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Juvenile arthritis and uveitis
1Prince Charles Eye Unit, King Edward VII Hospital, Windsor, Berkshire, United Kingdom.
Insights
Juvenile arthritis can lead to uveitis, an eye inflammation. Early detection and management are crucial for preserving vision in children with juvenile rheumatoid arthritis (JRA).
Area of Science:
- Ophthalmology
- Rheumatology
- Pediatrics
Background:
- Juvenile arthritis (JA) is associated with ocular complications, particularly uveitis.
- Anterior uveitis is observed in HLA-B27 related spondyloarthropathies and in a subset of juvenile rheumatoid arthritis (JRA) patients.
Purpose of the Study:
- To review the association between juvenile arthritis and uveitis.
- To identify risk factors and prognosis for uveitis in JRA patients.
Main Methods:
- Literature review of studies on juvenile arthritis and uveitis.
- Analysis of patient data including demographics, clinical features, and outcomes.
Main Results:
- Approximately 20% of IgM rheumatoid factor-negative JRA patients develop chronic anterior uveitis.
- Risk factors include female gender, pauciarticular onset, antinuclear antibodies, and specific HLA antigens (HLA-DW5, HLA-DPw2).
- Visual prognosis is good in 25%, fair in 50%, with 25% experiencing visual impairment due to complications like cataract and glaucoma.
Conclusions:
- Uveitis in JRA is a significant concern with variable visual outcomes.
- Management of complicated cataracts shows good results with lensectomy-vitrectomy, while inflammatory glaucoma management remains challenging.
Abstract:
The association between juvenile arthritis and uveitis is reviewed. Some children with the HLA-B27 related spondyloarthropathies develop anterior uveitis. About 20% of patients with juvenile rheumatoid arthritis (JRA) who are negative for IgM rheumatoid factor develop a frequently bilateral, nongranulomatous chronic anterior uveitis. Risk factors for uveitis in JRA patients are: female gender, pauciarticular onset of arthritis, presence of circulating antinuclear antibodies, and the antigens HLA-DW5 and HLA-DPw2. Uveitis is rare after seven years or more have elapsed from the onset of arthritis. The visual prognosis in patients with uveitis is good in 25% and fair in 50%. The remaining 25% develop visual impairment from complicated cataract and/or secondary inflammatory glaucoma. The potential benefit of cytotoxic agents in the treatment of intractable uveitis is outweighed by the risk of serious side effects. The management of secondary inflammatory glaucoma is unsatisfactory, but the results of treatment of complicated cataracts by lensectomy-vitrectomy are good.