, band keratopathy, and macular oedema. There is increasing evidence for the early introduction of systemic immunosuppressive therapies to reduce topical and systemic use of glucocorticoids. A recently published randomised controlled trial of adalimumab in JIA-associated uveitis now provides convincing evidence for the use of this biologic in patients who fail to respond adequately to methotrexate. Tocilizumab and abatacept are being investigated as alternatives in children inadequately treated with anti-tumour necrosis factor drugs.
Collapse
Affiliation(s)
- Ethan S Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK; Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
| |
Collapse
|
20
|
Pyo JK, Lee S, Kim KN. Prevalence, Risk Factors, and Expression of Human Leukocyte Antigen-DRB1 in Juvenile Idiopathic Arthritis-associated Uveitis. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.1.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Jin Kyu Pyo
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sol Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Nam Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| |
Collapse
|
21
|
Cosickic A, Halilbasic M, Selimovic A, Avdagic H. Uveitis Associated with Juvenile Idiopathic Arthritis, our Observations. Med Arch 2017; 71:52-55. [PMID: 28428675 PMCID: PMC5364790 DOI: 10.5455/medarh.2017.71.52-55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Uveitis as extra-articular manifestation of juvenile idiopathic arthritis (JIA) is present in 20% of children with the persistent form, in 30% with the extended oligoarticular form, while it is present in psoriatic and polyarticular rheumatoid factor (RF) negative arthritis in 10% and 14%, respectively. Aim: The aim of the study was to evaluate the frequency of uveitis and its complications in children with JIA. Material and Methods: A retrospective study was conducted with an analysis of the medical records of children with JIA who were treated for the last 5 years. The analysis included the following: the child’s age and sex, age at onset of arthritis, of uveitis, complications, RF values and antinuclear antibodies (ANA). Results: The study included 97 children with JIA: in 14 (14.4%) uveitis was observed; the most common form of JIA was the oligoarticular extended form (6/14), oligoarticular persistent form was observed in 5 children, while 3 children with uveitis had polyarticular RF negative JIA. The age of arthritis onset was lower in children with uveitis (4.7 vs 8.2 years); ANA positivity was more common in children with JIA and uveitis (64% vs 41%). Uveitis was the first manifestation of the disease for 2 children; 28.6% of children had clinically asymptomatic uveitis, while 42.4% of children developed uveitis within 4 years from the JIA onset. 8/14 children developed uveitis complications: 3 cases of synechia, 2 band keratopathy, 2 cataracta, 1 glaucoma. Conclusion: Uveitis as significantly present manifestation of JIA requires to timely recognize, treat, monitor children in order to prevent complications.
Collapse
Affiliation(s)
- Almira Cosickic
- Clinic for Children's Diseases, University Clinical Centre Tuzla, Bosnia and Herzegovina
| | - Meliha Halilbasic
- Ophthalmology Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amela Selimovic
- Clinic for Children's Diseases, University Clinical Centre Tuzla, Bosnia and Herzegovina
| | - Harun Avdagic
- Clinic for cardiovascular diseases, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
| |
Collapse
|
22
|
|
23
|
Haasnoot AMJW, Vernie LA, Rothova A, v. d. Doe P, Los LI, Schalij-Delfos NE, de Boer JH. Impact of Juvenile Idiopathic Arthritis Associated Uveitis in Early Adulthood. PLoS One 2016; 11:e0164312. [PMID: 27723840 PMCID: PMC5056754 DOI: 10.1371/journal.pone.0164312] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Typically juvenile idiopathic arthritis (JIA)-associated uveitis (further referred as 'JIA-uveitis') has its onset in childhood, but some patients suffer its, sometimes visual threatening, complications or ongoing disease activity in adulthood. The objective of this study was to analyze uveitis activity, complications and visual prognosis in adulthood. METHODS In this multicenter study, 67 adult patients (129 affected eyes) with JIA-uveitis were retrospectively studied for best corrected visual acuity, visual fields, uveitis activity, topical/systemic treatments, ocular complications, and ocular surgeries during their 18th, 22nd and 30th year of life. Because treatment strategies changed after the year 1990, outcomes were stratified for onset of uveitis before and after 1990. RESULTS Sixty-two of all 67 included patients (93%) had bilateral uveitis. During their 18th life year, 4/52 patients (8%) had complete remission, 28/52 (54%) had uveitis activity and 37/51 patients (73%) were on systemic immunomodulatory treatment. Bilateral visual impairment or legal blindness occurred in 2/51 patients (4%); unilateral visual impairment or legal blindness occurred in 17/51 patients (33%) aged 18 years. The visual prognosis appeared to be slightly better for patients with uveitis onset after the year 1990 (for uveitis onset before 1990 (n = 7) four patients (58%) and for uveitis onset after 1990 (n = 44) 13 patients (30%) were either visual impaired or blind). At least one ocular surgery was performed in 10/24 patients (42%) between their 18th and 22nd year of life. CONCLUSIONS Bilateral visual outcome in early adulthood in patients with JIA-uveitis appears to be fairly good, although one third of the patients developed one visually impaired or blind eye. However, a fair amount of the patients suffered from ongoing uveitis activity and needed ongoing treatment as well as surgical interventions. Awareness of these findings is important for ophthalmologists and rheumatologists treating patients with JIA-uveitis, as well as for the patients themselves.
