Editorial board comment
Uveitis is a dreaded complication in children with juvenile idiopathic arthritis (JIA). Being able to identify children at risk for uveitis, before the inflammation has started, is the dream for all pediatric rheumatologists and ophthalmologists. The findings by Nordal et al bring us one step closer to this goal.
The investigators found elevated levels of antinuclear and anti-histone antibodies in children with uveitis compared to those without uveitis. As far as we know, there is no specific ocular antigen as the target for these antibodies. What is happening here? Are these antibodies a signal for other ocular antigens that we have not yet identified? These are interesting questions for future research studies.
One of the most humbling things I took away from this study is the high prevalence of uveitis, even in the current age of biologic therapy for JIA. Over 20% of the children developed uveitis, and 18.4% developed chronic disease. Even scarier, while the uveitis developed within one year from arthritis in 53.9% of children, 4.5% had onset of uveitis more than 8 years after the onset of arthritis. This is a stark reminder that we need to be diligent about scheduled ophthalmologic screening in these children.