AB1072 UVEITIS IN PEDIATRIC RHEUMATOLOGY: TERTIARY CENTER EXPERIENCE IN TURKEY

Abstract

Background Since pediatric uveitis is generally asymptomatic, the diagnosis and treatment may be mostly delayed. Severe complications and visual loss may be observed even at the initial visit. Pediatric uveitis is tend to be chronic, persistent, recurrent, and the management may be complex (1). Objectives The aim of this study is to report epidemiology, etiology, clinical features, management and the outcomes of non infectious pediatric uveitis at a tertiary pediatric rheumatology center in Turkey. Methods The clinical records of the patients with non infectious uveitis who were followed up by department of pediatric rheumatology and ophtalmology were reviewed, from January 2013 to June 2018, retrospectively. The inclusion criteria were as follows being age ≤ 16 years, following up at least 6 months in both the ophtalmology and pediatric rheumatology clinics. Uveitis was categorized anatomically according to the Standardization of Uveitis Nomenclature criteria (2). Results Of 37 patients (67 eyes), 45,9% were female. Mean age of onset was 8, 5 ± 4, 4 years (1,6 - 15,6), mean follow-up was 60 ± 42 months (6 - 191). The general features of uveitis were anterior, idiopathic and bilateral in this study similar to literature (Table 1).The most common systemic diseases associated with uveitis were juvenile idiopathic arthritis (JIA).Two patients improved with local medications, while the remaining 35 patients required systemic treatments such as short-time (oral/iv) corticosteroids (CS) in 94.5% of them, methotrexate (MTX) in 86.4%, azathioprine (AZA) in 5.4%, adalimumab (ADA) in 67.5%, tocilizumab (TCB) in 2.7%. In 26.1% of patients receiving ADA who did not respond to standard dose of ADA, we had to shorten the dosage intervals of ADA from every 2 weeks to every week. At least 1 ocular complication was observed in 83.7% of the patients, such as cataract, glaucoma, band keratopathy, synechiae, macular edema and retinal detachment. Four (10.8%) patients had moderate visual loss and 6 (16.2%) patients severe visual loss (3). The prevalence of surgery in our study was 18.9% for cataract and glaucoma treatment. Conclusion Diagnosis and management of uveitis in childhood is complicated. Despite the new medication options, the advancements in diagnosis and surgical techniques, the complications are still high. Usage of shorter dose interval of ADA may be an alternative to control of the disease in patients with unresponsive to standard dosage of ADA. However large-scale clinical trials are required to assess the efficacy and safety of this treatment.