Chronic uveitis in children with and without juvenile idiopathic arthritis: differences in patient characteristics and clinical course.

Objective: Anterior uveitis (AU) in childhood may be the first manifestation of juvenile idiopathic arthritis (JIA). We identified factors that may help to differentiate JIA-associated AU from the more common idiopathic AU (IAU) before the onset of arthritis.

Methods: Children with IAU and with JIA-associated AU were analyzed for their demographics, age at onset of uveitis, uveitis course and complications, ocular surgery, antiinflammatory medication, and best corrected visual acuity (BCVA).

Results: AU was associated with JIA in 88 cases, and was idiopathic in another 49. In the JIA group, 60% of patients were female compared to 47% in the IAU group (p = 0.154). Antinuclear antibody (ANA) was significantly more frequent in the JIA group (88% vs 33%; p < 0.001, OR 14.4, 95% CI 5.8-35.6). Insidious uveitis onset occurred more often in JIA than in IAU patients (67% vs 31%; p < 0.001, OR 4.6, 95% CI 2.2-9.8). Persistent uveitis was found in 82% of JIA patients, and in 57% of IAU patients (p = 0.003, OR 3.4, 95% CI 1.5-7.4). Median age of AU onset was 5 years in JIA and 9 years in IAU (p < 0.001). Uveitis complications at first presentation at our institutions were more frequent in JIA than in IAU patients (79% vs 61%; p = 0.027, OR 2.5, 95% CI 1.1-5.3). During followup, 69 surgical procedures (51% of patients, 1.31 per patient) were performed in the JIA group, and 18 in IAU patients (0.57 per patient) (p = 0.008). BCVA was better in the IAU patients at first presentation (p = 0.001).

Conclusion: The IAU and JIA-associated AU in childhood differ in their clinical course. ANA positivity, presence of uveitis complications at first manifestation, insidious onset, duration over 3 months, BCVA of 20/50 or less, and an age of 3 years or younger might help to detect AU associated with JIA. JIA uveitis manifests earlier, has more complications, and more often requires systemic immunosuppression and surgical intervention.