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Uveitis as a marker of active arthritis in 372 patients with juvenile idiopathic seronegative oligoarthritis or
K Kotaniemi1, A Kotaniemi, A Savolainen
1Department of Ophthalmology, Helsinki University Hospital, Finland.
Insights
Children with juvenile idiopathic arthritis (JIA) and uveitis show increased inflammatory arthritis activity. This indicates a need for closer monitoring and tailored treatment strategies for JIA patients with uveitis.
Area of Science:
- Pediatric Rheumatology
- Ophthalmology
- Immunology
Background:
- Juvenile idiopathic arthritis (JIA) is a common rheumatic disease in children.
- Uveitis, an inflammatory eye condition, can be associated with JIA.
- Seronegative oligoarthritis and polyarthritis are subtypes of JIA.
Purpose of the Study:
- To compare arthritis activity in children with recently diagnosed seronegative oligoarthritis or polyarthritis, with and without uveitis.
- To evaluate the impact of uveitis on disease activity and treatment in JIA.
Main Methods:
- A prospective study of 372 children with recently diagnosed seronegative oligoarthritis or polyarthritis.
- Assessment of arthritis activity using clinical and laboratory parameters over a mean follow-up of 4.5 years.
- Comparison of disease characteristics between JIA patients with and without asymptomatic anterior uveitis.
Main Results:
- Patients with uveitis had higher erythrocyte sedimentation rates and lower hemoglobin levels at diagnosis.
- Increased joint inflammation and greater need for systemic corticosteroids and methotrexate were observed in patients with uveitis.
- Clinical remission rates were significantly lower in JIA patients with uveitis (21%) compared to those without (42%).
Conclusions:
- The inflammatory activity of arthritis is heightened in children with seronegative oligoarthritis or polyarthritis and uveitis.
- Uveitis is associated with more severe arthritis and poorer treatment outcomes in JIA.
- These findings underscore the importance of screening for uveitis in JIA and managing co-existing conditions aggressively.
Objective:
To compare the activity of arthritis in children with recently diagnosed seronegative oligoarthritis or polyarthritis with or without uveitis.
Methods:
The study covered 372 JIA children with recently diagnosed seronegative oligoarthritis or polyarthritis. The mean prospective follow-up period was 4.5 years. Asymptomatic anterior uveitis was found in 96 cases. The activity of arthritis in all 372 patients was assessed clinically and by laboratory parameters.
Results:
The erythrocyte sedimentation rate was significantly higher (p = 0.001) at the diagnosis of arthritis and at the end of the follow-up (p = 0.02) in the 96 JIA patients with uveitis than in the 276 JIA patients without uveitis. The hemoglobin value was significantly lower (p = 0.008) at the diagnosis of arthritis in patients with uveitis, but not at the end of the follow-up. The number of inflamed joints was significantly greater at the end of the follow-up in patients with persistent polyarthritis and uveitis (p = 0.01) compared to those polyarthritis patients without uveitis. Patients with uveitis were significantly more often treated with oral prednisolone (p < 0.001), glucocorticoid joint injections (p < 0.001), and with methotrexate (p = 0.003) compared to patients without uveitis. Clinical remission of arthritis was achieved significantly less frequently in patients with uveitis than in patients without uveitis (21% versus 42%, p<0.001).
Conclusion:
The inflammatory activity of arthritis seems to be increased in patients with seronegative oligo- or polyarthritis and uveitis compared to those without uveitis.
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