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Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort.
Arthritis Care Res (Hoboken). 2019 11; 71(11):1436-1443.AC

Abstract

OBJECTIVE

Identification of the incidence of juvenile idiopathic arthritis (JIA)-associated uveitis and its risk factors is essential to optimize early detection. Data from the Research in Arthritis in Canadian Children Emphasizing Outcomes inception cohort were used to estimate the annual incidence of new-onset uveitis following JIA diagnosis and to identify associated risk factors.

METHODS

Data were reported every 6 months for 2 years, then yearly to 5 years. Incidence was determined by Kaplan-Meier estimators with time of JIA diagnosis as the reference point. Univariate log-rank analysis identified risk factors and Cox regression determined independent predictors.

RESULTS

In total, 1,183 patients who enrolled within 6 months of JIA diagnosis met inclusion criteria, median age at diagnosis of 9.0 years (interquartile range [IQR] 3.8-12.9), median follow-up of 35.2 months (IQR 22.7-48.3). Of these patients, 87 developed uveitis after enrollment. The incidence of new-onset uveitis was 2.8% per year (95% confidence interval [95% CI] 2.0-3.5) in the first 5 years. The annual incidence decreased during follow-up but remained at 2.1% (95% CI 0-4.5) in the fifth year, although confidence intervals overlapped. Uveitis was associated with young age (<7 years) at JIA diagnosis (hazard ratio [HR] 8.29, P < 0.001), positive antinuclear antibody (ANA) test (HR 3.20, P < 0.001), oligoarthritis (HR 2.45, P = 0.002), polyarthritis rheumatoid factor negative (HR 1.65, P = 0.002), and female sex (HR 1.80, P = 0.02). In multivariable analysis, only young age at JIA diagnosis and ANA positivity were independent predictors of uveitis.

CONCLUSION

Vigilant uveitis screening should continue for at least 5 years after JIA diagnosis, and priority for screening should be placed on young age (<7 years) at JIA diagnosis and a positive ANA test.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Lee JJY
Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
Duffy CM
Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
Guzman J
British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Oen K
University of Manitoba, Winnipeg, Manitoba, Canada.
Barrowman N
Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
Rosenberg AM
Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Shiff NJ
University of Florida Health Shands Children's Hospital and University of Florida, Gainesville.
Boire G
Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Stringer E
IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Spiegel L
Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Morishita KA
British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Lang B
IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Reddy D
Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
Huber AM
IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Cabral DA
British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Feldman BM
Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Yeung RSM
Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Tucker LB
British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Watanabe Duffy K
Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
ReACCh-Out Investigators
No affiliation info available

MeSH

Age FactorsAntibodies, AntinuclearArthritis, JuvenileCanadaChildChild, PreschoolFemaleHumansIncidenceKaplan-Meier EstimateMaleProportional Hazards ModelsProspective StudiesRheumatoid FactorRisk FactorsUveitis

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30320957

Citation

Lee, Jennifer J Y., et al. "Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: the Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort." Arthritis Care & Research, vol. 71, no. 11, 2019, pp. 1436-1443.
Lee JJY, Duffy CM, Guzman J, et al. Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort. Arthritis Care Res (Hoboken). 2019;71(11):1436-1443.
Lee, J. J. Y., Duffy, C. M., Guzman, J., Oen, K., Barrowman, N., Rosenberg, A. M., Shiff, N. J., Boire, G., Stringer, E., Spiegel, L., Morishita, K. A., Lang, B., Reddy, D., Huber, A. M., Cabral, D. A., Feldman, B. M., Yeung, R. S. M., Tucker, L. B., & Watanabe Duffy, K. (2019). Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort. Arthritis Care & Research, 71(11), 1436-1443. https://doi.org/10.1002/acr.23783
Lee JJY, et al. Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: the Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort. Arthritis Care Res (Hoboken). 2019;71(11):1436-1443. PubMed PMID: 30320957.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort. AU - Lee,Jennifer J Y, AU - Duffy,Ciarán M, AU - Guzman,Jaime, AU - Oen,Kiem, AU - Barrowman,Nick, AU - Rosenberg,Alan M, AU - Shiff,Natalie J, AU - Boire,Gilles, AU - Stringer,Elizabeth, AU - Spiegel,Lynn, AU - Morishita,Kimberly A, AU - Lang,Bianca, AU - Reddy,Deepti, AU - Huber,Adam M, AU - Cabral,David A, AU - Feldman,Brian M, AU - Yeung,Rae S M, AU - Tucker,Lori B, AU - Watanabe Duffy,Karen, AU - ,, PY - 2018/06/08/received PY - 2018/10/09/accepted PY - 2018/10/16/pubmed PY - 2020/4/11/medline PY - 2018/10/16/entrez SP - 1436 EP - 1443 JF - Arthritis care & research JO - Arthritis Care Res (Hoboken) VL - 71 IS - 11 N2 - OBJECTIVE: Identification of the incidence of juvenile idiopathic arthritis (JIA)-associated uveitis and its risk factors is essential to optimize early detection. Data from the Research in Arthritis in Canadian Children Emphasizing Outcomes inception cohort were used to estimate the annual incidence of new-onset uveitis following JIA diagnosis and to identify associated risk factors. METHODS: Data were reported every 6 months for 2 years, then yearly to 5 years. Incidence was determined by Kaplan-Meier estimators with time of JIA diagnosis as the reference point. Univariate log-rank analysis identified risk factors and Cox regression determined independent predictors. RESULTS: In total, 1,183 patients who enrolled within 6 months of JIA diagnosis met inclusion criteria, median age at diagnosis of 9.0 years (interquartile range [IQR] 3.8-12.9), median follow-up of 35.2 months (IQR 22.7-48.3). Of these patients, 87 developed uveitis after enrollment. The incidence of new-onset uveitis was 2.8% per year (95% confidence interval [95% CI] 2.0-3.5) in the first 5 years. The annual incidence decreased during follow-up but remained at 2.1% (95% CI 0-4.5) in the fifth year, although confidence intervals overlapped. Uveitis was associated with young age (<7 years) at JIA diagnosis (hazard ratio [HR] 8.29, P < 0.001), positive antinuclear antibody (ANA) test (HR 3.20, P < 0.001), oligoarthritis (HR 2.45, P = 0.002), polyarthritis rheumatoid factor negative (HR 1.65, P = 0.002), and female sex (HR 1.80, P = 0.02). In multivariable analysis, only young age at JIA diagnosis and ANA positivity were independent predictors of uveitis. CONCLUSION: Vigilant uveitis screening should continue for at least 5 years after JIA diagnosis, and priority for screening should be placed on young age (<7 years) at JIA diagnosis and a positive ANA test. SN - 2151-4658 UR - https://www.unboundmedicine.com/medline/citation/30320957/Prospective_Determination_of_the_Incidence_and_Risk_Factors_of_New_Onset_Uveitis_in_Juvenile_Idiopathic_Arthritis:_The_Research_in_Arthritis_in_Canadian_Children_Emphasizing_Outcomes_Cohort_ DB - PRIME DP - Unbound Medicine ER -