Background/Purpose: Uveitis is the most common extra-articular complication of juvenile Idiopathic arthritis (JIA). Due to its typical indolent and chronic course, children with this condition are at risk for ocular morbidity with a significant impact on their quality of life. The aim of this study is to describe demographic and clinical features, treatment approaches and outcome of a population of patients with JIA-associated uveitis.

Methods: Charts of patients with JIA-associated uveitis, followed in two tertiary Pediatric Rheumatology Centres were retrospectively reviewed with regard to clinical features, therapeutic choices and outcome

Results: Data from 162 JIA patients with uveitis were analysed (81.5% female), with a mean follow up of 8.9 years (SD ± 2.56). Mean age at JIA onset was 3.6 years (SD± 3.1) and the mean JIA duration at uveitis onset was 2.5 years (SD ± 4.3). Uveitis was diagnosed at JIA onset in 9.9% of patients. The most frequent JIA category was oligoarthritis (88.9%), which was persistent in 72.8% of cases, followed by RF- polyarthritis (9.3%). No systemic JIA was reported. Uveitis was predominantly anterior (96.9%), and reported bilateral in 65.4% of cases. In almost all patients (87.6%) antinuclear antibodies (ANA) were positive. Systemic medications were required in 134 (82.7 %) patients. Methotrexate and cyclosporine were used in 66.0% and 7.4% of cases, respectively, while 86 patients (53.1%) required biologic therapy, mainly adalimumab (34.6%), followed by infliximab (10.5%) and tocilizumab (3.7%). In 28.4% of cases more than 1 biologic was needed.  Mean recurrence rate in our cohort was 1.3 per year (SD ±1.1). In 79 patients (49.8%) uveitis was complicated by ocular damage, which is summarized in Table 1. A best-corrected visual acuity (BCVA) ≤ 0.4 and ≤ 0.1 were observed in 14.2% and 10.5% of patients, respectively.

Table 1. Ocular damage in the cohort (total JIA patients with uveitis, n = 162)

Conclusion: Despite continue improvement in JIA therapeutic options, uveitis remains a complication with high morbidity. Clinical predictors and biomarkers are needed to identify patients at higher risk of unfavourable outcome. Careful monitoring and follow-up are crucial for timely detection of ocular inflammation and prevention of damage.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/morbidity-of-jia-associated-uveitis-half-of-patients-despite-systemic-treatment-still-show-ocular-damage-during-a-long-term-follow-up/