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Experimental Autoimmune Uveitis: An Intraocular Inflammatory Mouse Model
Published on: January 12, 2022
Disease of the year: juvenile idiopathic arthritis-associated uveitis--classification and diagnostic approach
Ilknur Tugal-Tutkun1, Pierre Quartier, Bahram Bodaghi
1Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine , Istanbul , Turkey .
Insights
Juvenile idiopathic arthritis (JIA) is a common childhood rheumatic disease. Specific JIA subtypes, like ANA-positive oligoarticular JIA, carry a higher risk for chronic uveitis, while enthesitis-related arthritis presents with acute iridocyclitis.
Area of Science:
- Pediatric Rheumatology
- Ophthalmology
- Genetics
Background:
- Juvenile idiopathic arthritis (JIA) is the most prevalent chronic rheumatic condition in children.
- JIA is associated with uveitis, an inflammatory eye condition, with varying risks across its subtypes.
- The International League of Associations for Rheumatology (ILAR) classification system defines seven JIA subtypes.
Purpose of the Study:
- To outline the classification and ocular manifestations of Juvenile idiopathic arthritis (JIA).
- To identify risk factors for uveitis within different JIA subtypes.
- To discuss diagnostic approaches and emerging genetic insights for JIA.
Main Methods:
- Review of existing literature on JIA classification and uveitis.
- Analysis of ocular involvement patterns in different JIA subtypes.
- Summary of diagnostic criteria and laboratory investigations for JIA.
Main Results:
- Systemic JIA and juvenile-onset rheumatoid arthritis rarely present with uveitis.
- Early-onset antinuclear antibody (ANA)-positive oligoarticular JIA shows the highest risk for chronic iridocyclitis.
- Enthesitis-related arthritis is linked to recurrent acute symptomatic iridocyclitis.
Conclusions:
- Accurate JIA classification is crucial for predicting ocular complications like uveitis.
- Diagnostic workup for JIA involves clinical assessment, serological tests (ANA, RF, HLA-B27), and imaging.
- Gene expression profiling shows promise for improving JIA diagnosis, classification, and patient management.
Abstract:
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease and the most common systemic association of uveitis in children. JIA is subdivided into seven clinically more homogeneous subtypes, using the International League of Associations for Rheumatology (ILAR) classification system: systemic arthritis, oligoarthritis, rheumatoid factor (RF)-negative polyarthritis, RF-positive polyarthritis, psoriatic arthritis, enthesitis-related arthritis, and undifferentiated arthritis. Uveitis is very rare in patients with systemic onset JIA and in patients with juvenile-onset rheumatoid arthritis. Patients with early-onset antinuclear antibody (ANA)-positive oligoarticular JIA have the highest risk of developing chronic iridocyclitis. Ocular involvement in enthesitis-related arthritis is characterized by recurrent acute symptomatic iridocyclitis. The diagnosis and differential diagnosis of JIA are based on history, physical examination, and laboratory investigations, including complete blood count, acute-phase reactants, ANA, RF, HLA-B27, and musculoskeletal imaging studies. Recent studies have revealed distinct gene expression profiles that may be useful in the diagnosis, classification, and follow-up of JIA patients.
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