Background Anterior uveitis (AU) is the most important extra-articular complication of juvenile idiopathic arthritis (JIA) but to date, there are no universally accepted criteria for defining its activity and severity in children.
Objectives Aim of this study was to define activity and severity criteria for JIA-related AU by a consensus-based methodology.
Methods The project was conducted in three phases. 1.First Delphi: A detailed questionnaire on activity and severity criteria used in clinical practice for JIA-related uveitis was sent to pediatric rheumatologists and ophthalmologists from 23 Pediatric Rheumatology referral Centers in Italy 2. Consensus meeting (CM): criteria where 80% consensus among participants was not reached have been discussed during a one-day-meeting and consensus reassessed (Nominal Group Technique) 3. Second Delphi: to establish the final set of criteria, the only group of ophthalmologists were then asked to re-rate, after 2 weeks thinking time, their level of agreement on a few criteria in which agreement was not reached at CM.
Results High agreement was reached for the following criteria of AU activity: white keratic precipitates, new onset of endothelial traces, anterior chamber cells (≥1+), anterior chamber flare, new onset/progression of complications such as posterior synechiae, CME or increased ocular pressure. For AU Severity criteria a uniform consensus was reached on posterior synechiae, cataract, band keratopathy, vitreitis, glaucoma, no. ≥3 AU relapses/year and ≥2 weeks uveitis duration of each AU episode. For two severity criteria (Best Corrected Visual Acuity reduction rate and uveitis bilaterality) agreement among investigators was reached and they have been temporarily excluded.
Conclusions These preliminary criteria for JIA-related uveitis will help standardize classification of patients for clinical research, epidemiology, outcome studies and therapeutic trials. A prospective validation of these criteria using the OMERACT filter is ongoing.
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Tappeniner C et al. Elavated laser flare values correlate with complicated course of anterior uveitis in patients with juvenile idiopathic arthritis, Acta Ophtalmol, 2011
Disclosure of Interest None Declared
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