Collapse
Affiliation(s)
| | - Lenneke A. Vernie
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Leonoor I. Los
- Department of Ophthalmology, Groningen University Medical Center, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | | | - Joke H. de Boer
- Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
24
|
Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis. Am J Ophthalmol 2016; 169:113-124. [PMID: 27345732 DOI: 10.1016/j.ajo.2016.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/12/2016] [Accepted: 06/13/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe risk factors for hypotony in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN Retrospective cohort study. METHODS All patients with JIA-associated uveitis (N = 108; affected eyes = 196) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014 were included in this study. Prevalence and incidence of hypotony (intraocular pressure [IOP] <5 mm Hg) and low IOP (5 mm Hg ≤ IOP < 8 mm Hg) and risk factors for developing hypotony were analyzed. RESULTS At presentation, 9.3% of patients (7.1% of affected eyes) had hypotony. During a median follow-up of 5.3 years, the rate of developing hypotony and low IOP were 0.04 per eye-year (/EY; 95% confidence interval [CI]: 0.02/EY, 0.05/EY) and 0.06/EY (95% CI: 0.04/EY, 0.08/EY), respectively. Risk factors for development of hypotony during follow-up appeared to be associated with more severe uveitic disease, such as the presence of panuveitis (adjusted hazard ratio [aHR], 43.1; P = .004), anterior chamber cells or flare ≥ 3+ (aHR, 25.6, P < .001), posterior synechiae (aHR, 5.9, P = .02), and the use of oral corticosteroid (aHR 28.9; P = .003) at the presenting examination. Receiving immunosuppressive drug therapy at the time of presentation was associated with a lower risk of development of hypotony (aHR, 0.02; P = .002). CONCLUSIONS Hypotony affects a small but significant proportion of patients with JIA-associated uveitis and is associated with signs of active and severe uveitis. Immunosuppression was associated with significantly lower risk of hypotony, suggesting that aggressive control of the inflammation may reduce risk of hypotony in JIA-associated uveitis.
Collapse
|
25
|
Haasnoot AMJW, Kuiper JJW, Hiddingh S, Schellekens PAWJF, de Jager W, Imhof SM, Radstake TRDJ, de Boer JH. Ocular Fluid Analysis in Children Reveals Interleukin-29/Interferon-λ1 as a Biomarker for Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Rheumatol 2016; 68:1769-79. [PMID: 26866822 DOI: 10.1002/art.39621] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/02/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Childhood uveitis is a vision-threatening inflammatory eye disease commonly attributed to juvenile idiopathic arthritis (JIA). The pathogenesis is poorly understood, which makes clinical management challenging. We analyzed soluble mediators in ocular fluid (aqueous humor [AqH]) and serum from children with JIA-associated uveitis and common childhood uveitis to identify potential biomarkers and investigate the ocular microenvironment of this sight-threatening eye disease. METHODS AqH (n = 73) and paired serum (n = 66) samples were analyzed for 51 soluble mediators of inflammation by multiplex immunoassay. Twenty-one children with JIA-associated uveitis were compared to 15 children with chronic anterior uveitis without arthritis, 29 children with noninfectious idiopathic uveitis, and 8 children with noninflammatory conditions (controls). For visualization of the joint effect of multiple mediators, we used the radial coordinate visualization (Radviz) method. Optimal biomarker level cutoffs were also determined. RESULTS The levels of interleukin-29 (IL-29)/interferon-λ1 (IFNλ1) were decreased (P < 0.001) and the levels of latency-associated peptide and osteoprotegerin were increased (P = 0.002 and P = 0.001, respectively) in samples of AqH, but not serum, from patients with JIA-associated uveitis. Multivariate analysis correcting for disease activity and treatment revealed that intraocular levels of IL-29/IFNλ1 were specifically decreased in patients with JIA-associated uveitis as compared to those with idiopathic uveitis. Indeed, JIA-associated uveitis patients and idiopathic uveitis patients showed distinct profiles of intraocular soluble mediators. IL-29/IFNλ1 showed a high area under the curve value (0.954), with 23.5 pg/ml as the optimal cutoff value. CONCLUSION We identified IL-29/IFNλ1 as an intraocular biomarker for JIA-associated uveitis, which suggests that aberrant IFNλ signaling might be important in JIA-associated uveitis and distinct from other forms of childhood uveitis.
