J.ophthalmol.(Ukraine).2019;2:22-27.

http://doi.org/10.31288/oftalmolzh201922227

Received: 05 February 2019; Published-online: 24 April 2019


Features of the course and treatment of JIA-associated uveitis

M.V. Panchenko,1 Dr Sc (Med); N.S. Shevchenko,2,3 Dr Sc (Med);  M.V. Demianenko,3 MD; Honchar O.M., 1 Cand Sc (Med); L.G. Avilova,1 MD

1 Kharkiv National Medical University

2 Karazin Kharkiv National University

3 Pediatric and Adolescent Health Institute of the NAMS of Ukraine;

Kharkiv (Ukraine) 

E-mail: panchenko0802@gmail.com

Purpose: To investigate the features of the clinical course of and the state of eye care for patients with juvenile idiopathic arthritis (JIA)-associated uveitis (JIA-U).

Materials and Methods: We analyzed the results of monitoring 121 patients aged 7 to 18 years with JIA. Twenty one (17.35%) of these had uveitis.

Results: In 17 (80.95%) of the examined JIA-U patients, JIA onset age was younger than 6 years, and mean JIA onset age was significantly younger than in JIA patients without uveitis (2.89±0.26 years vs 6.43±0.4 years, р<0.05). Most (85.7%) JIA-U patients were asymptomatic. Chronic keratic precipitates and posterior synechiae were found in 38.09% and 42.85%, respectively, of cases. Uveal cataract was the most common complication (57.14%), followed by corneal degeneration (33.33%), macular edema (28.57%), ocular hypertension/ secondary glaucoma (19.05%), optic nerve edema (14.28%), hypotony (14.28%), vitreous fibrosis (9.52%), and retinal detachment (4.76%). The frequency of administration of biologics was 57.14%. The mean time from disease onset to administration of biologics in our JIA-U patients (2.67±0.79 years) was 2.5 times less than the value for JIA-U patients from all over Ukraine (6.9 years), indicating that biologics were timely administered.

Conclusion: Patients with the condition are commonly asymptomatic and have frequent ocular complications, with uveal cataract being the most common, followed by corneal degeneration and macular edema. 

Keywords:  uveitis, juvenile idiopathic arthritis

References

1.Clarke SL, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J. 2016 Apr;14(1):27.

Crossref    PubMed

2.Sen ES, Dick AD, Ramanan AV. Uveitis associated with juvenile idiopathic arthritis. Nat Rev Rheumatol. 2015;11:338–48.

Crossref   PubMed

3.Wentworth BA, Freitas-Neto CA, Foster CS. Management of pediatric uveitis. F1000Prime Rep. 2014 Jun;6:41.

Crossref    PubMed

4.Mérida S, Palacios E, Navea A, Bosch-Morell F. New Immunosuppressive Therapie sin Uveitis Treatment. Int J Mol Sci. 2015 Aug;16(8):18778-95.

Crossref    PubMed

5.Jabs DA. Immunosuppression for the Uveitides. Ophthalmology. 2018 Feb;125(2):193-202.

Crossref   PubMed

6.Tugal-Tutkun І. Pediatric Uveitis. J Ophthalmic Vis Res. 2011;6(4):259-69.

7.Smith JA, Mackensen F, Sen HN et al. Epidemiology and course of disease in childhood uveitis. Ophthalmologу. 2009 Aug;116(8):1544-51.

Crossref   PubMed

8.Ramanan AV, Dick AD, Benton D et al., SYCAMORE Trial Management Group. A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). Trials. 2014 Jan;15:14. 

Crossref   PubMed

9.Ftrrara M, Eggenschwiler L, Stephenson A et al. The Challenge of Pediatric Uveitis: Tetriary Referral Center Experience in the United States. Ocul Immunol Inflamm. 2018 Jan;15:1-8. 

Crossref   PubMed

10.Foeldvari I, Walscheid K, Heiligenhaus A. Uveitis in juvenile idiopathic arthritis. Z Rheumatol. 2017 Oct;76(8):664-72. 

Crossref    PubMed

11.Heiligenhaus A, Niewerth M, Ganser G et al. Prevalence and complications of uveitis in juvenile idiopathiс arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology. 2007; 46:1015–1019.

Crossref    PubMed  

12.Cosickic A, Halilbasic M, Selimovic A, Avdagic H. Uveitis Associated with Juvenile Idiopathic Arthritis, our Observations. Med Arch. 2017 Feb; 71(1): 52-5.

Crossref   PubMed  

13.Angeles-Han ST, Rabinovich CE. Uveitis in children. Curr Opin Rheumatol. 2016 Sep;28(5):544-9.

