Novel advances in juvenile idiopathic arthritis associated uveitis

Juvenile idiopathic arthritis-associated uveitis (JIA-U) is an important cause of childhood and adult visual impairment. Advances in surveillance approaches and treatment have improved outcomes, yet delayed detection and treatment-refractory disease remain substantial challenges. This review summarises recent developments across disease stratification, imaging, pharmacologic management, and psychosocial support, following the natural history of disease from inception to adulthood.

Risk-stratified screening based on antinuclear antibody status, JIA subtype, and age at arthritis onset is now standard, but many cases present outside screening windows. Novel biomarkers, including S100A8/A9, S100A12, and genetic risk alleles, offer promise for earlier identification. Ocular imaging modalities such as anterior segment optical coherence tomography and optical coherence tomography angiography enable objective, child-friendly detection of inflammation and subclinical vascular changes, potentially extending specialist-level assessment to community settings. Early initiation of immunomodulatory therapy in children with JIA is now prevalent care, reducing uveitis incidence and improving outcomes in childhood, although the consequence may be new challenges later in the lifecourse. Anti-tumour necrosis factor therapy has changed the management of JIA-U for the better, although precision strategies, such as anti-drug antibody monitoring, dose individualisation, and tapering approaches are needed to further optimise care. For refractory disease, biologics and other emerging therapies are under investigation, but new therapeutic targets are needed. Beyond ocular health, JIA-U imposes a heavy psychosocial burden on children and families, exacerbated by treatment side-effects and frequent medical visits. Validated tools, such as the EYE-Q questionnaire, and co-developed educational and self-management resources will be key to addressing mental health and quality-of-life concerns.

JIA-U remains a lifelong, vision-threatening condition despite advances in screening, diagnostics, and treatment. Integration of biomarker-based risk stratification, advanced imaging, and precision pharmacology holds promise for earlier detection and personalised care. Addressing psychosocial impacts through family-centred, multidisciplinary frameworks is essential. Future priorities include validating predictive biomarkers, refining tapering protocols, and ensuring equitable access to novel diagnostics and therapeutics to optimise lifelong outcomes.