Posterior Segment Involved in JIA-Associated Uveitis

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Traditionally, uveitis associated with juvenile idiopathic arthritis (JIA) has been thought to occur in the anterior segment alone. More recently, however, some studies have detected inflammation in the pos­terior segment. Now, a retrospective evaluation with widefield fundus angiography (WFA) has confirmed the presence of posterior segment inflammation in more than 70% of eyes.¹

The clinical implications are significant, said Charles Stephen Foster, MD, FACR, FACS, in private practice in Waltham, Massachusetts. “JIA uveitis is a systemic vision-threatening disease that requires aggressive systemic therapy.”

Evaluating WFA characteristics. Dr. Foster and his coauthors culled the electronic records of their practice for patients who were diagnosed with JIA and under­went WFA with the Spectralis system (Heidelberg). The search yielded 20 patients (37 eyes) who were age 2 to 14 years at diagnosis.

All told, 27 eyes (73%) showed some evidence of posterior segment inflammation. Other WFA find­ings included optic disc hyperfluorescence in 19 eyes (51.4%), macular leakage in 10 eyes (27%), and reti­nal vascular staining/leakage at the posterior pole in 10 eyes (27%) and at the peripheral retina in 24 eyes (64.9%). In addition, capillary leakage was noted at the posterior pole in 14 eyes (37.8%), and peripheral capil­lary leakage was detected in 22 eyes (59.5%).

Additional findings. The researchers also quanti­fied anterior chamber cells and severity of intraocular inflammation using standardized classification systems. Nine patients had quiet anterior chambers bilaterally, while seven had clinical anterior segment activity in only one eye. However, many of the patients presenting with few or no anterior chamber cells had the highest angiography scores—thus, significant inflammation would have been missed had the angiogram not been done, Dr. Foster said. A new course of treatment was prescribed for eight of the nine patients with bilateral quiet anterior chambers.

Going forward. The authors agreed that it will take larger, prospective studies to determine the exact role of WFA in JIA-associated uveitis. Nevertheless, the current findings suggest that subclinical posterior segment involvement may occur in many patients. “I strongly advise widefield angiography in the quest to understand as completely as possible what is going on,” Dr. Foster said. “The posterior segment must be considered, if one aims to cure the problem.”

—Miriam Karmel

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1 Tripathy K et al. Ocul Immunol Inflamm. Published online Dec. 2, 2020.

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Relevant financial disclosures—Dr. Foster: None.

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