Crossref   PubMed

14.Heiligenhaus A, Minden K, Foll D, Pleyer U. Uveitis in juvenile idiopathic arthritis. Dtsch Arztebl Int 2015; 112: 92–100.  

Crossref   PubMed  

15.Boer J, Wulffraat N, Rothova A. Visual loss in uveitis of childhood. Br J Ophthalmol. 2003 Jul;87(7):879-84.

Crossref   PubMed

16.Cann M., Ramanan AV., Crawford A. et al. Outcomes of non-infectious Paediatric uveitis in the era of biologic therapy. Pediatr Rheumatol Online J. 2018 Aug;16(1):51.

Crossref   PubMed  

17.Hersh AO, Cope S, Bohnsack JF et al. Use of Immunosuppressive Medications for Treatment of Pediatric Intermediate Uveitis. Ocul Immunol Inflamm. 2018;26(4):642-50. 

18.Dajee KP, Rossen JL, Bratton ML et al. A 10-year review of pediatric uveitis at a Hispanic dominated tertiary pediatric ophthalmic clinic. Clin Ophthalmol. 2016 Aug;10:1607-12. 

Crossref    PubMed  

19.Gregory AC, Kaçmaz RO, Foster CS et al. Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group. 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.

Crossref   PubMed

20.Ramanan AV, Dick AD, Jones AP et al. SYCAMORE Study Group. Adalimumab plus Methotrexate for Uveitis in Juvenile Idiopathic Arthritis. N Engl J Med. 2017 Apr;376(17):1637-46.

Crossref   

21.Davies R, Carrasco R, Foster HE et al. Treatment prescribing patterns in patients with juvenile idiopathic arthritis (JIA): Analysis from the UK Childhood Arthritis Prospective Study (CAPS). Semin Arthritis Rheum. 2016 Oct; 46(2): 190–195. 

Crossref   PubMed

22.Cecchin V, Zannin ME, Ferrari D et al. Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis. The Journal of Rheumatology. 2018 Aug; 45 (8) 1167-72; 

Crossref   PubMed  

23.Quartier P, Baptiste A, Despert V. et al. ADJUVITE Study Group. ADJUVITE: a double-blind, randomised, placebo-controlled trial of adalimumab in early onset, chronic, juvenile idiopathic arthritis-associated anterior uveitis. Ann Rheum Dis. 2018 Jul;77(7):1003-11.

Crossref   PubMed  

24.Constantin T, Foeldvari I, Anton J et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann Rheum Dis. 2018 Aug;77(8):1107-17.

25.Angeles-Han ST, McCracken C, Yeh S, et al. Characteristics of a cohort of children with Juvenile Idiopathic Arthritis and JIA-associated Uveitis. Pediatr Rheumatol Online J. 2015 Jun;13:19. 

Crossref   PubMed

26.Angeles-Han ST, Pelajo CF, Vogler LB et al. CARRA Registry Investigators. Risk markers of juvenile idiopathic arthritis-associated uveitis in the Childhood Arthritisand Rheumatology Research Alliance. J Rheumatol. 2013 Dec;40(12):2088-96.

Crossref   PubMed 

27.Paroli MP, Abbouda A, Restivo L et al. Juvenile idiopathic arthritis-associated uveitis at an Italian tertiary referral center: clinical features and complications. Ocul Immunol Inflamm. 2015 Feb;23(1):74-81. 

Crossref   PubMed  

28.Skarin A, Elborgh R, Edlund E, Bengtsson-Stigmar E. Long-term follow-up of patients with uveitis associated with juvenile idiopathic arthritis: a cohort study. Ocul Immunol Inflamm. 2009;17(2):104–8. 

Crossref   PubMed

29.Stroh IG, Moradi A, Burkholder BM, et al. Occurrence of and Risk Factors for Ocular Hypertension and Secondary Glaucoma in Juvenile Idiopathic Arthritis-associated Uveitis. Ocul Immunol Inflamm. 2017 Aug;25(4):503-512. 

Crossref   PubMed 

30.Boers M. Understanding the window of opportunity concept in early rheumatoid arthritis. Arthritis Rheum. 2003;48(7):1771–4.

Crossref   PubMed

31.Nigrovic PA. Review: is there a window of opportunity for treatment of systemic juvenile idiopathic arthritis? Arthritis Rheumatol. 2014;66(6):1405–13.

Crossref   PubMed  

32.Ravelli A, Consolaro A, Horneff G, et al. Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2018 Jun; 77(6): 819-828. 

Crossref  PubMed 

33.Henderson LA, Zurakowski D, Angeles-Han ST et al. Medication use in juvenile uveitis patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J. 2016; 14: 9. 

Crossref   PubMed


The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.