Predictors of uveitis in children with JIA identified
medwireNews: A Nordic cohort study has identified factors associated with the development of uveitis among children with juvenile idiopathic arthritis (JIA).
The detection of JIA-associated uveitis “may be obvious in cases with acute uveitis, but the challenge remains to provide optimal screening programs and treatment to minimize long-term complications in all forms of JIA-associated uveitis,” explain the study authors.
They add: “Robust predictors of uveitis will help [with] selecting high-risk children for frequent eye examinations to ensure early diagnosis and treatment.”
Ellen Nordal (University Hospital of North Norway, Tromsø) and fellow researchers found that 89 (20.5%) of the 435 children with JIA who were included in the study developed uveitis over a median 8.2 years of follow-up. A total of 80 participants were diagnosed with chronic insidious uveitis, whereas nine had acute uveitis.
This is a stark reminder that we need to be diligent about scheduled ophthalmologic screening in these children.
Almost three-quarters (71.9%) of the children with uveitis were diagnosed with JIA before 7 years of age, compared with approximately half (54.6%) of those without uveitis, a significant difference (odds ratio [OR]=2.1).
Furthermore, participants with uveitis were significantly more likely to have antihistone antibodies (AHA) at a concentration of 15 U/mL and above or to have antinuclear antibodies (ANA) than those without uveitis, at 40.9% versus 12.5% (OR=4.8) and 42.5% versus 23.2% (OR=2.4), respectively.
When the results were stratified by gender, there was a significant association between ANA and uveitis development in girls and boys, but JIA onset before 7 years of age and AHA were only significantly associated with uveitis among girls.
These findings suggest that “[e]arly-onset arthritis and presence of AHA in girls, as well as presence of ANA in both genders, were significant predictors” of uveitis development, say Nordal and colleagues in Pediatric Rheumatology.
The team also analyzed the timeframe over which uveitis was diagnosed, finding that 53.9% of participants developed uveitis within the first year after JIA onset, while 82.0% had the condition within 4 years of arthritis onset, emphasizing “the need for immediate eye examination in children with onset of non-septic or non-specific arthritis even before the diagnosis of JIA is confirmed, and frequent early follow-up when a diagnosis of JIA has been established.”
And 4.5% of the children developed uveitis more than 8 years after their diagnosis of arthritis, suggesting that “long-term ophthalmologic follow-up into adulthood must be considered.”
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