Tags

Type your tag names separated by a space and hit enter

Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study.
Ophthalmology. 2013 Jan; 120(1):186-92.O

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.

Authors+Show Affiliations

Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23062650

Citation

Gregory, Anthony C., et al. "Risk Factors for Loss of Visual Acuity Among Patients With Uveitis Associated With Juvenile Idiopathic Arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study." Ophthalmology, vol. 120, no. 1, 2013, pp. 186-92.
Gregory AC, Kempen JH, Daniel E, et al. Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study. Ophthalmology. 2013;120(1):186-92.
Gregory, A. C., Kempen, J. H., Daniel, E., Kaçmaz, R. O., Foster, C. S., Jabs, D. A., Levy-Clarke, G. A., Nussenblatt, R. B., Rosenbaum, J. T., Suhler, E. B., & Thorne, J. E. (2013). Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study. Ophthalmology, 120(1), 186-92. https://doi.org/10.1016/j.ophtha.2012.07.052
Gregory AC, et al. Risk Factors for Loss of Visual Acuity Among Patients With Uveitis Associated With Juvenile Idiopathic Arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study. Ophthalmology. 2013;120(1):186-92. PubMed PMID: 23062650.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study. AU - Gregory,Anthony C,2nd AU - Kempen,John H, AU - Daniel,Ebenezer, AU - Kaçmaz,R Oktay, AU - Foster,C Stephen, AU - Jabs,Douglas A, AU - Levy-Clarke,Grace A, AU - Nussenblatt,Robert B, AU - Rosenbaum,James T, AU - Suhler,Eric B, AU - Thorne,Jennifer E, AU - ,, Y1 - 2012/10/11/ PY - 2012/03/01/received PY - 2012/07/17/revised PY - 2012/07/18/accepted PY - 2012/10/16/entrez PY - 2012/10/16/pubmed PY - 2013/3/8/medline SP - 186 EP - 92 JF - Ophthalmology JO - Ophthalmology VL - 120 IS - 1 N2 - 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. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/23062650/Risk_factors_for_loss_of_visual_acuity_among_patients_with_uveitis_associated_with_juvenile_idiopathic_arthritis:_the_Systemic_Immunosuppressive_Therapy_for_Eye_Diseases_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(12)00687-2 DB - PRIME DP - Unbound Medicine ER -