J Korean Ophthalmol Soc.  2013 Dec;54(12):1838-1843.

Clinical Manifestation of Juvenile Idiopathic Arthritis Associated Uveitis in Korea

• Kwon SI
• Baek SU
• Park IW
• Kim KN
• Park CK

Abstract

PURPOSE
To investigate the incidence and clinical characteristics of juvenile idiopathic arthritis (JIA)-associated uveitis in Korea and to identify the risk factors for developing uveitis and poor visual outcome.
METHODS
We performed a retrospective chart review of 149 patients who were diagnosed as JIA between January 2001 and December 2012. Patients were classified based on the International League of Associations for Rheumatology (ILAR) criteria and the incidence and clinical course of uveitis according to each subtype was investigated. We also evaluated the risk factors for poor prognostic outcomes.
RESULTS
The present study included 79 males and 70 females and the mean age was 7.42 +/- 3.82 years. In 13 patients (8.6%), uveitis manifested evenly among JIA subtypes, including 5 patients with oligoarthritis type, 4 patients with polyarthritis rheumatoid negative type, and 4 patients with systemic type. Anti-nuclear antibody (ANA) was detected more in the uveitic group (46.13%). The characteristics of uveitis were acute (85%), bilateral (85%), and anterior uveitis (92%). Chronic uveitis occurred in only 2 patients who had uveitis at an early age (mean age of 5 years) and had severe anterior chamber reaction at presentation. Poor visual outcome was associated with band keratopathy and posterior synechiae preceded by the chronic uveitis.
CONCLUSIONS
JIA-associated uveitis occurred evenly in each subtype. Uveitis was increased in the presence of ANA. Most uveitis showed good visual outcomes but in cases of early uveitis onset and with severe anterior chamber reaction at presentation the risk of chronic uveitis increased resulting in poor visual outcomes.

Keyword

ANA; Juvenile idiopathic arthritis; Risk factor; Uveitis

MeSH Terms

Anterior Chamber
Arthritis
Arthritis, Juvenile Rheumatoid*
Female
Humans
Incidence
Korea*
Male
Retrospective Studies
Rheumatology
Risk Factors
Uveitis*
Uveitis, Anterior

Reference

References

1. Jacobs JC. Pediatric rheumatology for the practitioner. 2nd ed.New York: Springer-Verlag;1993. p. 231–359.

2. Cassidy JT, Levinson JE, Bass JC. . A study of classification criteria for a diagnosis for juvenile rheumatoid arthritis. Arthritis Rheum. 1986; 29:274–81.

3. European League Against Rheumatism(EULAR). Bulletin No. 4. Nomenclature and Classification of Arthritis in Children. Basel: National Zeitung AG;1977.

4. Petty RE, Southwood TR, Manners P. . International League of Associations for Rheumatology classification of juvenile idio-pathic arthritis: second revision. Edmonton. 2001; J Rheumatol. 2004; 31:390–2.

5. Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uvei-tis nomenclature for reporting clinical data. Results of the first in-ternational workshop. Am J Ophthalmol. 2005; 140:509–16.

6. Schaller JG. Juvenile rheumatoid arthritis. Nelson Textbook of Pediatrics. 14th ed.Philadelphia: WB Saunders Co;1992. chap. 48.

7. Wolf MD, Lichter PR, Ragsdale CG. Prognostic factors in the uveitis of juvenile rheumatoid arthritis. Ophthalmology. 1987; 94:1242–8.

8. Kotaniemi K, Kautiainen H, Karma A, Aho K. Occurrence of uvei-tis in recently diagnosed juvenile chronic arthritis: a prospective study. Ophthalmology. 2001; 108:2071–5.

9. Cassidy JT, Sullivan DB, Petty RE. Clinical patterns of chronic iri-docyclitis in children with juvenile rheumatoid arthritis. Arthritis Rheum. 1977; 20(2 Suppl):224–7.

10. Cabral DA, Petty RE, Malleson PN. . Visual prognosis in chil-dren with chronic anterior uveitis and arthritis. J Rheumatol. 1994; 21:2370–5.

11. Kim JG, Jeong JY, Yoon BY, Hahn YS. Clinical observations on ju-venile rheumatoid arthritis (I. systemic type). J Korean Rheum Assoc. 1994; 1:175–82.

12. Hahn YS, Kim JG. A clinical study on pauciarticular juvenile rheu-matoid arthritis (JRA). J Korean Pediatr Soc. 1995; 38:386–96.

13. Hahn YS, Park JS, Kim JG. A clinical study on polyarticular juve-nile rheumatoid arthritis (JRA) (III. Polyarticular Type). J Korean Rheum Assoc. 1997; 4:70–81.

14. Shin YJ, Yu YS, Chung H, Kim JG. The ocular manifestations of the Korean juvenile rheumatoid arthritis children. J Korean Ophthalmol Soc. 2002; 43:492–7.

15. Macaubas C, Nguyen K, Milojevic D. . Oligoarticular and pol-yarticular JIA: epidemiology and pathogenesis. Nat Rev Rheumatol. 2009; 5:616–26.

16. Oh KT, Jung SS, Yoo TS. . Analytic study of the clinical fea-tures of Korean juvenile rheumatoid arthritis (JRA). J Korean Rheum Assoc. 1997; 4:121–30.

17. Shin JI, Kim DS, Lee SK, Kim HW. Disease course and prognostic factors of juvenile idiopathic arthritis. J Korean Rheum Assoc. 2003; 10:374–93.

18. Chylack LJ. The ocular manifestations of juvenile rheumatoid arthritis. Arthritis Rheum. 1977; 20(Suppl):217–23.

19. Giannini EH, Malagon CN, Van Kerckhove C. . Longitudinal analysis of HLA associated risks for iridocyclitis in juvenile rheu-matoid arthritis. J Rheumatol. 1991; 18:1394–7.

20. Ravelli A, Felici E, Magni-Manzoni S. . Patients with anti-nuclear antibody– positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease. Arthritis Rheum. 2005; 52:826–32.

21. Thorne JE, Woreta F, Kedhar SR. . Juvenile idiopathic arthritis-associated uveitis: incidence of ocular complications and visual acuity loss. Am J Ophthalmol. 2007; 143:840–6.e2.

22. Woreta F, Thorne JE, Jabs DA. . Risk factors for ocular compli-cations and poor visual acuity at presentation among patients with uveitis associated with juvenile idiopathic arthritis. Am J Ophthalmol. 2007; 143:647–55.