Visual prognosis in children with chronic anterior uveitis and arthritis

To determine the visual and ocular prognosis for children with uveitis and chronic arthritis and in patients with uveitis with juvenile rheumatoid arthritis (JRA) or juvenile psoriatic arthritis (JPsA) and to evaluate risk factors associated with ocular complications.

We studied 49 children with chronic arthritis having greater than 2 years ophthalmological followup from onset of uveitis. Visual acuity and ocular complications (band keratopathy, synechiae, cataracts, glaucoma, or phthisis bulbi) were documented. For the 45 patients with JRA/JPsA, the antinuclear antibody and HLA status, time and mode of onset, and the course of uveitis, were evaluated as risk factors for developing complications.

Mean followup was 9.4 years from diagnosis of uveitis (82 affected eyes). Ocular complications developed in 27 eyes (33%). Visual impairment (corrected acuity 20/50 or worse), occurring only in the presence of complicated uveitis, was present in 12 eyes (15%). Of 45 patients with JRA/JPsA, over 95% developed uveitis within 5 years of onset of arthritis. Those with complicated uveitis (n = 13, mean followup 8.6 years) and uncomplicated uveitis (n = 32, mean followup 10 years) were compared: factors significantly associated with complicated uveitis were (1) a chronic course of uveitis (2) JPsA (3) diagnosis of uveitis prior to, or at the time of arthritis onset (4) symptomatic onset.

The risk of developing uveitis 5 years after the onset of JRA/JPsA is small. Although ocular complications were common (33%) among patients with uveitis, normal vision was maintained or correctable for over half of them. Those with uveitis and risk factors for developing ocular complications may need close ophthalmological scrutiny.