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.
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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 |
P-value 1a All groups |
P-value 2b JIA vs. JIA-U |
P-value 3c JIA vs. I-U |
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Demographic Characteristics Age, mean years + SD Gender, female, N (%) Hispanic, N (%) Race, N (%) Caucasian African American Other+
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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
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0.380 0.283 0.221 0.296
0.026* |
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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 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
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0.004*
0.008*
<0.0001* 0.589 0.589 0.072 1.000 0.352 1.000 1.000 |
0.594
0.985 |
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Labs, N (%) ANA RF Anti-CCP HLA-B27
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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 |
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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
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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) |
0.005* 0.057
0.015*
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0.347 0.029*
0.002*
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0.103 0.111 0.097 0.028* 0.032* 0.188
0.032* 0.302 0.529 |
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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 |
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Table 2. Mean scores on quality of life and function measures
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JIA N = 104 |
JIA-U N = 19 |
I-U N = 9 |
P value |
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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 |
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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. |
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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;
M. Kent,
None;
K. Jenkins,
None;
S. Lambert,
None;
C. Drews-Botsch,
None;
S. Prahalad,
None.
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