Collapse
Affiliation(s)
| | | | - Sanne Hiddingh
- Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Wilco de Jager
- Utrecht University Medical Center and Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Saskia M Imhof
- Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Joke H de Boer
- Utrecht University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
26
|
Clarke SLN, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J 2016; 14:27. [PMID: 27121190 PMCID: PMC4848803 DOI: 10.1186/s12969-016-0088-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/21/2016] [Indexed: 12/14/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood, with JIA-associated uveitis its most common extra-articular manifestation. JIA-associated uveitis is a potentially sight-threatening condition and thus carries a considerable risk of morbidity. The aetiology of the condition is autoimmune in nature with the predominant involvement of CD4(+) T cells. However, the underlying pathogenic mechanisms remain unclear, particularly regarding interplay between genetic and environmental factors. JIA-associated uveitis comes in several forms, but the most common presentation is of the chronic anterior uveitis type. This condition is usually asymptomatic and thus screening for JIA-associated uveitis in at-risk patients is paramount. Early detection and treatment aims to stop inflammation and prevent the development of complications leading to visual loss, which can occur due to both active disease and burden of disease treatment. Visually disabling complications of JIA-associated uveitis include cataracts, glaucoma, band keratopathy and macular oedema. There is a growing body of evidence for the early introduction of systemic immunosuppressive therapies in order to reduce topical and systemic glucocorticoid use. This includes more traditional treatments, such as methotrexate, as well as newer biological therapies. This review highlights the epidemiology of JIA-associated uveitis, the underlying pathogenesis and how affected patients may present. The current guidelines and criteria for screening, diagnosis and monitoring are discussed along with approaches to management.
Collapse
Affiliation(s)
- Sarah L. N. Clarke
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK ,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Ethan S. Sen
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK ,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Athimalaipet V. Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ UK ,School of Clinical Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
27
|
Stroh IG, Moradi A, Burkholder BM, Hornbeak DM, Leung TG, Thorne JE. Occurrence of and Risk Factors for Ocular Hypertension and Secondary Glaucoma in Juvenile Idiopathic Arthritis-associated Uveitis. Ocul Immunol Inflamm 2016; 25:503-512. [PMID: 27003850 DOI: 10.3109/09273948.2016.1142573] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the incidence of ocular hypertension (OHT) and secondary glaucoma (SG) in JIA-associated uveitis, identify risk factors for development of these complications, and describe their effect on visual outcomes. METHODS A retrospective cohort of 108 patients (196 eyes) with JIA-associated uveitis seen over 30 years at an academic practice. RESULTS Of examined eyes, 40% had OHT or SG at presentation. These eyes had a nearly three-fold higher incidence of legal blindness during follow-up, compared with eyes without OHT or SG. An additional 41 eyes developed OHT or SG during follow-up. Presenting with anterior uveitis, active inflammation, and using systemic corticosteroids were risk factors for developing OHT, while use of immunosuppressive medication at presentation reduced this risk. Risk factors for developing SG included anterior uveitis and use of systemic corticosteroids. CONCLUSIONS OHT and SG were common in patients with JIA-associated uveitis. Use of immunosuppressive drugs may decrease the risk of developing OHT.
