Background/Purpose: The Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh Out) cohort is a multi-centre prospective inception cohort of newly diagnosed Juvenile Idiopathic Arthritis (JIA) patients. From our analysis of JIA associated new onset uveitis, we reported the first true incidence of uveitis of 2.9% per year and prevalence of 6.9%, the latter considerably lower than previously reported. We identified a positive ANA and young age at diagnosis of JIA (< 7 years) as independent risk factors for uveitis. In this study, we examined the association between medications, uveitis and these independent risk factors.

Objectives:  1) to assess medications administered prior to uveitis and after diagnosis 2) to determine the association between the independent risk factors for uveitis and specific medication use and 3) their association with asymptomatic versus symptomatic presentation.

Methods: The ReACCh Out cohort recruited newly diagnosed JIA patients from 16 Canadian centres between January 2005 and December 2010. Prospective data was collected every 6 months for 2 years, then yearly. Clinical and laboratory data, medications, the presence of uveitis and complications determined by an ophthalmologist, was documented at each visit. Descriptive statistics characterize the uveitis cohort and frequencies were obtained for the medications used. We calculated the relative risk for certain medications, controlled for by the presence or absence of independent risk factors.

Results: 1104 newly diagnosed (≤ 6 months) JIA patients with ≥1 follow-up visit were included. Patients were predominantly female (63%), median age at diagnosis of 9.3 (3.9, 13.0) years. Time from diagnosis to enrollment was 0.3 (0, 1.6) months. Follow-up to last visit was 34.2 (21.5, 48) months. 23 patients, uveitis status not available, were excluded. 77 patients with new onset uveitis were identified. Patients were on the following systemic medications prior to uveitis diagnosis:  NSAIDs (71; 92.2%), Methotrexate (34; 44.2%), other DMARDs (7; 9.1%), systemic glucocorticoids (20; 26%), biologics (12; 15.6%). Following diagnosis:  NSAIDs (45; 58.4%), Methotrexate (56; 72.7%), other DMARDs (10; 13%), systemic glucocorticoids (23; 30%), biologics (11; 14.3%).

58 (75.3%) patients had asymptomatic uveitis:  43 (74.1%) ANA positive compared to 13 (22.4%) ANA negative. ANA positive uveitis patients were 2.48 and 1.10 times more likely to be placed on methotrexate and biologics respectively, compared to those who were ANA negative. 52 (90%) of the asymptomatic uveitis patients were < 7 years old, compared to 6 (10%) of patients ≥ 7 years old and were 1.29 and 1.32 times more likely to be on methotrexate and biologics respectively, compared to the older group.

Conclusion: In a large inception cohort of newly diagnosed JIA patients followed prospectively, we evaluated medications administered prior to and after the diagnosis, uveitis presentation and independent risk factors for uveitis. The majority of ANA positive patients and of a younger age (< 7 years) at diagnosis of JIA, presented with asymptomatic uveitis, highlighting the important role of these independent risk factors for uveitis screening.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-research-in-arthritis-in-canadian-children-emphasizing-outcomes-reacch-out-cohort-independent-risk-factors-and-medication-use-in-new-onset-uveitis-in-juvenile-idiopathic-arthritis/