Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Juvenile idiopathic arthritis-associated uveitis (JIA-U) can lead to poor visual outcomes. American Academy of Pediatric guidelines recommend screening every 3 months in children with oligoarticular (oligo) or polyarticular (poly) rheumatoid factor (RF) (-) subtype, ANA positivity, <4 years of arthritis, and onset <7 years old. Identification of other risk markers could help modify current screening and improve outcomes.
Methods
In our prospective cohort of 250 JIA patients, rheumatology and ophthalmology medical record reviews and parent/patient based questionnaires were completed every 3-6 months (2011-2014). We collected data on demographics, arthritis and uveitis, and quality of life/function. We compared children with JIA and JIA-U, and African American (AA) and Caucasians (W) with uveitis.
Results
Our cohort was primarily W females with oligo persistent and poly RF (-) JIA. There were 45/250 (18%) with uveitis of whom 15.6% were AA (Table 1). Compared to JIA alone, JIA-U were more frequently of the oligo persistent JIA subtype (p = <0.001), younger at arthritis diagnosis (p = <0.001), ANA positive (p = 0.029), anti-CCP negative (p = 0.018) and had reduced vision related quality of life and function (p = < 0.001). No children with JIA-U had psoriatic (p = 0.030), systemic (p=0.029) or poly RF (+) (p=0.133) JIA.
On regression analysis, young age at diagnosis (OR = 0.88, (95% CI 0.81-0.98), p <0.001) and oligo persistent JIA (OR 3.15, (95% CI 1.42-6.98), p = 0.011) were predictors for uveitis. AA race approached significance (OR = 2.56, (95% CI = 0.93-7.02), p = 0.068). ANA was not significant after adjustment.
Comparing JIA-U by race, there were fewer AA children then W overall (7/40 (17.5%) vs. 33/40 (82%)) (Table 2). However, there was no significant difference in the frequency of uveitis between AA and W (7/33 (21%) vs. 33/190 (17%), p=0.624). They were similar in age at arthritis diagnosis, JIA subtype, ANA positivity, arthritis characteristics, and treatment. AA were older at uveitis diagnosis (p = 0.018) with more ocular complications –synechiae (p<0.027) and band keratopathy (p<0.011).
Conclusion
In our cohort, uveitis was less frequent in AA children overall. However, we found a similar likelihood of uveitis in AA compared to W (21% vs 17%). AA were older when diagnosed and suffered more ocular complications. We also confirmed known uveitis risk factors (young age at JIA diagnosis and JIA subtype). Further investigation into the role of race should be conducted as uveitis may be more common in AA but diagnosed later leading to increased visual complications, or may be more severe in AA.
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Table 1. Characteristics of children with JIA and JIA-associated uveitis
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Characteristics N (%)1 |
Group |
p-value |
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|
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JIA N=205 |
JIA-U N=45 |
|
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Demographics |
|
|
|
|
Age (yrs), Mean ± SD |
11.1 ± 4.6 |
9.6 ± 4.9 |
0.053 |
|
Gender, female |
144 (70.2%) |
35 (77.8%) |
0.310 |
|
Hispanic |
16 (7.8%) |
7 (15.6%) |
0.104 |
|
Race |
|
|
|
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Caucasian |
157 (76.6%) |
33 (73.3%) |
0.582 |
|
African American |
26 (12.7%) |
7 (15.6%) |
0.219 |
|
Other |
22 (10.7%) |
5 (11.1%) |
0.465 |
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Disease Characteristics |
|
|
|
|
Age at arthritis diagnosis (yrs), Mean ± SD |
8.1 ± 4.7 |
5.0 ± 4.9 |
<0.001* |
|
Duration of JIA (yrs), Mean ± SD |
2.9 ± 3.1 |
4.6 ± 4.0 |
0.012* |
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JIA subtype |
|
|
|
|
Oligoarticular persistent |
65 (31.7%) |
31 (68.9%) |
< 0.001* |
|
Oligoarticular extended |
12 (5.9%) |
2 (4.4%) |
0.754 |
|
Polyarticular RF (-) |
55 (26.8%) |
6 (13.3%) |
0.056 |
|
Polyarticular RF (+) |
13 (6.2%) |
0 (0.0%) |
0.133 |
|
Systemic |
20 (9.8%) |
0 (0.0%) |
0.029* |
|
Psoriatic |
10 (4.9%) |
0 (0.0% |
0.030* |
|
Enthesitis related arthritis |
27 (13.2%) |
4 (8.9%) |
0.4300 |
|
Undifferentiated |
2 (1.0%) |
0 (0.0%) |
1.00 |
|
Labs |
|
|
|
|
ANA (+) |
74 (37.8%) |
24 (55.8%) |
0.029* |
|
RF (+) |
26 (12.7%) |
1 (2.2%) |
0.059 |
|
Anti-CCP (+) |
23 (11.3%) |
0 (0.0%) |
0.018* |
|
HLA-B27 (+) |
20 (14.3%) |
5 (17.9%) |
0.771 |
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Quality of Life/Function scores (child) 2 |
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PedsQL3 (Total), Mean ± SD |
76.4 ± 19.1 |
76.5 ± 20.5 |
0.982 |
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PedsQL3 (Psychosocial), Mean ± SD |
77.8 ± 16.11 |
75.0 ± 16.4 |
0.325 |
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CHAQ4, Mean ± SD |
0.44 ± 0.46 |
0.43 ± 0.53 |
0.907 |
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EYE-Q5, Mean ± SD |
3.60 ± 0.37 |
3.32 ± 0.41 |
< 0.001* |
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Quality of Life/Function scores (parent) 2 |
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PedsQL3 (Total), Mean ± SD |
73.9 ± 20.7 |
78.8 ± 18.6 |
0.154 |
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PedsQL3 (Psychosocial), Mean ± SD |
79.4 ± 16.3 |
80.3 ± 16.7 |
0.746 |
