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Clinical characteristics of pediatric noninfectious uveitis and risk factors for severe disease: a single-center
Lutfiye Koru1, Fehim Esen2, Ozlem Turkyilmaz2
1Department of Pediatric Rheumatology, Istanbul Medeniyet University, Istanbul, Turkey.
Insights
Pediatric non-infectious uveitis requires close monitoring in females and those with early onset or Behçet's disease (BD) due to increased severe disease risk. These factors predict the need for biological treatment and complications.
Area of Science:
- Ophthalmology
- Pediatrics
- Rheumatology
Background:
- Non-infectious uveitis in children is a significant cause of vision loss.
- Limited data exists on risk factors for severe disease and treatment needs in pediatric non-infectious uveitis.
Purpose of the Study:
- To present demographic, clinical, and laboratory data of pediatric non-infectious uveitis patients.
- To evaluate risk factors for complications and the need for biological treatment.
Main Methods:
- Retrospective analysis of 123 children with non-infectious uveitis followed for at least one year.
- Data collected included demographics, age at diagnosis, co-existing rheumatic diseases, and anti-nuclear antibody status.
- Severe disease was defined by complications or need for biologic therapy.
Main Results:
- Nearly a quarter of patients (28.5%) had associated rheumatic diseases, most commonly juvenile idiopathic arthritis.
- Biologic agents were required in 48.8% of patients, and 11.4% developed complications.
- Early onset (aOR 0.875) and female gender (aOR 2.99) predicted need for biologics; Behçet's disease (aOR 14.133) predicted complications.
Conclusions:
- Female gender, early disease onset, and Behçet's disease are associated with increased risk of severe non-infectious uveitis in children.
- These patient groups require close monitoring for potential complications and need for advanced therapies.
- Findings highlight the importance of early identification and management strategies for pediatric non-infectious uveitis.
Objectives:
We aimed to present the demographic, clinical, laboratory, and treatment data of children with non-infectious uveitis and to evaluate the risk factors for the development of complications and the need for biological treatment.
Method:
Patients diagnosed with non-infectious uveitis in childhood and followed up for at least 1 year were included in the study. Demographic data, including age, gender, age at diagnosis, uveitis in first-degree relatives, and rheumatologic diseases, were obtained retrospectively from medical records. The presence of complications or the need for biologic therapy was considered a composite outcome suggesting severe disease.
Results:
The study included 123 patients (female: n = 59, 48%). The mean age at diagnosis was 14.89 ± 4.86 years. Uveitis was symptomatic in 104 patients (84.6%). Approximately one-quarter of the patients had at least one rheumatic disease (n = 35, 28.5%), the most common being juvenile idiopathic arthritis. Thirty-three patients (26.8%) had anti-nuclear antibody positivity. Biologic agents were needed in 60 patients (48.8%). Complications developed in 14 patients (11.4%). Early age at disease onset (aOR, 0.875; 95% C.I. 0.795-0.965, p = 0.007) and female gender (aOR, 2.99; 95% C.I. 1.439-6.248, p = 0.003) were significantly associated with the need for biologic treatment, while Behçet's disease (BD) was strongly associated with uveitis-related complications (aOR, 14.133; 95% C.I. 2.765-72.231, p = 0.001).
Conclusion:
We suggest that among pediatric patients with non-infectious uveitis, females, those with an early age of disease onset, and those with BD need to be closely monitored due to a significantly increased risk of severe disease. Key Points • Limited data exist on the clinical course of non-infectious uveitis in children and the associated risk factors for severe disease. • Our study reveals that nearly a quarter of pediatric patients with non-infectious uveitis also have a rheumatic disease. • Among pediatric patients diagnosed with non-infectious uveitis, we observed an increased risk of severe disease in those with an earlier onset age, in female patients, and in those diagnosed with Behçet's disease.
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