TY - JOUR
T1 - Uveitis in Juvenile Idiopathic Arthritis
T2 - 18-Year Outcome in the Population-based Nordic Cohort Study
AU - Rypdal, Veronika
AU - Glerup, Mia
AU - Songstad, Nils Thomas
AU - Bertelsen, Geir
AU - Christoffersen, Terje
AU - Arnstad, Ellen D
AU - Aalto, Kristiina
AU - Berntson, Lillemor
AU - Fasth, Anders
AU - Herlin, Troels
AU - Ekelund, Maria
AU - Peltoniemi, Suvi
AU - Toftedal, Peter
AU - Nielsen, Susan
AU - Leinonen, Sanna
AU - Bangsgaard, Regitze
AU - Nielsen, Rasmus
AU - Rygg, Marite
AU - Nordal, Ellen
AU - Nordic Study Group of Pediatric Rheumatology
N1 - Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - PURPOSE: To assess the long-term outcome of uveitis in juvenile idiopathic arthritis (JIA).DESIGN: Population-based, multicenter, prospective JIA cohort, with a cross-sectional assessment of JIA-associated uveitis (JIA-U) 18 years after the onset of JIA.PARTICIPANTS: A total of 434 patients with JIA, of whom 96 had uveitis, from defined geographic areas of Denmark, Finland, Norway, and Sweden.METHODS: 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.MAIN OUTCOME MEASURES: 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.RESULTS: 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.CONCLUSIONS: 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.
AB - PURPOSE: To assess the long-term outcome of uveitis in juvenile idiopathic arthritis (JIA).DESIGN: Population-based, multicenter, prospective JIA cohort, with a cross-sectional assessment of JIA-associated uveitis (JIA-U) 18 years after the onset of JIA.PARTICIPANTS: A total of 434 patients with JIA, of whom 96 had uveitis, from defined geographic areas of Denmark, Finland, Norway, and Sweden.METHODS: 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.MAIN OUTCOME MEASURES: 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.RESULTS: 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.CONCLUSIONS: 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.
KW - disease activity
KW - juvenile idiopathic arthritis
KW - long-term outcome
KW - ocular complications
KW - population-based
KW - prospective
KW - risk factors for ocular complications
KW - SUN criteria
KW - treatment
KW - uveitis
KW - uveitis cumulative incidence
UR - http://www.scopus.com/inward/record.url?scp=85098632366&partnerID=8YFLogxK
U2 - 10.1016/j.ophtha.2020.08.024
DO - 10.1016/j.ophtha.2020.08.024
M3 - Journal article
C2 - 32866542
SN - 0161-6420
VL - 128
SP - 598
EP - 608
JO - Ophthalmology
JF - Ophthalmology
IS - 4
ER -