Session Information
Date: Tuesday, October 23, 2018
Title: Pediatric Rheumatology – Clinical Poster III: Juvenile Idiopathic Arthritis and Uveitis
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Pediatric chronic non-infectious uveitis can lead to ocular complications and vision loss. The ophthalmic clinical exam is primarily used to assess uveitis outcomes but may be imprecise since it may not reflect changes in quality of vision and effects of vision impairment. Our goal is to provide a comprehensive assessment of the impact of uveitis on health-related quality of life (HRQOL), mental health, visual function, and vision-related QOL in children with JIA-associated uveitis (JIA-U).
Methods: We reviewed records of 79 children (26 JIA alone, 29 JIA-U, 24 other uveitis types). Parents and patients completed questionnaires on general QOL (Pediatric Quality of Life Inventory- PedsQL), depression and anxiety (Revised ChildrenÕs Anxiety and Depression Scale- RCADs), and visual function and vision-related QOL (Effect of YoungstersÕ Eyesight on QOL-EYE-Q). The EYE-Q has items assessing both visual function (i.e. near, far, color, and night vision) and vision-related QOL (i.e medication use, school absences, and lab draws). We used Wilcoxon Rank-Sum tests to compare disease groups: 1) children with JIA vs. JIA-U, and 2) children with JIA vs. uveitis of all types.
Results: Of 79 children, most were non-Hispanic (88%), Caucasian (66%), females (70%). (Table 1) Among uveitis patients, most had bilateral (70%), anterior (83%) disease with complications (70%).
Children with JIA-U had worse EYE-Q total scores compared to those with JIA alone for Parent reports (median 1.25 vs. 1.15, p=0.007). (Table 2) However, there were no differences in the scores of the EYE-Q by child report, RCADS, or PedsQL.
Children with all forms of uveitis (JIA-U and other uveitis types) had worse EYE-Q total scores compared to those with JIA alone by Parent (median 1.25 vs. 1.15, p=0.001) and Child reports (1.29 vs. 1.17, p=0.009). (Table 2) Results were similar when comparing visual function and vision-related QOL sub scores from the EYE-Q. Child reported PedsQL scores in patients with JIA alone were worse than those with uveitis (80.4 vs. 87, p=0.023).
Conclusion: This is one of the first assessments of children with JIA-U to incorporate HRQOL, mental health, visual function, and vision-related QOL. We demonstrate the impact of eye disease as children with uveitis had worse vision-related function and QOL compared to children with JIA, but similar general HRQOL and mental health. Uveitis-specific measures like the EYE-Q may reveal disease-related impairments that affect QOL and are not quantified using general measures. An approach that integrates all aspects of disability should be considered.
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Table 1. Characteristics of Children with Juvenile Idiopathic Arthritis and Uveitis
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N (%), unless indicated
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Overall (N = 79)
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JIAa alone (N = 26)
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JIA-Ub (N = 29)
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Other Uc (N = 24)
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Characteristics
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Demographics
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Age, median (25th, 75th) |
9 (5, 12) |
10 (4, 12) |
9 (3, 11) |
10 (8, 13) |
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Race |
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White |
52 (65.8) |
20 (76.9) |
23 (79.3) |
9 (37.5) |
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African American |
18 (22.8) |
5 (19.2) |
0 (0.0) |
13 (54.2) |
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American Indian/Alaskan Native |
1 (1.3) |
0 (0.0) |
1 (3.5) |
0 (0.0) |
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Asian |
2 (2.5) |
0 (0.0) |
2 (6.9) |
0 (0.0) |
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Multi-racial |
4 (5.1) |
0 (0.0) |
3 (10.3) |
1 (4.2) |
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Unknown/Declined |
2 (2.5) |
1 (3.9) |
0 (0.0) |
1 (4.2) |
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Ethnicity, Non-Hispanic |
68 (88.3) |
22 (88.0) |
25 (86.2) |
21 (91.3) |
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Gender, female |
53 (69.7) |
15 (62.5) |
21 (72.4) |
17 (73.9) |
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Duration of follow up, years, median (25th, 75th) |
9.5 (5.1, 13.0) |
10.1 (4.7, 13.0) |
8.4 (3.6, 11.2) |
10.3 (8.1, 13.7) |
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JIA Characteristics (N = 55)
