Background Uveitis is one of the most threatening complications in juvenile idiopathic arthritis (JIA). It occurs in approximately 10% of all JIA patients. Whether the frequency of uveitis in JIA has decreased over time as a result of the widespread use of immunosuppressive substances, is still an open question. Few data on the occurrence of JIA-associated uveitis and related secondary complications are available from population-based studies.
Objectives To determine the change in uveitis prevalence and related secondary complications in patients with JIA between 2002 and 2013.
Methods Data source for this study was the National Paediatric Rheumatological Database (NPRD). Uveitis onset, disease characteristics and details on treatment were provided by rheumatologists once a year. Ophthalmologists reported about uveitis characteristics such as eye involvement, uveitis activity and eye complications in detail in a specific uveitis add-on module. Data from the years 2002 to 2013 were used to determine the annual prevalence of uveitis and frequency of secondary complications. Two-level random effect models were used for investigating the change between 2002 and 2013.
Results A total of 60 centers included 18,555 JIA patients, which were recorded in the NPRD between 2002 and 2013. The mean age of the patients was 11.4±4.6 years, their mean disease duration 4.4±3.7 years. 66.9% were female and 51.7% ANA positive. Patients' mean age at arthritis onset was 6.9±4.5 years. In a multivariable regression analysis, the following risk factors for uveitis were identified: oligoarthritis (OR=4.21, p<0.001), and ANA positivity (OR=2.61, p<0.001), a higher disease activity measured by the cJADAS-10 (OR=1.02, p=0.001), whereas higher age at JIA onset was negatively associated with the onset of uveitis (OR=0.90, p<0.001). Treatment rates with conventional and biological DMARDs increased during the observation period (csDMARD: 39.8% to 47.2%, bDMARD: 3.3% to 21.8%). Uveitis prevalence significantly decreased from 2002 to 2013 (13.0% to 11.6%, OR =0.98, p<0.015). The prevalence of secondary uveitis complications also significantly decreased between 2002 and 2013 (33.6% to 23.9%, OR=0.94, p<0.001). Among the complications, the most common complications were posterior synechiae (2002: 40.6%; 2013: 46.7%), cataract (2002: 40.6%; 2013: 29.3%) and band keratopathy (2002: 42.2%; 2013: 13.3%). The percentage of patients with inactive uveitis significantly increased from 30.6% in 2002 to 65.3% in 2013 (OR=1.15, p<0.001). Visual acuity of the worse eye also improved over time, in fact a relevant visual loss of <20/50 was found in 36.7% of uveitis cases in 2002 compared to 8.0% in 2013.
Conclusions Uveitis prevalence and the frequency of secondary complications significantly decreased between 2002 and 2013. Both were correlated with a more frequent use of DMARDs.
Acknowledgements The study was supported by a grant from Pfizer Pharma GmbH Germany (Forschungsförderung Rheumatologie). The national pediatric database is financially supported by the Children's Arthritis Foundation (Kinder-Rheumastiftung).
Disclosure of Interest J. Klotsche: None declared, K. Minden: None declared, S. Schenck: None declared, M. Niewerth: None declared, T. Hospach Speakers bureau: Pfizer, Abbvie, J.-P. Haas: None declared, R. Berendes: None declared, G. Ganser Grant/research support from: Abbott, Actelion, Pfizer, A. Heiligenhaus Grant/research support from: AbbVie, Pfizer, Novartis, and Deutsche Forschungsgemeinschaft, and has received study fees from AbbVie, Alimera Sciences, Allergan, Santen, and XOMA., C. Tappeiner Grant/research support from: Swiss Foundation for Grants in Biology and Medicine (SFGBM), Swiss National Science Foundation (SNSF) and Novartis.