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CHAQ4, Mean ± SD |
0.43 ± 0.45 |
0.35 ± 0.48 |
0.266 |
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EYE-Q5, Mean ± SD |
3.70 ± 0.28 |
3.41 ± 0.41 |
< 0.001* |
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1N(%) unless otherwise specified; 2Indicates missing data; 3Pediatric Quality of Life Inventory; 4Childhood Health Assessment Questionnaire; 5Effects of Youngsters’ Eyesight on Quality of Life *p value <0.05
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Table 2. Comparison of Caucasian and African American children with JIA-associated uveitis
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Characteristics N (%)1 |
Group |
p-value |
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Caucasian (n =33) |
(African American n = 7) |
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Demographics |
|
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Age, Mean ± SD |
8.7 ± 4.1 |
13.5 ± 5.4 |
0.011* |
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Gender, female |
26 (78.8%) |
4 (57.1%) |
0.338 |
|
Hispanic |
6 (18.2%) |
0 (0.0%) |
0.103 |
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Arthritis Disease Characteristics |
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|
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Age at arthritis diagnosis (yrs), Mean ± SD |
4.4 ± 4.1 |
9.6 ± 7.6 |
0.169 |
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Duration of JIA (yrs), Mean ± SD |
4.5 ± 3.5 |
4.2 ± 5.7 |
0.916 |
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JIA subtype |
|
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Oligo persistent |
24 (72.7%) |
3 (42.9%) |
0.187 |
|
Oligo extended |
1 (3.1%) |
0 (0.0%) |
1.000 |
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Poly RF (-) |
4 (12.1)%) |
2 (28.6%) |
0.567 |
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ERA |
3 (9.1%) |
1 (14.3%) |
1.000 |
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Uveitis Disease Characteristics |
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Age at uveitis diagnosis (yrs), Mean ± SD |
5.6 ± 3.9 |
9.9 ± 4.9 |
0.018* |
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Anterior Location |
27 (81.2%) |
5 (83.3%) |
0.611 |
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Bilateral involvement |
24 (72.7%) |
4 (66.7%) |
0.410 |
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Complications |
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Cataracts |
8 (24.2%) |
3 (42.9%) |
0.369 |
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Glaucoma |
2 (6.1%) |
0 (0%) |
1.000 |
|
Synechiae |
8 (24.2%) |
5 (71.4%) |
0.027* |
|
Band keratopathy |
4 (57.1%) |
3 (9.1%) |
0.011* |
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Cystoid macular edema |
2 (6.1%) |
2 (28.6%) |
0.134 |
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Labs |
|
|
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ANA (+) |
18 (58.1%) |
4 (50.0%) |
1.000 |
|
HLA-B27 (+) |
5 (23.8%) |
0 (0.0%) |
0.545 |
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Medication use |
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|
|
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Methotrexate all routes |
28 (84.5% |
5 (71.4%) |
0.584 |
|
Oral |
21 (63.6%) |
5 (71.4%) |
1.00 |
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Subcutaneous injection |
24 (72.7%) |
5 (71.4%) |
1.00 |
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Anti-TNF Use |
15 (45.5%) |
4 (57.1%) |
0.689 |
|
Infliximab |
10 (30.3%) |
3 (42.9%) |
0.662 |
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Adalimumab |
2 (6.1%) |
1 (14.3%) |
0.448 |
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Quality of Life/Function scores (child) 2 |
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PEDSQL3 (Total), Mean ± SD |
74.0 ± 16.5 |
78.7 ± 15.1 |
0.490 |
|
PEDSQL3 (Psychosocial), Mean ± SD |
73.1 ± 16.7 |
78.7 ± 15.1 |
0.405 |
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CHAQ4, Mean ± SD |
0.45 ± 0.52 |
0.38 ± 0.62 |
0.790 |
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EYE-Q5, Mean ± SD |
3.33 ± 0.34 |
3.44 ± 0.63 |
0.741 |
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Quality of Life/Function scores (parent) 2 |
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PEDSQL3 (Total), Mean ± SD |
79.2 ± 17.3 |
77.4 ± 16.9 |
0.804 |
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PEDSQL3 (Psychosocial), Mean ± SD |
79.9 ± 18.1 |
77.6 ± 14.9 |
0.753 |
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CHAQ4, Mean ± SD |
0.36 ± 0.46 |
0.43 ± 0.71 |
0.817 |
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EYE-Q5, Mean ± SD |
3.42 ± 0.34 |
3.23 ± 0.71 |
0.512 |
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1N(%) unless otherwise specified; 2Indicates missing data; 3Pediatric Quality of Life Inventory; 4Childhood Health Assessment Questionnaire; 5Effects of Youngsters’ Eyesight on Quality of Life *p value <0.05
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Disclosure:
S. T. Angeles-Han,
None;
C. McCracken,
None;
S. Yeh,
None;
K. Jenkins,
None;
E. Myoung,
None;
D. Stryker,
None;
K. A. Rouster-Stevens,
None;
L. B. Vogler,
None;
C. Kennedy,
None;
S. Prahalad,
None;
C. Drews-Botsch,
None.
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