Features of patients with uveitis associated with juvenile idiopathic arthritis required eye surgery

Uveitis associated with juvenile idiopathic arthritis (U-JIA) is a vision-threatening condition. Estimates of prevalence of uveitis in patients with known juvenile idiopathic arthritis range from 11.6% to 30.0%. First-line treatment includes topical glucocorticoids; methotrexate (MTX) is used if topical corticosteroids are ineffective. In severe cases biological therapy like adalimumab may be prescribed. Complications, including vision loss, may be related to the disease and the ongoing treatment (topical corticosteroids). In severe cases surgical intervention is often necessary and is typically associated with poor vision outcomes.

To highlight the characteristics of operated U-JIA and to identify predictors of treatment failure.

A retrospective cohort study analyzed data from 68 pediatric patients (under 18 years old) with U-JIA between 2007 and 2023. The study focused on demographic, clinical, treatment, and outcome variables. Survival analysis using Kaplan-Meier curves and the Cox proportional hazards model was performed to estimate the impact of surgical intervention on the course of uveitis and to identify predictors of treatment failure.

Eye surgery was performed on 17 (25%) patients with U-JIA. It was associated with an earlier onset of uveitis (P = 0.017), lower uveitis remission rate [odds ratio = 5.29, 95% confidence interval (CI): 1.23-24.90, P = 0.015], longer time to remission (P = 0.036), reduced probability of achieving remission on MTX (P = 0.033), and the necessity of the following treatment with biological disease-modifying antirheumatic drugs (odds ratio = 5.60; 95%CI: 1.11-55.19, P = 0.021) with similar efficacy with biological treatments in operated and non-operated cases. Kaplan-Meier curves showed a borderline difference in time to surgical intervention based on the MTX initiation cutoff (P = 0.065) although earlier MTX initiation might be associated with a higher likelihood of deferred surgery.

Operated patients exhibited an aggressive early-onset uveitis profile that needed early and more intensive treatment. Delayed and failed MTX treatment as well as delayed switching to biologics often required subsequent eye surgery.