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    Pediatric Ophth/Strabismus, Uveitis

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    Review of: Uveitis in juvenile idiopathic arthritis: 18-year outcome in the population-based Nordic cohort study

    Rypdal V, Glerup M, Songstad N, et al. Ophthalmology, April 2021

    This prospective study reports the long-term outcomes of uveitis among children with juvenile idiopathic arthritis (JIA).

    Study design

    Researchers from 12 centers across Denmark, Finland, Norway and Sweden followed 434 patients with JIA for 18 years. Outcomes included diagnosis of uveitis, use of systemic immunosuppressive therapy, ocular complications and visual acuity.

    Outcomes

    By the end of the study, more than 20% of patients developed uveitis, and most were diagnosed with uveitis within the first 8 years of JIA diagnosis; however, a small percentage of patients developed uveitis after 8 years. A short duration between each diagnosis increased the risk of developing ocular complications. All patients diagnosed with uveitis prior to JIA developed cataract and were at high risk for developing glaucoma (OR 31.5). Children with uveitis were more likely to be on systemic immunosuppressive medication.

    Limitations

    Given the geography of the study centers, the cohort was relatively homogeneous. Although the 18-year follow-up provides important long-term data, there has been an important evolution of systemic immunosuppressant therapy over this time. The use of biologic agents at the beginning of this study was less common than it is in current practice.

    Clinical significance

    Approximately a quarter of patients with newly diagnosed JIA will also have uveitis. Ocular complications are more common if uveitis develops either before or soon after JIA diagnosis. Early systemic immunosuppression can help mitigate risk of ocular complications from JIA-associated uveitis.