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Occurrence of uveitis in recently diagnosed juvenile chronic arthritis: a prospective study
K Kotaniemi1, H Kautiainen, A Karma
1Rheumatism Foundation Hospital, Heinola, Finland.
Insights
Uveitis occurred in 24% of juvenile chronic arthritis (JCA) patients, often presenting early and asymptomatic. Early-onset arthritis and antinuclear antibodies (ANA) were linked to higher uveitis rates, with good visual outcomes in most cases.
Area of Science:
- Ophthalmology
- Pediatric Rheumatology
- Immunology
Background:
- Juvenile chronic arthritis (JCA) is a significant autoimmune condition in children.
- Ocular manifestations, particularly uveitis, can impact visual health in JCA patients.
- Early detection and characterization of uveitis in JCA are crucial for management.
Purpose of the Study:
- To determine the incidence and clinical features of uveitis in children newly diagnosed with JCA.
- To investigate the association between JCA subtypes, disease onset, and uveitis development.
- To assess the impact of uveitis on visual acuity and complications in this pediatric cohort.
Main Methods:
- A prospective observational case series involving 426 children with newly diagnosed JCA.
- Regular ophthalmologic and pediatric examinations were conducted for up to 9.7 years.
- Data collected included arthritis type, uveitis presentation, antinuclear antibody (ANA) status, and visual outcomes.
Main Results:
- Uveitis was diagnosed in 104 of 426 children (24%), frequently asymptomatic.
- Uveitis was equally common in oligoarthritis (27%) and seronegative polyarthritis (25%) subtypes.
- Significantly higher ANA positivity (66%) was observed in children with uveitis compared to those without (37%).
- Uveitis onset occurred early, within 3 months of arthritis diagnosis in 49% of cases.
- Visual prognosis was generally good, with only 3 children experiencing significant visual acuity reduction.
Conclusions:
- Uveitis is a common complication of JCA, often appearing early in the disease course.
- Early-onset JCA combined with ANA positivity is associated with a higher risk of uveitis.
- Oligoarthritis and polyarthritis subtypes show similar uveitis prevalence, and there is no gender predilection.
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 > or = 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.