Factors related to severe uveitis at diagnosis in children with juvenile idiopathic arthritis in a screening program

Abstract

Purpose To identify factors associated with severe uveitis at diagnosis of eye disease in children with juvenile idiopathic arthritis (JIA) who were observed in a screening program, and to identify temporal changes in findings associated with screening during the period 1986 to 2000. Design Case control study. Methods Uveitis was defined as being severe at diagnosis if there were associated synechiae, cataracts, or retinal edema. Clinical factors for all patients undergoing screening for JIA-associated uveitis from 1986 to 2000 at one institution were studied retrospectively. Children with severe uveitis at diagnosis (cases) were compared with those with mild uveitis at diagnosis and those who never developed uveitis during follow-up in the screening program (controls). Results Severe uveitis was present at diagnosis in 22 (5.4%) of 409 patients. Male patients were more likely to have severe uveitis at diagnosis (odds ratio [OR] 3.7 [95% confidence interval 1.3 to 10.7], P = .014). A longer interval from the onset of arthritis symptoms to the diagnosis of uveitis was associated with a reduced risk of severe uveitis at diagnosis (OR 0.95 [0.91 to 1.0], P = .044). There was no difference in the frequency of severe uveitis at diagnosis between two screening periods: 1986 to 1993 (before American screening guidelines were published) and 1994 to 2000. Conclusions Male children are more likely than female children to have severe uveitis at diagnosis. The proportion of children with severe uveitis at diagnosis has not changed since current screening guidelines have been widely publicized, suggesting the need for refinements in screening procedures to target high-risk children with increased surveillance.