Collapse
Affiliation(s)
- Inna G Stroh
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Ahmadreza Moradi
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Bryn M Burkholder
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Dana M Hornbeak
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Theresa G Leung
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Jennifer E Thorne
- a Division of Ocular Immunology, Department of Ophthalmology , The Wilmer Eye Institute, The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.,b Department of Epidemiology , The Johns Hopkins University Bloomberg School of Public Health , Baltimore , Maryland , USA
| |
Collapse
|
28
|
Gupta A, Ramanan AV. Uveitis in Children: Diagnosis and Management. Indian J Pediatr 2016; 83:71-7. [PMID: 26420255 DOI: 10.1007/s12098-015-1889-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/17/2015] [Indexed: 12/14/2022]
Abstract
Uveitis is a term used to describe inflammation of uvea, which is the middle layer of eye. It is an important cause of blindness in children in both developed and developing countries. Delayed diagnosis, inadequate treatment and risk of amblyopia are some of the factors that are unique to childhood uveitis and are responsible for significant morbidity seen with this disease.
Collapse
Affiliation(s)
- Anju Gupta
- Division of Allergy Immunology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A V Ramanan
- Department of Pediatric Rheumatology, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK. .,Royal National Hospital for Rheumatic Diseases, Bath, UK.
| |
Collapse
|
29
|
Angeles-Han ST, McCracken C, Yeh S, Jenkins K, Stryker D, Travers C, Rouster-Stevens K, Vogler LB, Lambert SR, Drews-Botsch C, Prahalad S. The Association of Race With Childhood Uveitis. Am J Ophthalmol 2015; 160:919-928.e1. [PMID: 26255577 DOI: 10.1016/j.ajo.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 08/01/2015] [Accepted: 08/02/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To identify risk factors for a severe uveitis course among children with noninfectious uveitis. DESIGN Retrospective cohort study. METHOD This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3-6 months (2011-2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications, and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African-American and non-Hispanic white children only. RESULTS Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African-American and white children showed an increased prevalence of VA ≤20/200 in non-Hispanic African-Americans (18/25; 72% vs 4/43; 9%). Non-Hispanic African-Americans were more likely to be diagnosed at an older age (P = .030) and to have intermediate uveitis (P = .026), bilateral disease (P = .032), a history of VA ≤20/50 (P = .002), VA ≤20/200 (P < .001), and a higher rate of complications (P < .001). On multivariable analysis, non-Hispanic African-American race was a significant predictor of blindness (OR = 31.6, 95% CI 5.9-168.5, P < .001), after controlling for uveitis duration. Non-Hispanic African-Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic whites when controlling for uveitis type and duration. CONCLUSIONS There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African-American children with non-juvenile idiopathic arthritis-associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations.
Collapse
Affiliation(s)
- Sheila T Angeles-Han
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Steven Yeh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Daneka Stryker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Larry B Vogler
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Scott R Lambert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| |
Collapse
|
30
|
Angeles-Han ST, McCracken C, Yeh S, Jenkins K, Stryker D, Rouster-Stevens K, Vogler LB, Lambert SR, Drews-Botsch C, Prahalad S. Characteristics of a cohort of children with Juvenile Idiopathic Arthritis and JIA-associated Uveitis. Pediatr Rheumatol Online J 2015; 13:19. [PMID: 26031738 PMCID: PMC4450472 DOI: 10.1186/s12969-015-0018-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/22/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis-associated uveitis (JIA-U) can lead to poor visual outcomes and impact a child's quality of life (QOL) and function. Our aim is to identify risk markers of JIA-U and examine differences in the QOL of children with JIA and JIA-U. METHODS Rheumatology and ophthalmology record reviews and questionnaires were completed every 4-6 months on 287 children with JIA. We collected arthritis, uveitis, and QOL data. We examined data through last study visit. RESULTS There were 52/287 (18%) children with JIA-U who were younger at arthritis diagnosis, had oligoarticular persistent JIA, and ANA positive. Confirmed uveitis predictors were age at JIA diagnosis (OR = 0.86) and oligoarticular subtype (OR = 5.92). They had worse vision specific QOL and function, but similar general QOL. Blindness occurred in 17.5% of children but was more common in African American children compared to non-Hispanic Caucasian children ((5/7 (71%) vs. 2/29 (7%), p <0.001) despite a similar uveitis prevalence (22% vs. 16%). Both races had similar complications, although band keratopathy was more frequent in African Americans (75% vs. 15.6%, p = 0.003). CONCLUSIONS We confirm young age at JIA diagnosis and the oligoarticular JIA subtype as predictors of uveitis development. Although we were unable to identify predictors of ocular complications or blindness, AA children appeared to have a more severe disease course manifested by increased ocular complications, vision loss and blindness. Potential causes that warrant additional study include underlying disease severity, access to medical care and referral bias. Further investigation of the risk factors for vision-compromising uveitis and its' long-term effects should be conducted in a large racially diverse population.
