Risk of uveitis among children with autoimmune diseases: a nationwide matched-cohort study of 3,643 cases

Pediatric uveitis, though accounting for less than 10% of all uveitis cases, presents significant diagnostic and therapeutic challenges due to its asymptomatic onset and potential for severe, vision-threatening complications. Despite known associations with autoimmune diseases, data on risk factors in Asian pediatric populations remain limited. This study aimed to quantify the risk of uveitis in Taiwanese children with autoimmune diseases, identify key comorbidities, and evaluate the effects of immunosuppressive therapies.

Using Taiwan's National Health Insurance Research Database (2009-2019), we conducted a nationwide retrospective cohort study of 3,643 pediatric patients with autoimmune diseases matched 1:1 to controls. Patients were followed for up to 12 years, with uveitis risk assessed through Cox proportional hazards models and cumulative incidence analyzed using Kaplan-Meier curves.

During a mean follow-up of 5.5 years, autoimmune diseases were associated with increased uveitis risk (adjusted HR [aHR] = 2.65 [95% CI, 1.67-4.19]), with juvenile idiopathic arthritis showing the highest risk (aHR = 25.70 [95% CI, 7.41-89.22]). Risk was significant only in adolescents aged 10-14 years (aHR = 2.58 [95% CI, 1.29-5.14]) and 15-18 years (aHR = 2.60 [95% CI, 1.27-5.31]) and was notably higher in patients without diabetes (aHR = 6.88 [95% CI, 2.54-18.61]) compared with those with diabetes (aHR = 1.67 [95% CI, 0.98-2.82]). In medication analysis, sulfasalazine use (aHR = 2.00 [95% CI, 1.04-3.84]) and high-daily dose prednisolone (≥30 mg/day; aHR = 2.25 [95% CI, 1.12-4.53]) were associated with increased risk, while moderate cumulative prednisolone doses were associated with a lower risk compared with low-dose exposure (aHR = 0.32 [95% CI, 0.13-0.79]).

This cohort study identified distinct patterns of uveitis risk across specific autoimmune diseases and age groups. These findings suggest the need for risk-stratified ophthalmologic screening based on autoimmune diagnosis and age in pediatric patients requiring immunosuppressive therapy.