Background Uveitis is one of the major extra-articular manifestations of Juvenile Idiopathic Arthritis (JIA), appearing in 10-30% of these patients. Most cases of uveitis in JIA patients are asymptomatic, bilateral and recurrent, representing a challenge for ophthalmologists and pediatric rheumatologists given its aggressiveness and frequent complications. For this reason, during the first national meeting of JIA-associated uveitis (Barcelona, 2008), a working group was established to provide a consensus protocol for follow-up and treatment of these patients, as well as designing a national database.
Objectives The aim of this paper is to analyze the characteristics of patients with JIA-associated uveitis included in this multicenter registry.
Methods Retrospective analysis of medical records of patients with JIA-associated uveitis in 10 centers in Spain, from databases of ophthalmology and/or pediatric rheumatology units at each center. We collected epidemiological, clinical, and in some centers follow-up and treatment parameters.
Results A total of 152 patients were collected, 77% of whom were women, 80% had positive antinuclear antibodies (ANA) and 20% were HLA-B27 positive. The most frequent subtype of JIA presenting uveitis was oligoarticular (76%), followed by polyarticular (11%) and it was anecdotally observed in enthesitis related arthritis (5%), psoriatic arthritis (5%) and undifferentiated arthritis (2.5%). No patient with uveitis had systemic onset JIA. Around 90% of patients had anterior uveitis and 55% were bilateral. The mean age at diagnosis of JIA was 3.7±3.1 years. In 13% of patients uveitis was diagnosed before the onset of JIA and in 48% at the time of diagnosis of JIA or during the first year. In 44 patients (29%) data of complications were registered, of which 27 had synechiae, 23 cataracts, 16 band keratopathy, 11 cystoid macular edema and 5 glaucoma. As for treatments used for uveitis and/or arthritis: 140 patients received methotrexate, 65 adalimumab, 34 etanercept, 15 infliximab and 5 abatacept.
Conclusions Most patients with uveitis are girls with positive ANA oligoarticular JIA subtype, with chronic anterior uveitis, and bilateral localization in more than half of cases. Although 13% of patients presented uveitis before arthritis and therefore were at increased risk of complications, we emphasize the need for periodic eye screening in all patients diagnosed with JIA, according to the risk to the subtype of JIA, presence of ANA, age and years since onset of arthritis. We also want to stress the importance of multicenter data collection, which allows a better evaluation of these patients and the possibility of designing prospective studies.
Disclosure of Interest None Declared
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