Uveitis in Juvenile Idiopathic Arthritis: 18-Year Outcome in the Population-based Nordic Cohort Study.

Autor:	Rypdal V; Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway. Electronic address: veronika.rypdal@unn.no., Glerup M; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark., Songstad NT; Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway., Bertelsen G; Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway., Christoffersen T; Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway., Arnstad ED; Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway., Aalto K; Department of Pediatrics, University of Helsinki, Helsinki, Finland., Berntson L; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden., Fasth A; Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Herlin T; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark., Ekelund M; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Ryhov County Hospital, Jonkoping, Sweden., Peltoniemi S; Department of Pediatrics, University of Helsinki, Helsinki, Finland., Toftedal P; Department of Pediatrics, Rigshospitalet University Hospital, Copenhagen, Denmark., Nielsen S; Department of Pediatrics, Rigshospitalet University Hospital, Copenhagen, Denmark., Leinonen S; Department of Ophthalmology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland., Bangsgaard R; Department of Ophthalmology, Rigshospitalet University Hospital, Copenhagen, Denmark., Nielsen R; Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark., Rygg M; Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway., Nordal E; Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
Jazyk:	angličtina
Zdroj:	Ophthalmology [Ophthalmology] 2021 Apr; Vol. 128 (4), pp. 598-608. Date of Electronic Publication: 2020 Aug 29.
DOI:	10.1016/j.ophtha.2020.08.024
Abstrakt:	Purpose: To assess the long-term outcome of uveitis in juvenile idiopathic arthritis (JIA). Design: Population-based, multicenter, prospective JIA cohort, with a cross-sectional assessment of JIA-associated uveitis (JIA-U) 18 years after the onset of JIA. Participants: A total of 434 patients with JIA, of whom 96 had uveitis, from defined geographic areas of Denmark, Finland, Norway, and Sweden. Methods: Patients with onset of JIA between January 1997 and June 2000 were prospectively followed for 18 years. Pediatric rheumatologists and ophthalmologists collected clinical and laboratory data. Main Outcome Measures: Cumulative incidence of uveitis and clinical characteristics, JIA and uveitis disease activity, ocular complications, visual outcome, and risk factors associated with the development of uveitis-related complications. Results: Uveitis developed in 96 (22.1%) of 434 patients with JIA. In 12 patients (2.8%), uveitis was diagnosed between 8 and 18 years of follow-up. Systemic immunosuppressive medication was more common among patients with uveitis (47/96 [49.0%]) compared with patients without uveitis (78/338 [23.1%]). Active uveitis was present in 19 of 78 patients (24.4%) at the 18-year visit. Ocular complications occurred in 31 of 80 patients (38.8%). Short duration between the onset of JIA and the diagnosis of uveitis was a risk factor for developing ocular complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8). Patients with a diagnosis of uveitis before the onset of JIA all developed cataract and had an OR for development of glaucoma of 31.5 (95% CI, 3.6-274). Presence of antinuclear antibodies (ANAs) was also a risk factor for developing 1 or more ocular complications (OR, 3.0; 95% CI, 1.2-7.7). Decreased visual acuity (VA) <6/12 was found in 12 of 135 eyes (8.9%) with uveitis, and 4 of 80 patients (5.0%) with JIA-U had binocular decreased VA <6/12. Conclusions: Our results suggest that uveitis screening should start immediately when the diagnosis of JIA is suspected or confirmed and be continued for more than 8 years after the diagnosis of JIA. Timely systemic immunosuppressive treatment in patients with a high risk of developing ocular complications must be considered early in the disease course to gain rapid control of ocular inflammation. (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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