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Abstract Number: 2005

Clinical Course and Outcomes of Children with Juvenile Idiopathic Arthritis-Associated Uveitis and Idiopathic Uveitis

Sheila T. Angeles-Han1, Steven Yeh2, Courtney McCracken3, Larry B. Vogler4, Kelly A. Rouster-Stevens5, Christine W. Kennedy6, Matthew Kent4, Kirsten Jenkins7, Scott Lambert8, Carolyn Drews-Botsch9 and Sampath Prahalad10, 1Pediatrics, Emory Univ School of Medicine, Atlanta, GA, 2Ophthalmology, Emory University School of Medicine, Atlanta, GA, 3Emory University School of Medicine, Atlanta, GA, 4Dept of Pediatrics, Emory Univ School of Medicine, Atlanta, GA, 5Pediatric Rheumatologist, Emory Children's Center, Atlanta, GA, 6Rheumatology Immunology, Emory Children's Center, Atlanta, GA, 7Children's Healthcare of Atlanta, Atlanta, GA, 8Ophthalmology, Emory Univ School of Medicine, Atlanta, GA, 9Epidemiology, Emory University School of Public Health, Atlanta, GA, 10Pediatrics, Emory Children's Center, Atlanta, GA

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: juvenile idiopathic arthritis (JIA), ocular involvement, outcome measures and pediatric rheumatology

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Session Information

Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Diseases

Session Type: Abstract Submissions (ACR)

Background/Purpose:  Uveitis can lead to vision loss and blindness.  Few studies focus on the outcomes of children with both juvenile idiopathic arthritis-associated uveitis (JIA-U) and idiopathic uveitis (I-U).  The determination of risk markers for uveitis development and disease severity is important in examining the long-term outcomes of this population. Our objective is to characterize the epidemiology and clinical outcomes of children with JIA-U and I-U in a cohort of children in an urban tertiary care center in the Southeast.

Methods: Children with JIA, JIA-U, and I-U participated.  Medical record reviews were performed. Questionnaires were completed on overall quality of life (QOL) (Pediatric QOL Inventory – PedsQL), physical function (Childhood Health Assessment Questionnaire – CHAQ), and visual function (Effects of Youngsters’ Eyesight on QOL – EYE-Q).

Results:  Our 132 patients were primarily female (72%), non-Hispanic (89.4%) and Caucasian (74.2%).  Compared to JIA, children with JIA-U were more frequently African American, diagnosed with oligoarticular extended JIA and had a younger age of arthritis onset (Table 1).  There were no significant differences in gender, ANA, RF or HLA-B27.  Children with I-U were more frequently HLA-B27 (+) (p=0.023), had worse visual acuity (p=0.005), and more band keratopathy (p=0.028), cystoid macular edema (p=0.032) and cataract extractions (p=0.032). 

There were significant differences in the EYE-Q scores in children with uveitis compared to JIA (p=0.043), significant differences in the CHAQ and PedsQL Physical scale scores in children with arthritis compared to I-U (p=0.046), and no differences in PedsQL total and psychosocial QOL scores in all groups (p=0.045, p=0.023) (Table 2). 

Conclusion: Children with I-U may have a poorer visual outcome compared to JIA-U.  Race, HLA-B27 (+), age of arthritis onset, and JIA subtype may be important risk factors for developing uveitis, whereas gender, ANA, and RF may not be as significant. As expected, visual disability was worse in uveitis, and physical disability was worse in arthritis.  Hence, compared to JIA and I-U, children with JIA-U have more components of disability.  All children had similar psychosocial and overall QOL probably secondary to having a chronic illness.

To improve the assessment of outcomes in JIA-U, a comprehensive approach incorporating all aspects of disability should be considered.  Likewise, the determination of risk markers leading to poor outcomes in children with uveitis is crucial.  Longitudinal studies examining the outcome of children with uveitis are ongoing.

Table 1. Characteristics of children with JIA-associated uveitis, JIA alone, and idiopathic uveitis

JIA alone

N = 104

JIA-U

N = 19

I-U

N = 9

P-value 1a

All groups

P-value 2b

JIA vs. JIA-U

P-value 3c

JIA vs. I-U

 Demographic Characteristics

     Age, mean years + SD

     Gender, female, N (%)

     Hispanic, N (%)

     Race, N (%)

          Caucasian

          African American

          Other+

 

11.6±4.8

74 (71.8)

10 (9.7)

 

81 (77.9)

13 (12.5)

10 (9.6)

 

10.5±4.5

16 (84.2)

4 (22.2)

 

12 (70.6)

5 (29.4)

0 (0)

 

11.7±4.9

5 (55.6)

0 (0)

 

5 (55.6)

4 (44.4)

0 (0)

 

0.669

0.269

0.159

0.245

 

 

0.380

0.283

0.221

0.296

 

0.026*

 

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

   JIA subtype, N (%)

          Oligo persistent

          Oligo extended

          Poly RF (+)

          Poly RF (-)

          Psoriatic

          Systemic

          ERA

          Undifferentiated

 

7.4±4.5

 

3.99±3.51

  

 

27 (26.2)

6 (5.8)

6 (5.8)

24 (24.3)

7 (6.8)

9 (8.74)

9 (8.74)

2 (1.94)

 

4.0±4.6

6.8±5.1

6.48±3.74

3.68±3.56

 

15 (79.0)

0 (0)

0 (0)

1 (5.3)

1 (5.3)

0 (0)

2(10.5)

0 (0)

 

 

8.0±4.4

 

3.65±3.12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0.004*

 

0.008*

 

 

<0.0001*

0.589

0.589

0.072

1.000

0.352

1.000

1.000

 

 

0.594

 

0.985

Labs, N (%)

     ANA

     RF

     Anti-CCP

     HLA-B27

 

32 (36.0)

12 (13.4)

9 (10.1)

6 (6.8)

 

9 (47.4)

0 (0)

0 (0)

2 (10.5)

 

1 (12.5)

0 (0)

0 (0)

3 (37.5)

 

0.226

0.126

0.238

0.023*

 

0.437

0.120

0.212

0.630

Ophthalmology exam, most recent

     LogMarVA mean±SD, worse eye

     Intraocular pressure, worse eye

     Slit lamp exam, worse eye

        Cells, N

            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

N = 34

0.17±0.24

11.5 (7.8)

 

 

34

0

0

0

0

0

 

 

 

 

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)

 

0.005*

0.057

 

0.015*

 

 

 

 

 

 

 

0.347

0.029*

 

0.002*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0.103

0.111

0.097

0.028*

0.032*

0.188

 

 

0.032*

0.302

0.529

ANOVA, Chi-square, *p-value <0.05

aP value 1: comparison of all groups, bP value 2: comparison of JIA and JIA-U, cP value 3: comparison of JIA-U and I-U

+Other races: American Indian, Asian, and unreported/unknown

Table 2. Mean scores on quality of life and function measures

JIA

N = 104

JIA-U

N = 19

I-U

N = 9

P value

EYE-Qa (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

3.31 ± 0.44

0.72 +0.67

60.47 + 24.7

69.0 +17.9

65.98 + 18.90

3.37 ± 0.79

0.00 ± 0.00

91.5 ±5.3

81.8 ±18.4

85.31 ± 18.89

0.043*

0.046*

0.023*

0.334

0.102

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

Note: The sample size in each group varies by scoring tool.


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;

M. Kent,
None;

K. Jenkins,
None;

S. Lambert,
None;

C. Drews-Botsch,
None;

S. Prahalad,
None.

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