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Age at Diagnosis, median (25th, 75th) |
4.3 (2.0, 10.6) |
8.7 (2.9, 10.6) |
3.4 (1.8, 9.6) |
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Duration of Disease, years, median (25th, 75th) |
5.0 (2.8, 7.3) |
5.1 (2.9, 6.1) |
4.6 (2.2, 9.0) |
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JIA Subtype |
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Oligoarticular Persistent |
22 (40.0) |
6 (23.1) |
16 (55.2) |
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Oligoarticular Extended |
3 (5.5) |
0 (0.0) |
3 (10.3) |
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Polyarticular RF(-) |
15 (27.3) |
11 (42.3) |
4 (13.8) |
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Uveitis Characteristics (N = 53)
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Age at Diagnosis, median (25th, 75th) |
8.4 (3.8, 10.5) |
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4.2 (3.4, 9.1) |
10.0 (8.7, 12.3) |
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Duration of Disease, years, median (25th, 75th) |
3.7 (2.2, 6.4) |
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4.2 (2.4, 7.3) |
2.7 (1.7, 4.8) |
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Bilateral Disease |
37 (69.8) |
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21 (72.4) |
16 (66.7) |
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Location |
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Anterior |
44 (83.0) |
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28 (96.6) |
16 (66.7) |
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Intermediate |
2 (3.8) |
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0 (0.0) |
2 (8.3) |
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Posterior |
5 (9.4) |
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0 (0.0) |
5 (20.8) |
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Panuveitis |
1 (1.9) |
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0 (0.0) |
1 (4.2) |
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Unknown |
1 (1.9) |
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1 (3.5) |
0 (0.0) |
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Ocular Complications, ever |
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Synechiae |
26 (49.1) |
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10 (34.5) |
16 (66.7) |
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Cataracts |
20 (37.7) |
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11 (37.9) |
9 (37.5) |
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Cystoid Macular Edema |
14 (26.4) |
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5 (17.2) |
9 (37.5) |
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Band Keratopathy |
13 (24.5) |
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7 (24.1) |
6 (25.0) |
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Glaucoma/ocular hypertension |
10 (18.9) |
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4 (13.8) |
6 (25.0) |
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Otherd
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16 (30.2) |
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5 (17.2) |
11 (45.8) |
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Treatment, ever
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Steroid drops |
48 (60.8) |
0 (0.0) |
28 (96.6) |
20 (83.3) |
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Pressure lowering drops |
13 (16.5) |
0 (0.0) |
8 (27.6) |
5 (20.8) |
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Dilating drops |
18 (22.8) |
0 (0.0) |
7 (24.1) |
11 (45.8) |
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Methotrexate oral |
51 (64.6) |
20 (76.9) |
21 (72.4) |
10 (41.7) |
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Methotrexate SQ |
60 (76.0) |
17 (65.4) |
23 (79.3) |
20 (83.3) |
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Mycophenolate |
3 (3.8) |
0 (0.0) |
2 (6.9) |
1 (4.2) |
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Etanercept |
13 (16.5) |
10 (38.5) |
2 (6.9) |
1 (4.2) |
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Infliximab |
20 (25.3) |
1 (3.9) |
10 (34.5) |
9 (37.5) |
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Adalimumab |
28 (35.4) |
6 (23.1) |
15 (51.7) |
7 (29.2) |
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Abatacept |
5 (6.3) |
1 (3.9) |
4 (13.8) |
0 (0.0) |
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Tocilizumab |
1 (1.3) |
1 (3.9) |
0 (0.0) |
0 (0.0) |
