Risk Factors for Loss of Visual Acuity among Patients with Uveitis Associated with Juvenile Idiopathic Arthritis: The Systemic Immunosuppressive Therapy for Eye Diseases Study

Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ophthalmology (Impact Factor: 6.17). 01/2013; 120(1). DOI: 10.1016/j.ophtha.2012.07.052
Source: PubMed

ABSTRACT PURPOSE: To describe the incidence of and risk factors for visual acuity (VA) loss and ocular complications in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN: Multicenter retrospective cohort study. PARTICIPANTS: A total of 327 patients (596 affected eyes) with JIA-associated uveitis managed at 5 tertiary uveitis clinics in the United States. METHODS: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) cohort study. Demographic and clinical characteristics were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. MAIN OUTCOME MEASURES: Loss of VA to 20/50 or to 20/200 or worse thresholds and the development of ocular complications. RESULTS: At presentation, 240 eyes (40.3%) had a VA of ≤20/50, 144 eyes (24.2%) had a VA of ≤20/200, and 359 eyes (60.2%) had at least 1 ocular complication. The incidences of VA loss to the ≤20/50 and ≤20/200 thresholds were 0.18 and 0.09 per eye-year (EY), respectively; the incidence of developing at least 1 new ocular complication over follow-up was 0.15/EY (95% confidence interval [CI], 0.13-0.17). However, among eyes with uveitis that had no complications at presentation, the rate of developing at least 1 ocular complication during follow-up was lower (0.04/EY; 95% CI, 0.02-0.06). Posterior synechiae, active uveitis, and prior intraocular surgery were statistically significantly associated with VA to the ≤20/50 and ≤20/200 thresholds both at presentation and during follow-up. Increasing (time-updated) anterior chamber cell grade was associated with increased rates of visual loss in a dose-dependent fashion. Use of immunosuppressive drugs was associated with a reduced risk of visual loss, particularly for the ≤20/50 outcome (hazard ratio, 0.40; 95% CI, 0.21-0.75; P<0.01). CONCLUSIONS: Ocular complications and vision loss were common in our cohort. Increasing uveitis activity was associated with increased risk of vision loss, and use of immunosuppressive drugs was associated with reduced risk of vision loss, suggesting that control of inflammation and use of immunosuppression may be critical aspects in improving the outcomes of patients with JIA-related uveitis. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Available from: Jennifer E Thorne, Jan 10, 2014
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    ABSTRACT: Juvenile idiopathic arthritis (JIA) is a clinically heterogeneous group of diseases whose general characteristics is joint involvement in children and adolescents before the age of 16 which persists for a period of 6 weeks and is of non-infectious nature and undefined cause. Most common exta-articular manifestation of JIA is intraocular inflammation in form of bilateral nongranulomatous anterior uveitis. This study consists of 42 patients with JIA (21 with and 21 without ocular manifestations) with females being represented in significantly higher numbers (Z = 6.451, р = 0.039 < 0.05). There was no JIA – associated uveitis in children under the age of 4. No statistically significant difference between age intervals 4 – 6 and 7 – 12 was noted, while the group over the age of 12 had male predominance. Group, which consisted of individuals with no ocular manifestations i.e. the control group, but had JIA also showed that 90.48% were under the age of six. All of the patients in the examined group had ocular manifestations that post-dated joint involvement. There were no children with polyarticular type of the disease as part of the control group of patients. On the other hand, examined group consisted of individuals with a single joint involvement (monoarticular) or systemic type of disease. Majority of patients with monoarticular type of disease were girls. In presence of JIA – associated uveitis there was no noted difference between occurrence of oligoarticular and polyarticular form of disease, whilst antinuclear antibody (ANA) positivity was more common in the group with JIA – associated uveitis (p < 0.5). All of the patients had serofibrinous, bilateral, form of uveitis and 33.33% had disc edema. Severe and moderate forms of uveitis were more frequent and had similar probability (47.62% vs. 52.38%). Initially there were 52.38% of individuals with visual efficiency (VE) greater than 0.5 with no statistically important increase having occurred during the follow-up period. In 61.90% of cases, as result of the disease, there was complicated cataract formation, and one third of patients had macular edema as consequence of the same. Systemic corticosteroid therapy was used as part of the treatment plan in 76.19% of cases. Methotrexate (MTX) was applied in 42.86% of the control group and 47.62% of the examined group. Subtenonial injections of triamcinolone acetonide were used in 9.52% of cases with macular edema.
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    ABSTRACT: Uveitis is a common complication of juvenile idiopathic arthritis (JIA) affecting up to 30% of patients with JIA. Although the typical bilateral chronic anterior uveitis associated with the persistent and extended oligoarticular and polyarticular, rheumatoid factor negative variants of JIA occurs predominantly in girls, boys may be more commonly affected in the HLA-B27 positive, enthesitis variant of JIA. While female gender has been associated with the development of the chronic anterior uveitis in children with JIA, the clinical course of JIA-associated uveitis may be worse in boys than in girls. The purpose of this paper is to review the available published literature to determine the role of gender in the clinical presentation and outcomes of patients with JIA-associated uveitis.
    Journal of Ophthalmology 02/2014; 2014:461078. DOI:10.1155/2014/461078 · 1.94 Impact Factor
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    ABSTRACT: Abstract Purpose: To describe the frequencies and risk factors of ocular complications and poor visual outcomes in children with juvenile idiopathic arthritis (JIA). Methods: Retrospective cohort study, including 69 consecutive children (116 eyes) affected by JIA-associated uveitis managed at a tertiary uveitis clinic. Results: The incidence of visual loss to the 20/50 or worse threshold was 0.04/eye-year (EY) and to the 20/200 or worse threshold was 0.02/EY. The most common complications at baseline were posterior synechiae (52%), band keratopathy (38%), and cataract (12%). Risk factor for a visual acuity threshold of 20/50 or worse included hypotony (p = 0.01; hazard ratio [HR] 3.7; 95% CI 1.3-10.4); anterior chamber flare >1 (p = 0.04; HR 1.3; 95% CI 0.5-3.4); a positive antinuclear antibody (ANA) (p = 0.02; HR1.4; 95% CI 0.8-2.4). Hypotony and positive ANA are also associated to the 20/200 or worse threshold (p = 0.03; HR 5.1; 95% CI 1.1-23.9 and p = 0.04; HR 1.0; 95% CI 0.4-2.3; respectively). Use of immunosuppressive drugs was associated with a reduced risk of visual loss of 20/200 or worse (odds ratio 0.14, 95% CI, 0.02-1.29; p = 0.04). Conclusions: Loss of vision and ocular complications still occur among children with JIA-related uveitis. Prompt diagnosis and a strict follow up associated to immunosuppressive therapy may decrease the poor visual outcome.
    Ocular immunology and inflammation 12/2013; 23(1). DOI:10.3109/09273948.2013.855798 · 1.44 Impact Factor