A case note review of uveitis screening of children diagnosed with juvenile idiopathic arthritis

Abstract

Introduction The prevalence of uveitis in juvenile idiopathic arthritis (JIA) overall is approximately 8–30%, but in young oligoarticular onset group it may be as high as 45–57%. The annual incidence of JIA in the UK is 1:10 000 with a prevalence of 1:1000. The uveitis in JIA is asymptomatic and therefore screening by slit-lamp is essential for diagnosis. Early detection and treatment can prevent the development of complications and can prevent permanent visual impairment. These complications are more frequent and more severe in younger children and are often asymptomatic. British Society for Paediatric and Adolescent Rheumatology and the RCPOphth guideline recommends that, the initial screening examination should occur as soon as possible and no later than 6 weeks from referral. Patients with symptoms or patients suspected of cataracts or synechiae should be seen within a week of referral. Aim To review the referral pattern of children diagnosed with JIA to ophthalmology clinic for uveitis screening and compare it with BSPAR standards Methods A retrospective case note review was performed for 22 patients with JIA attending rheumatology clinic at local district general hospital. Data were collected by reviewing the clinic letters using a proforma for data collection. Results A total of 22 case notes where reviewed. 12 patients were females and 10 males. Diagnoses included six polyarthritis, six oligoarthritis, four enthesitis related arthritis, three psoariatic arthritis, one systemic onset arthritis, two others. Of 22 patients audited 20 patients had uveitis screen, one was never referred and another awaiting to be seen on the date of audit. None of the patients screened had Uveitis. 17 out of 21 patients were referred within 7 days of diagnosis. Number of days from diagnosis to first seen in ophthalmology clinic ranged from 35 to 298 days with a mean of 70.5 days. Out of 20 patients referred to ophthalmology, only two were seen within 6 weeks, thus failing to achieve BSPAR standard. Conclusion Majority of the patients though diagnosed with JIA on the first appointment in rheumatology clinic, experienced delay in being seen in ophthalmology clinic, a few of them had inordinate delay.