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aJIA: juvenile idiopathic arthritis; bJIA-U: JIA-associated uveitis; cOther U: all other uveitis not associated with JIA; d Other complications include: amblyopia, vitreous hemorrhage, optic disc edema, aphakia, choroidal neovascular membranes, choriorential scare, retinal neovascularization, retinal detachment, keratic precipitates, peri retinal fibrosis, floaters, blindness, ocular hypertension
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Table 2. Patient Reported Outcome Measures in Children with Juvenile Idiopathic Arthritis, Juvenile Idiopathic Arthritis Associated Uveitis, and All Uveitis
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Measure Median (IQR)a Range
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JIA (N = 26)
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JIA-U (N = 29)
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All Uveitis JIA-U and other uveitis types (N = 53)
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p-value 1b JIA vs. JIA-U |
p-value 2c JIA vs. All Uveitis |
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EYE-Qd Parent Total (N = 40)
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1.15 (1.04, 1.21) |
1.25 (1.16, 1.52) |
1.25 (1.17, 1.49) |
0.007*
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0.001*
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1.00 – 1.54 |
1.07 – 1.91 |
1.04 – 2.54 |
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Visual Function |
1.00 (1.00, 1.20) |
1.17 (1.00, 1.48) |
1.27 (1.00, 1.47) |
0.056 |
0.007*
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1.00 – 1.60 |
1.00 – 2.29 |
1.00 – 2.80 |
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Vision-related QOL
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1.44 (1.00, 1.44) |
1.44 (1.29, 1.56) |
1.44 (1.29, 1.57) |
0.013*
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0.008*
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1.00 – 1.44 |
1.13 – 1.67 |
1.13 – 2.22 |
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EYE-Qd Child Total (N = 29) |
1.17 (1.14, 1.25) |
1.26 (1.14, 1.46) |
1.29 (1.17, 1.54) |
0.092 |
0.009*
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1.04 – 1.39 |
1.00 – 1.88 |
1.00 – 2.14 |
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Visual Function |
1.07 (1.00, 1.20) |
1.13 (1.00, 1.27) |
1.27 (1.13, 1.53) |
0.174 |
0.025*
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1.00 – 1.46 |
1.00 – 2.00 |
1.00 – 2.38 |
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Vision-related QOL |
1.33 (1.00, 1.44) |
1.44 (1.22, 1.56) |
1.44 (1.33, 1.56) |
0.072 |
0.028*
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1.00 – 1.67 |
1.00 – 1.78 |
1.00 – 2.67 |
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RCADSe Parent Total (N = 24) |
41.9 (36.9, 50.7) |
38.1 (36.5, 55.6) |
39.0 (36.1, 45.9) |
0.582 |
0.347 |
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33.1 – 120.0 |
33.1 – 78.8 |
31.8 – 78.8 |
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RCADSe Child Total (N = 26) |
35.1 (29.8, 38.6) |
34.5 (30.6, 36.8) |
34.5 (30.6, 40.9) |
1.000 |
0.844 |
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26.8 – 54.4 |
28.8 – 71.5 |
24.2 – 71.5 |
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PedsQLf Parent Total (N = 43) |
84.8 (69.6, 100.0) |
79.9 (59.8, 91.3) |
83.7 (68.5, 98.9) |
0.518 |
1.000 |
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51.1 – 100.0 |
34.8 – 100.0 |
34.8 – 100.0 |
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PedsQLf Child Total (N = 36) |
80.4 (63.0, 83.7) |
84.8 (75.0, 92.4) |
87.0 (78.3, 98.9) |
0.222 |
0.023*
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43.5 – 100.0 |
45.7 – 100.0 |
45.7 – 100.0 |
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*p<0.05; a IQR: Interquartile Range; bp-value 1: comparison of JIA and JIA-U; cp-value 2: comparison of JIA and all uveitis; dEYE-Q: Effects of YoungstersÕ Eyesight on Quality of Life, scores range from 0-2, higher scores indicate worse visual function and vision-related QOL; eRCADS: Revised ChildrenÕs Anxiety and Depression Scale, scores ³ 70 indicate clinically significant anxiety and depression; fPedsQL: Pediatric Quality of Life Inventory, scores range from 0-100, higher scores indicate better QOL
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To cite this abstract in AMA style:
McDonald J, Travers C, McCracken C, Yeh S, Rouster-Stevens KA, Vega-Fernandez P, Ramsay E, Prahalad S, Drews-Botsch C, Angeles-Han S. Health-Related Quality of Life, Functioning, and Mental Health of Children with Chronic Non-Infectious Uveitis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/health-related-quality-of-life-functioning-and-mental-health-of-children-with-chronic-non-infectious-uveitis/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/health-related-quality-of-life-functioning-and-mental-health-of-children-with-chronic-non-infectious-uveitis/