Clinical features and characteristics of uveitis associated with juvenile idiopathic arthritis in Japan: first report of the pediatric rheumatology association of Japan (PRAJ)

Junko Yasumura,Fumiya Yamaide,Masaki Shimizu,Yasuo Nakagishi,Yuka Okura,Masato Yashiro,Masao Kobayashi,Kosuke Shabana,Masaaki Mori,Naomi Iwata,Hiroaki Umebayashi,Tomohiro Kubota,Minako Tomiita,Mao Mizuta,Kenichi Nishimura,Hiroyuki Wakiguchi,Ryoki Hara,Takahiro Yasumi,Nami Okamoto

doi:10.1186/s12969-019-0318-5

Abstract

BackgroundAlthough there are many reports on Juvenile Idiopathic arthritis-associated uveitis (JIA-U) from various countries, especially from Europe and North America, there are few reports from Asia. Our aim was to investigate the epidemiology, characteristics and predictors of JIA-U in Japan.MethodsData were retrospectively collected on 726 patients with JIA from medical records as of April 2016 at 15 medical centers specialized in pediatric rheumatic diseases. Of these, patients with uveitis were further investigated for the specific characteristics of this manifestation.ResultsThe prevalence of uveitis was 6.1% in the 726 JIA patients examined. Incidence of uveitis was significantly higher in patients with an earlier arthritis onset (2.6-vs.-5.8 years, P < 0.0001), oligoarthritis (16.1%-vs.-1.6%, P < 0.001), or anti-nuclear antibodies. On the contrary, it was significantly less common in patients with rheumatoid factor or anti-cyclic citrullinated peptide antibodies. A history of using methotrexate (MTX), infliximab or adalimumab was also associated with uveitis occurrence. The median age at uveitis diagnosis was 5 years, and the median time from arthritis onset to uveitis diagnosis was 2 years. The occurrence of anterior and bilateral uveitis was 79.3 and 53.7%, respectively. There were no symptoms at uveitis diagnosis in 58.5% of cases. Complications arising between the time of uveitis diagnosis and the last observation increased from 31.7 to 56.1%; in particular, cataract was increased 3-fold. While no patients lost their vision, 61.9% did not recover normal vision (≥ 1.0), and in many cases active uveitis persisted, especially in males. In addition to steroid eye drops (97.6%) and MTX (15.4%), biological agents were used for treating the uveitis in 41.5% of patients.ConclusionsThe epidemiology, characteristics and predictors of JIA-U in Japan are described here for the first time. Although the prevalence of JIA-U in Japan is lower than in predominantly Caucasian cohorts, as reported from North America and Europe, the epidemiology, characteristics and predictors were found to be similar.

Highlights

There are many reports on Juvenile Idiopathic arthritis-associated uveitis (JIA-U) from various countries, especially from Europe and North America, there are few reports from Asia
Significant differences were noted for infliximab (IFX), adalimumab (ADA), and tocilizumab (TCZ) use: IFX and ADA were more frequently used in the uveitis group, whereas TCZ was more frequently used by patients without uveitis
We investigated whether the prevalence and characteristics of juvenile idiopathic arthritis (JIA)-U in Japan are different from those reported elsewhere

Summary

Introduction

There are many reports on Juvenile Idiopathic arthritis-associated uveitis (JIA-U) from various countries, especially from Europe and North America, there are few reports from Asia. Numerous reports have identified risk factors for JIA-U such as female sex, oligoarthritis, earlier arthritis onset, ANA-positivity, and RF-negativity in predominantly Caucasian cohorts [2, 7, 8]. Do these characteristics apply to JIA-U in East Asia? The members of the Pediatric Rheumatology Association of Japan (PRAJ), issued recommendations for ophthalmologic screening intervals for JIA patients in Japan [9, 10] (Table 1), these were based on other countries’ guidelines [2, 11]. We reviewed the charts of outpatients making regular hospital visits as of April 2016

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