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Juvenile arthritis-associated uveitis: visual outcomes and prognosis.
Can J Ophthalmol. 2004 Oct; 39(6):614-20.CJ

Abstract

BACKGROUND

The current issues in the management of uveitis associated with juvenile arthritis revolve mainly around the treatment of mild disease and how to treat patients with more severe disease. The aims of this study were to determine the incidence of uveitis in a cohort of patients with juvenile arthritis as well as the nature of treatment and the risk factors for visual loss.

METHODS

Review of the charts of 71 patients with juvenile arthritis, as defined by the American Academy of Rheumatology, seen between 1992 and 2001 at a combined rheumatology and ophthalmology clinic. Information collected included the patient's sex, age at diagnosis of arthritis and uveitis, and date of diagnosis of arthritis and uveitis. The rheumatologic diagnosis, results of serologic testing, and details of systemic and topical treatments were also recorded.

RESULTS

There were 47 girls and 24 boys ranging in age from 16 months to 13 years. The median age at diagnosis of juvenile arthritis was 4 years and 1 month. Twenty-seven patients (38%) had uveitis. The median age at uveitis onset was 5.9 years, with an average interval of 18 months from the diagnosis of arthritis; 11 patients had uveitis at the time of arthritis diagnosis. There was a positive relation between anti-nuclear antibody positivity and the development of uveitis (p < 0.05). Thirteen (48%) of the 27 patients with uveitis had mild anterior segment inflammation, with fewer than 25 cells in the anterior chamber. This group had spontaneous resolution of uveitis without topical therapy. All the patients without uveitis had a final visual acuity of 6/9 or better. Five of the patients with uveitis had a final visual acuity of 6/36 or worse. Cataract was the most common complication affecting visual outcome. Cataract extraction initially improved the visual acuity, but posterior segment complications and glaucoma compromised the final visual outcome.

INTERPRETATION

We found an incidence of uveitis of 38% with long-term follow-up of patients with juvenile arthritis; the uveitis was diagnosed an average of 18 months after the arthritis. Almost half of the patients with uveitis had minor anterior segment inflammation. These patients did not receive topical treatment and had good visual outcomes. Patients with uveitis at the time of diagnosis of arthritis tended to have a worse visual prognosis and experienced persistent uveitis despite treatment. In this series, cataract extraction was beneficial in improving visual acuity immediately postoperatively, but posterior segment changes and glaucoma may compromise final visual outcomes.

Authors+Show Affiliations

Department of Ophthalmology, Women's and Children's Hospital, North Adelaide, SA, Australia. celiachen@bigpond.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15559647

Citation

Chen, Celia S., et al. "Juvenile Arthritis-associated Uveitis: Visual Outcomes and Prognosis." Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie, vol. 39, no. 6, 2004, pp. 614-20.
Chen CS, Roberton D, Hammerton ME. Juvenile arthritis-associated uveitis: visual outcomes and prognosis. Can J Ophthalmol. 2004;39(6):614-20.
Chen, C. S., Roberton, D., & Hammerton, M. E. (2004). Juvenile arthritis-associated uveitis: visual outcomes and prognosis. Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie, 39(6), 614-20.
Chen CS, Roberton D, Hammerton ME. Juvenile Arthritis-associated Uveitis: Visual Outcomes and Prognosis. Can J Ophthalmol. 2004;39(6):614-20. PubMed PMID: 15559647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Juvenile arthritis-associated uveitis: visual outcomes and prognosis. AU - Chen,Celia S, AU - Roberton,Don, AU - Hammerton,Michael E, PY - 2004/11/24/pubmed PY - 2004/12/24/medline PY - 2004/11/24/entrez SP - 614 EP - 20 JF - Canadian journal of ophthalmology. Journal canadien d'ophtalmologie JO - Can J Ophthalmol VL - 39 IS - 6 N2 - BACKGROUND: The current issues in the management of uveitis associated with juvenile arthritis revolve mainly around the treatment of mild disease and how to treat patients with more severe disease. The aims of this study were to determine the incidence of uveitis in a cohort of patients with juvenile arthritis as well as the nature of treatment and the risk factors for visual loss. METHODS: Review of the charts of 71 patients with juvenile arthritis, as defined by the American Academy of Rheumatology, seen between 1992 and 2001 at a combined rheumatology and ophthalmology clinic. Information collected included the patient's sex, age at diagnosis of arthritis and uveitis, and date of diagnosis of arthritis and uveitis. The rheumatologic diagnosis, results of serologic testing, and details of systemic and topical treatments were also recorded. RESULTS: There were 47 girls and 24 boys ranging in age from 16 months to 13 years. The median age at diagnosis of juvenile arthritis was 4 years and 1 month. Twenty-seven patients (38%) had uveitis. The median age at uveitis onset was 5.9 years, with an average interval of 18 months from the diagnosis of arthritis; 11 patients had uveitis at the time of arthritis diagnosis. There was a positive relation between anti-nuclear antibody positivity and the development of uveitis (p < 0.05). Thirteen (48%) of the 27 patients with uveitis had mild anterior segment inflammation, with fewer than 25 cells in the anterior chamber. This group had spontaneous resolution of uveitis without topical therapy. All the patients without uveitis had a final visual acuity of 6/9 or better. Five of the patients with uveitis had a final visual acuity of 6/36 or worse. Cataract was the most common complication affecting visual outcome. Cataract extraction initially improved the visual acuity, but posterior segment complications and glaucoma compromised the final visual outcome. INTERPRETATION: We found an incidence of uveitis of 38% with long-term follow-up of patients with juvenile arthritis; the uveitis was diagnosed an average of 18 months after the arthritis. Almost half of the patients with uveitis had minor anterior segment inflammation. These patients did not receive topical treatment and had good visual outcomes. Patients with uveitis at the time of diagnosis of arthritis tended to have a worse visual prognosis and experienced persistent uveitis despite treatment. In this series, cataract extraction was beneficial in improving visual acuity immediately postoperatively, but posterior segment changes and glaucoma may compromise final visual outcomes. SN - 0008-4182 UR - https://www.unboundmedicine.com/medline/citation/15559647/Juvenile_arthritis_associated_uveitis:_visual_outcomes_and_prognosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0008-4182(04)80026-7 DB - PRIME DP - Unbound Medicine ER -