Abstract
BackgroundThe incidence of uveitis associated with juvenile idiopathic arthritis (JIA) varies around the world. Our aim was to investigate the incidence and predictors of uveitis in a Nordic population-based cohort.MethodsConsecutive JIA cases from defined geographical areas in Denmark, Finland, Sweden and Norway with disease onset between January 1997 to June 2000 were followed for median 98 months in this prospective longitudinal cohort study. Potential clinical and immunological predictors of uveitis were identified with logistic regression analysis.ResultsUveitis occurred in 89 (20.5%) of the 435 children with regular ophtalmologic follow-up among the 500 included. Chronic asymptomatic uveitis developed in 80 and acute symptomatic uveitis in 9 children. Uveitis developed at a median interval of 0.8 (range − 4.7 to 9.4) years after onset of arthritis. Predictors of uveitis were age < 7 years at JIA onset (Odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3 to 3.5), presence of antihistone antibodies (AHA) > 15 U/ml (OR 4.8 (1.8 to 13.4)) and antinuclear antibodies (ANA) (OR 2.4 (1.5 to 4.0)). Mean combined IgM/IgG AHA was significantly higher in the uveitis group (19.2 U/ml) than in the non-uveitis group (10.2 U/ml) (p = 0.002). Young age at JIA onset predicted uveitis in girls (p < 0.001), but not in boys (p = 0.390).ConclusionEarly-onset arthritis and presence of AHA in girls, as well as presence of ANA in both genders, were significant predictors of chronic uveitis. The high incidence of uveitis in this long-term Nordic JIA cohort may have severe implications in a lifelong perspective.
Highlights
The incidence of uveitis associated with juvenile idiopathic arthritis (JIA) varies around the world
Regular ophthalmologic follow-up for more than 7 years was available in 435 (87.0%) of the 500 children included in the prospective multi-centre Nordic JIAcohort; 60 children were lost to follow-up, and in 5 children long-term ophthalmological data were missing
There were no uveitis in the systemic nor in the polyarticular rheumatoid factor (RF) positive categories, and highest incidence was noted in the juvenile psoriatic arthritis (35.7%) and enthesitis-related arthritis (25.0%) categories
Summary
The incidence of uveitis associated with juvenile idiopathic arthritis (JIA) varies around the world. Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA). This sightthreatening condition contributes significantly to the disease burden of JIA [1, 2]. We showed previously that AHA is a significant predictor of chronic uveitis in a Norwegian JIA cohort [11]. Whether this association is merely an epiphenomenon is not yet known, new interest for histones in autoimmune diseases has emerged through recent epigenetic findings [18, 19]
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