The ocular manifestations of juvenile rheumatoid arthritis

We followed 210 cases of JRA closely for 14 years. Thirty-six patients (17.2%) developed iridocyclitis; it most frequently occurred in young females (0-4 years) with monarticular or pauciarticular form of the disease. In 30% of the patients iridocyclitis was first detected after 16 years of age. Forty-two percent had active iridocyclitis on entry. By combining quantitative antinuclear antibody titers with age, sex, and time on onset of arthritis, it has been possible to define the risk of developing iridocyclitis in individual patients. Our approach was effective in detecting iridocyclitis in new cases and exacerbations of the disease in established cases. Forty-four percent of patients with iridocyclitis had one or more identifiable early signs or symptoms. Iridocyclitis in 36% of patients did not respond to more than 6 months of intensive topical treatment with corticosteroids and mydriatics. Despite this statistic, patients had a better outcome than those experiencing the 50% incidence of blinding complications cited in earlier studies. Cataract and band keratopathy occurred in only 19% and 11% of our group, respectively. Only one case of chorioretinopathy was found in 173 patients who had received antimalarials; a significant number of posterior subcapsular cataracts were found in 75 patients who had received systemic corticosteroids. Keratoconjunctivitis sicca developed in 3 patients with iridocyclitis. Surgical treatment of cataracts, band keratopathy, and glaucoma achieved uniformly discouraging results.