Pediatric Onset (< 16 Years) Non-infectious Uveitis: Results from Spanish National Registry

Pablo Mesa-del-Castillo B.¹, Ines Yago Ugarte¹, jose Miguel Bolarin², Berta Lopez Montesinos³, Honorio Barranco Gonzalez³, Daniel Clemente⁴, Isabel Valls Ferran⁴, Juan Carlos Lopez Robledillo⁴, Beatriz Bravo⁵, Marina Rubio Prats⁵, Carmen Alba Linero⁶, Laura Martin Pedraz⁶, Esmeralda Nuñez Cuadros⁶, Maria Concepción Mir Perelló⁷, Noelia Druetta⁷, Mari Carmen Pinedo Gago⁸, Alex Fonollosa Calduch⁸, Alex Souto⁹, Fernando Lopez Lopez¹⁰, Cristina Zarallo Reales¹¹, Maria Jerez Fidalgo¹¹, Jorge Solana Fajardo¹¹, NATALIA PALMOU FONTANA¹², Rosalía Demetrio-Pablo¹³, Maria Vega Jovani Casano¹⁴, Jose Juan Mondejar Garcia¹⁵, Anahy Maria Brandy-Garcia¹⁶, Alba Garcia Lopez¹⁷, Belen Sevilla¹⁸, Jose Luis Garcia Serrano¹⁹, Alfredo Tagarro²⁰, Mar Esteban²⁰, Joan Calzada²¹, Jesus Diaz Carrascosa²¹, Cesar Gavilan Martin²², Encarna Mengual Verdu²², Ester Carreño Salas²³, Sheila Recuero Diaz²³, Neus Quilis Marti²⁴, Mari Carmen Alvarado Valero²⁵, José Rosas²⁶, Juan Luis Sanchez Sevilla²⁷, Juan Carlos Nieto²⁸, Lucia Ibares²⁸, Jaime De Inocencio²⁹, Pilar Tejada²⁹ and Almudena Roman Pascual³⁰, ¹Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain, ²CENTIC (Centro tecnológico de las TICs de Murcia), Murcia, Spain, ³Hospital Universitari i Politècnic La Fe, Valencia, Spain, ⁴Hospital Infantil Universitario Niño Jesús, Madrid, Spain, ⁵Hospital Universitario Virgen de las Nieves, Granada, Spain, ⁶Hospital Universitario Regional de Málaga, Malaga, Spain, ⁷Hospital Universitari Son Espases, Palma de Mallorca, Spain, ⁸Hospital Universitario de Cruces, Bilbao, Spain, ⁹Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain, ¹⁰Hospital Clínico Universitario de Santiago, Santiago de Compostela, South Georgia & South Sandwich Islands, ¹¹Hospital Universitario de Badajoz, Badajoz, Spain, ¹²UNIVERSITARY HOSPITAL MARQUES VALDECILLA, Santander, Spain, ¹³Hospital Universitario de Marqués de Valdecilla, Santander, Spain, ¹⁴National Health system, Alicante, Spain, ¹⁵Hospital General Universitario de Alicante, Alicante, Spain, ¹⁶Hospital Germans Trias i Pujol, Badalona, Spain, ¹⁷Hospital Universitario de Cabueñes, Gijón, Spain, ¹⁸Division of Paediatrics, Hospital Universitario San Cecilio, Granada, Spain, ¹⁹Hospital Universitario Clínico San Cecilio, Granada, ²⁰Hospital Universitario Infanta Sofía, Madrid, Spain, ²¹Hospital maternoinfantil Sant Joan de Déu, Barcelona, Spain, ²²Hospital Universitario San Juan de Alicante, Alicante, Spain, ²³Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain, ²⁴Hospital del Vinalopó, Elche, Spain, ²⁵Hospital del Vinalopó, Elche, ²⁶Hospital Marina Baixa, Villajoyosa, ²⁷Hospital Marina Baixa, Villajoyosa, Spain, ²⁸Hospital General Universitario Gregorio Marañón, Madrid, Spain, ²⁹Hospital Universitario 12 de Octubre, Madrid, Spain, ³⁰Hospital Universitario Rey Juan Carlos, Madrid, Spain

Meeting: ACR Convergence 2021

Keywords: Eye Disorders, Juvenile idiopathic arthritis, Pediatric rheumatology

Session Information

Date: Tuesday, November 9, 2021

Title: Pediatric Rheumatology – Clinical Poster III: Miscellaneous Rheumatic Disease (1614–1644)

Session Type: Poster Session D

Session Time: 8:30AM-10:30AM

Background/Purpose: Pediatric noninfectious uveitis is a major clinical challenge for Pediatric ophthalmologists and rheumatologists. The burden of disease is considerable and etiological diagnosis elusive in many cases. Uveitis outcomes have improved dramatically with antirheumatic drugs, especially anti TNFα agents.

Methods: A multicenter cross sectional and retrospective cohort study was conducted from october 2019 to march 2021. Multidisciplinary participation was mandatory for joining the study; to ensure homogeneity data of associated systemic disease and disease modifying antirheumatic drug (DMARD) therapy were provided by rheumatologist and ophthalmology related data were introduced by ophthalmologist, in a web based form. Only patients with uveitis onset before 16th birthday and complete data were included in the analysis. Three distinct groups were made for comparison: Juvenile Idiopathic Arthritis related uveitis (JIAu), Idiopathic childhood uveitis (ICU) and Pars Planitis (PP).

