Uveitis
Uveitis with JIA
JIA is the commonest rheumatic disease in childhood (<16 years)
Associated with patients of european descent
Classification (by the International League of Associations of Rheumatologists)
- Systemic arthritis
- Oligoarthritis -persistent
- Oligoarthritis -extended
- Polyarthritis -RF negative
- Polyarthritis -RF positive
- Psoriatic arthritis
- Entesitis-related arthritis
- Undifferentiated
Clinical features
1/3rd develop uveitis
- Typically a chronic anterior uveitis
- White eye
- Typically bilateral
Hot Topic
Higher risk groups for uveitis in JIA
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Extended oligoarticular disease with ANA-positive disease
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Females
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Rheumatoid factor negative
-
Early onset JIA
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Lower extremity joint involvement
-
Lack of wrist involvement
- F>M but is worse in males
Complications
- Band keratopathy: can occur in any chronic uveitis but particularly those that begin in childhood
- Cataract
- Glaucoma
- CMO
- Vitritis and retinal vasculitis are more rare
Screening
Hot Topic
Screening of children with uveitis is a hot topic in exams!
- Initial screening should occur within 6 weeks of referral as uveitis commonly starts soon after onset of arthritis
- If symptomatic, they should be seen within 1 week
- Review every 2 months from onset of arthritis for 6 months
- Then every 3-4 months
- Patients are generally followed up to approx 11-12 years of age
Management
- Topical corticosteroids
- Methotrexate if frequent topical steroid is needed: can be given subcut on a weekly basis rather than orally
- anti-TNF agents: adalimumab with methotrexate was shown to reduced flares in the SYCAMORE RCT
- Defer cataract surgery until the eye has been quiet for 3 months (weigh against amblyopia risk in younger patients)
- Band keratopathy: EDTA chelation or excimer phototherapeutic keratectomy