Collapse
Affiliation(s)
- Sheila T. Angeles-Han
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322 USA ,Children’s Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329 USA ,Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Rd, Atlanta, GA 30322 USA
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
| | - Steven Yeh
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA. .,Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Rd, Atlanta, GA, 30322, USA.
| | - Kirsten Jenkins
- Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30329, USA.
| | - Daneka Stryker
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA. .,Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30329, USA.
| | - Larry B. Vogler
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322 USA ,Children’s Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329 USA
| | - Scott R. Lambert
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322 USA ,Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Rd, Atlanta, GA 30322 USA
| | - Carolyn Drews-Botsch
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA. .,Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30329, USA. .,Department of Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
| |
Collapse
|
31
|
Abstract
Uveitis is a potentially sight-threatening complication of juvenile idiopathic arthritis (JIA). JIA-associated uveitis is recognized to have an autoimmune aetiology characterized by activation of CD4(+) T cells, but the underlying mechanisms might overlap with those of autoinflammatory conditions involving activation of innate immunity. As no animal model recapitulates all the features of JIA-associated uveitis, questions remain regarding its pathogenesis. The most common form of JIA-associated uveitis is chronic anterior uveitis, which is usually asymptomatic initially. Effective screening is, therefore, essential to detect early disease and commence treatment before the development of visually disabling complications, such as cataracts, glaucoma, band keratopathy and cystoid macular oedema. Complications can result from uncontrolled intraocular inflammation as well as from its treatment, particularly prolonged use of high-dose topical corticosteroids. Accumulating evidence supports the early introduction of systemic immunosuppressive drugs, such as methotrexate, as steroid-sparing agents. Prospective randomized controlled trials of TNF inhibitors and other biologic therapies are underway or planned. Future research should aim to identify biomarkers to predict which children are at high risk of developing JIA-associated uveitis or have a poor prognosis. Such biomarkers could help to ensure that patients receive earlier interventions and more-potent therapy, with the ultimate aim of reducing loss of vision and ocular morbidity.
Collapse
|
32
|
|
33
|
Angeles-Han ST, Pelajo CF, Vogler LB, Rouster-Stevens K, Kennedy C, Ponder L, McCracken C, Lopez-Benitez J, Drews-Botsch C, Prahalad S. Risk markers of juvenile idiopathic arthritis-associated uveitis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol 2013; 40:2088-96. [PMID: 24187099 DOI: 10.3899/jrheum.130302] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To characterize the epidemiology and clinical course of children with juvenile idiopathic arthritis-associated uveitis (JIA-U) in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry and explore differences between African American (AA) and non-Hispanic white (NHW) children. METHODS There were 4983 children with JIA enrolled in the CARRA Registry. Of those, 3967 NHW and AA children were included in this study. Demographic and disease-related data were collected from diagnosis to enrollment. Children with JIA were compared to those with JIA-U. Children with JIA-U were also compared by race. RESULTS There were 459/3967 children (11.6%) with JIA-U in our cohort with a mean age (SD) of 11.4 years (± 4.5) at enrollment. Compared to children with JIA, they were younger at arthritis onset, more likely to be female, had < 5 joints involved, had oligoarticular JIA, and were antinuclear antibody (ANA)-positive, rheumatoid factor (RF)-negative, and anticitrullinated protein antibody-negative. Predictors of uveitis development included female sex, early age of arthritis onset, and oligoarticular JIA. Polyarticular RF-positive JIA subtype was protective. Nearly 3% of children with JIA-U were AA. However, of the 220 AA children with JIA, 6% had uveitis; in contrast, 12% of the 3721 NHW children with JIA had uveitis. CONCLUSION In the CARRA registry, the prevalence of JIA-U in AA and NHW children is 11.6%. We confirmed known uveitis risk markers (ANA positivity, younger age at arthritis onset, and oligoarticular JIA). We describe a decreased likelihood of uveitis in AA children and recommend further exploration of race as a risk factor in a larger population of AA children.
Collapse
Affiliation(s)
- Sheila T Angeles-Han
- From the Department of Pediatrics, and Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|