Pediatric Rheumatology Online Journal → June 2003 → Health-Related Quality of Life, Disease Activity and Outcome Assessments→ Abstract #38

OUTCOME IN JUVENILE ARTHRITIS ASSOCIATED UVEITIS

D. M. Roberton,¹ C. Chen,² M. E. Hammerton.²

¹Dept of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia; ²Dept of Ophthalmology, Womens and Childrens Hospital, Adelaide, South Australia, Australia

Seventy one children with with a newly established diagnosis of juvenile arthritis were audited as a case series in a combined paediatric rheumatology- ophthalmology clinic to determine outcome in juvenile arthritis (JA) associated uveitis. All children had established JA as defined by ILAR guidelines. Ophthalmological assessment was undertaken at intervals as recommended by the ACR - American Academy of Opththalmology guidelines (mean follow up 55 months). A uveitis score was recorded at each ophthalmological assessment.
The median age at diagnosis for JA was 4 years and 1 month (range 16m 13 years). Two thirds had an oligoarticular onset. Twenty seven children (38%: 19 females) developed uveitis. Twelve had a single diagnosed episode of uveitis, 7 had persistent uveitis, and 8 had relapsing/ remitting disease. The median age at onset of uveitis was 5.9 years, with an average interval of 18 months after the onset of arthritis. Eleven of the 71 (15%) had uveitis at the time of initial assessment leading to the diagnosis of JA, with uveitis scores between 8/20 and 17/20. Twenty five of the 27 had eventual bilateral eye involvement. ANA was positive in 33 of the 71 patients (46%), and uveitis developed in 5 of 38 ANA negative patients.
Of the 27 with uveitis, 13 (48%) had very mild mild anterior segment inflammation, with a uveitis score of less than 3/20. These children all received non steroidal antinflammatory medications, were followed closely and had resolution of their uveitis without topical therapy and without residua. Eight received topical steroid therapy only (uveitis score less than 5/20), and 6 had a mydriatic added (score 6/20 - 18/20) with or without systemic therapy.
The 44 patients without uveitis had normal VA at the final assessment. Of 52 involved eyes, band keratopathy developed in 8 (15%), cataracts in 7 (13%), and glaucoma in 3 (6%). At the final assessment, 8 eyes from 5 patients had a VA of 6/36 or worse: in these 5 children, VA was already abnormal at the time of presentation.