Impact of Juvenile Idiopathic Arthritis Associated Uveitis in Early Adulthood

Anne-Mieke J W Haasnoot; Lenneke A Vernie; Aniki Rothova; Patricia V D Doe; Leonoor I Los; Nicoline E Schalij-Delfos; Joke H de Boer

doi:10.1371/journal.pone.0164312

Impact of Juvenile Idiopathic Arthritis Associated Uveitis in Early Adulthood

PLoS One. 2016 Oct 10;11(10):e0164312. doi: 10.1371/journal.pone.0164312. eCollection 2016.

Authors

Anne-Mieke J W Haasnoot¹, Lenneke A Vernie¹, Aniki Rothova², Patricia V D Doe¹, Leonoor I Los^{3

4}, Nicoline E Schalij-Delfos⁵, Joke H de Boer¹

Affiliations

¹ Department of Ophthalmology, Utrecht University Medical Center, Utrecht, The Netherlands.
² Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.
³ Department of Ophthalmology, Groningen University Medical Center, Groningen, the Netherlands.
⁴ W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands.
⁵ Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

Background: Typically juvenile idiopathic arthritis (JIA)-associated uveitis (further referred as 'JIA-uveitis') has its onset in childhood, but some patients suffer its, sometimes visual threatening, complications or ongoing disease activity in adulthood. The objective of this study was to analyze uveitis activity, complications and visual prognosis in adulthood.

Methods: In this multicenter study, 67 adult patients (129 affected eyes) with JIA-uveitis were retrospectively studied for best corrected visual acuity, visual fields, uveitis activity, topical/systemic treatments, ocular complications, and ocular surgeries during their 18th, 22nd and 30th year of life. Because treatment strategies changed after the year 1990, outcomes were stratified for onset of uveitis before and after 1990.

Results: Sixty-two of all 67 included patients (93%) had bilateral uveitis. During their 18th life year, 4/52 patients (8%) had complete remission, 28/52 (54%) had uveitis activity and 37/51 patients (73%) were on systemic immunomodulatory treatment. Bilateral visual impairment or legal blindness occurred in 2/51 patients (4%); unilateral visual impairment or legal blindness occurred in 17/51 patients (33%) aged 18 years. The visual prognosis appeared to be slightly better for patients with uveitis onset after the year 1990 (for uveitis onset before 1990 (n = 7) four patients (58%) and for uveitis onset after 1990 (n = 44) 13 patients (30%) were either visual impaired or blind). At least one ocular surgery was performed in 10/24 patients (42%) between their 18th and 22nd year of life.

Conclusions: Bilateral visual outcome in early adulthood in patients with JIA-uveitis appears to be fairly good, although one third of the patients developed one visually impaired or blind eye. However, a fair amount of the patients suffered from ongoing uveitis activity and needed ongoing treatment as well as surgical interventions. Awareness of these findings is important for ophthalmologists and rheumatologists treating patients with JIA-uveitis, as well as for the patients themselves.

Publication types

Clinical Trial
Multicenter Study

MeSH terms

Adolescent
Adult
Arthritis, Juvenile / complications*
Arthritis, Juvenile / diagnosis
Arthritis, Juvenile / epidemiology*
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Male
Prognosis
Retrospective Studies
Uveitis / diagnosis
Uveitis / epidemiology*
Uveitis / etiology*
Uveitis / surgery

Grants and funding

This study was funded by the combined grants from the Dr. F.P. Fischer Stichting, Amersfoort; The ODAS Stichting, the Landelijke Stichting Voor Blinden en Slechtzienden, Utrecht; the Stichting Nederlands Oogheelkundig Onderzoek (SNOO), Rotterdam, the Netherlands. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.