Session Information
Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Juvenile Idiopathic Arthritis
Session Type: Abstract Submissions (ACR)
Background/Purpose: Studies on outcomes of children with juvenile idiopathic arthritis-associated uveitis (JIA-U) focus on the clinical ocular exam and physical disability secondary to arthritis. This assessment could improve by including measures of the impact of uveitis on daily life. However, until recently, there were no instruments that measured visual function in this population. Our objective is to validate a measure of visual function, the “Effects of Youngsters’ Eyesight on Quality of Life (QOL)” (EYE-Q), in children with uveitis.
Methods: Focus groups were held to modify the old EYE-Q for children with uveitis. The new EYE-Q contains items specific to uveitis. A parent-proxy version was also developed. Children with JIA, JIA-U, and idiopathic uveitis (I-U) participated. Medical record reviews were performed. Questionnaires were completed on QOL (Pediatric QOL Inventory – PedsQL), physical function (Childhood Health Assessment Questionnaire – CHAQ), and visual function (EYE-Q).
Results: Participants were 104 children with JIA, 19 with JIA-U and 9 with I-U (Table 1). There were significant differences in the child and parent EYE-Q scores in children with uveitis compared to children with JIA (Table 2). For the child report, there were mild correlations between EYE-Q scores and logmarVA (r = -0.35) and moderate correlations with the PedsQL (r = 0.50) and CHAQ (r = -0.53) (Table 3). Similar results were found with the parent report. There were strong correlations between the parent and child EYE-Q (r = 0.74), and the old and new versions of the EYE-Q (r = 0.96, r = 0.94).
Cronbach’s α for the old EYE-Q child and parent reports was 0.89. Cronbach’s α for the new EYE-Q child report was 0.91 and for the parent report was 0.90.
Conclusion: The new EYE-Q, with items specific to uveitis, is a valid measure of visual function in children with uveitis. There were differences in child and parent perception of disease hence the inclusion of both perspectives in disease assessment is important. The EYE-Q may be an important measure in the assessment of outcomes in this population and a better measure than the clinical exam and arthritis specific measures alone. Longitudinal studies examining the performance of the EYE-Q in children with JIA-U and I-U are ongoing.
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Table 1. Characteristics of children with JIA-associated uveitis, JIA alone, and idiopathic uveitis |
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JIA alone N = 104 |
JIA-U N = 19 |
I-U N = 9 |
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Demographic Characteristics Age, mean years + SD Gender, female, N (%) Hispanic, N (%)
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11.6±4.8 74 (71.8) 10 (9.7) |
10.5±4.5 16 (84.2) 4 (22.2) |
11.7±4.9 5 (55.6) 0 (0) |
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Disease characteristics Age at arthritis onset, mean years ±SD Age at uveitis onset, mean years ±SD Duration of JIA, mean years ±SD Duration of uveitis, mean years ±SD
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7.4±4.5
3.99±3.51 |
4.0±4.6 6.8±5.1 6.48±3.74 3.68±3.56 |
8.0±4.4
3.65±3.12 |
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Ophthalmology exam, most recent LogMarVA mean±SD, worse eye Intraocular pressure, worse eye Slit lamp exam, worse eye Cells 0 (<1 cell in field) 0.5+ (1-5 cells in field) 1+ (6-15 cells in field) 2+ (16-25 cells in field) 3+ (26-50 cells in field) 4+ (>50 cells in field)
Complications, N (%) Cataracts Glaucoma Synechiae Band keratopathy Cystoid macular edema Other complications
Surgeries, N (%) Cataract extraction Periocular steroid injection Other ocular surgeries
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N = 34 0.17±0.24 11.5 (7.8)
34 0 0 0 0 0
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N = 15 0.24±0.22 19.0 (7.5)
11 2 1 2 0 0
N = 17 5 (29.4) 0 (0) 6 (36.3) 2 (11.8) 0 (0) 3 (17.7)
0 (0) 2(11.8) 1 (5.9) |
N = 7 0.74±0.98 18.7 (8.6)
4 2 0 0 0 0
N = 9 6 (66.7) 2 (22.2) 7 (77.8) 5 (55.6) 3 (33.3) 4 (57.1)
3 (33.3) 3 (33.3) 2 (22.2) |
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Table 2. Mean scores on standard quality of life and function measures in JIA
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JIA N = 102 |
JIA-U N = 19 |
I-U N = 9 |
P value |
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Child Reports+ EYEQa (range 0-4)** CHAQb (range 0-3)++ PedsQLc Physical scale (range 0-100)** PedsQL Psychosocial scale PedsQL Total scale
Parent Reports EYEQa (range 0-4)** CHAQb (range 0-3)++ PedsQLc Physical scale (range 0-100)** PedsQL Psychosocial scale PedsQL Total scale |
3.64 ± 0.44 0.59 ± 0.61 70.3 + 24.4 74.5+18.8 73.1 + 19.5
3.78 ± 0.37 0.57 ± 0.63 69.48 + 25.44 76.29 + 20.15 73.83 + 20.49 |
3.31 ± 0.44 0.72 +0.67 60.47 + 24.7 69.0 +17.9 65.98 + 18.90
3.37 ± 0.57 0.56 +0.62 67.29 + 22.57 67.75 + 19.99 67.64 + 19.50 |
3.37 ± 0.79 0.00 ± 0.00 91.5 ±5.3 81.8 ±18.4 85.31 ± 18.89
3.33 ± 0.89 0.08 ± 0.17 98.2 ± 3.54 84.29 ±23.80 89.13 ± 15.42 |
0.043* 0.046* 0.023* 0.334 0.102
0.002* 0.077 0.010 0.135 0.061 |
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+ – data are missing ANOVA , *p-value <0.05 aEffects of Youngsters Eyesight on QOL; bChildhood Health Assessment Questionnaire; cPediatric Quality of Life Inventory **Greater scores indicate better QOL; ++Greater scores indicate worse QOL |
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Table 3. Correlations of the EYEQ with standard measures of quality of life and function in JIA
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R [95% CI]** |
P value |
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EYEQa child LogmarVAb CHAQc PedsQLd Total scale EYEQ parent New EYE-Q
EYEQa parent LogmarVAb CHAQc score PedsQLd total New EYEQa |
-0.35 [-0.60 – (-0.03)] -0.53 [ -0.78- (-0.57)] 0.50 [0.33-0.63] 0.74 [0.63 – 0.81] 0.96 [0.94 – 0.97]
-0.22 [-0.46 – 0.046] -0.34 [-0.48 – (-0.18)] 0.43 [0.28 – 0.57] 0.94 [0.916 – 0.96]
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0.029* <0.0001* <0.0001* <0.0001* <0.0001*
0.101 <0.001* <0.001* <0.001* |
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Spearman’s correlation coefficients, *p-value <0.05 ** Mild correlations: R <0.3; Moderate correlations: R = 0.3 - 0.7; Strong correlation: R = >0.7 aEffects of Youngsters Eyesight on QOL; bLogmar visual acuity; cChildhood Health Assessment Questionnaire; dPediatric Quality of Life Inventory |
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Disclosure:
S. T. Angeles-Han,
None;
S. Yeh,
None;
C. McCracken,
None;
L. B. Vogler,
None;
K. A. Rouster-Stevens,
None;
C. W. Kennedy,
None;
K. Jenkins,
None;
M. Kent,
None;
S. Lambert,
None;
C. Drews-Botsch,
None;
S. Prahalad,
None.
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