Results: A total of 501 patients from 22 centers were included in the analysis, 310 (61.9 %) with an associated immune disease, 91 (18.2%) with an ophthalmologically distinguishable uveitis and 100 (20%) idiopathic. JIAu accounted for 54.8 % (275), 259 (51.6%) non B27 related; 67 patients (13.3%) had PP. JIAu was significantly associated with female gender, younger age at uveitis onset, ANA positive, anterior location and insidious presentation, with less ocular complications, systemic corticoid use and ocular surgeries. DMARD exposure was more prolonged, started earlier after uveitis onset and had less unilateral severe visual loss. ICU tended to present as panuveitis and was associated with male gender, older age at onset, ANA negative, acute presentation and acute clinical course. Ocular complications were higher, mainly synechiae at onset and cataracts. Exposure to DMARD was significantly lower for both synthetic and biologic agents. PP showed the highest complication rate within groups (71.6%), especially cataracts during follow up and greater tendency to present vitreoretinal complications (macular edema, epiretinal membrane and retinoschisis), requiring ocular surgery more frequently. PP patients also received more systemic steroids, showing no difference in regards to DMARD use.

Conclusion: We present a large cohort of childhood onset not infectious uveitis. Homogeneity of data was cared for with a multidisciplinary approach, but case selection bias may have occurred as participation and case selection was voluntary. Our data suggest that differences in outcome may correspond partially to differences in treatment approach depending on the aetiology or diagnosis associated with the ocular inflammatory disease. Surprisingly, JIAu patients showed the best prognosis despite its chronicity in comparison with the other groups, traditionally considered mild self-limited diseases. Awareness of ophthalmologists and rheumatologists on these observations could ameliorate the burden of disease by inducing rheumatology referral for early treatment.

Table 1. Demographic and clinical data.

Table 2. Ocular complications, surgery and poor visual outcome.

Table 3. Treatment.

Disclosures: P. Mesa-del-Castillo B., Pfizer, 6, Abvvie, 6; I. Yago Ugarte, None; j. Bolarin, None; B. Lopez Montesinos, None; H. Barranco Gonzalez, None; D. Clemente, Pfizer, 6, Roche, 6, Lilly, 5, Sanofi, 5; I. Valls Ferran, None; J. Lopez Robledillo, None; B. Bravo, None; M. Rubio Prats, None; C. Alba Linero, None; L. Martin Pedraz, None; E. Nuñez Cuadros, None; M. Mir Perelló, None; N. Druetta, None; M. Pinedo Gago, None; A. Fonollosa Calduch, None; A. Souto, None; F. Lopez Lopez, Essilor España, 7, Sociedad Española Inflamación Ocular, 6; C. Zarallo Reales, None; M. Jerez Fidalgo, None; J. Solana Fajardo, None; N. PALMOU FONTANA, Novartis, 5, GSK, 6, Amgen, 6, Sanofi, 6; R. Demetrio-Pablo, None; M. Jovani Casano, None; J. Mondejar Garcia, None; A. Brandy-Garcia, None; A. Garcia Lopez, None; B. Sevilla, None; J. Garcia Serrano, None; A. Tagarro, None; M. Esteban, None; J. Calzada, None; J. Diaz Carrascosa, None; C. Gavilan Martin, None; E. Mengual Verdu, None; E. Carreño Salas, Abbvie, 6, Brill, 6, Eyevensis, 1, Allimera, 2; S. Recuero Diaz, None; N. Quilis Marti, None; M. Alvarado Valero, None; J. Rosas, None; J. Sanchez Sevilla, None; J. Nieto, None; L. Ibares, None; J. De Inocencio, None; P. Tejada, None; A. Roman Pascual, None.

To cite this abstract in AMA style:

Mesa-del-Castillo B. P, Yago Ugarte I, Bolarin j, Lopez Montesinos B, Barranco Gonzalez H, Clemente D, Valls Ferran I, Lopez Robledillo J, Bravo B, Rubio Prats M, Alba Linero C, Martin Pedraz L, Nuñez Cuadros E, Mir Perelló M, Druetta N, Pinedo Gago M, Fonollosa Calduch A, Souto A, Lopez Lopez F, Zarallo Reales C, Jerez Fidalgo M, Solana Fajardo J, PALMOU FONTANA N, Demetrio-Pablo R, Jovani Casano M, Mondejar Garcia J, Brandy-Garcia A, Garcia Lopez A, Sevilla B, Garcia Serrano J, Tagarro A, Esteban M, Calzada J, Diaz Carrascosa J, Gavilan Martin C, Mengual Verdu E, Carreño Salas E, Recuero Diaz S, Quilis Marti N, Alvarado Valero M, Rosas J, Sanchez Sevilla J, Nieto J, Ibares L, De Inocencio J, Tejada P, Roman Pascual A. Pediatric Onset (< 16 Years) Non-infectious Uveitis: Results from Spanish National Registry [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/pediatric-onset-16-years-non-infectious-uveitis-results-from-spanish-national-registry/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/pediatric-onset-16-years-non-infectious-uveitis-results-from-spanish-national-registry/