Inflammatory Eye Disease in Children with Chronic Arthritis

Abstract

Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis ( JIA). Chronic iridocyclitis with an indolent course is the most common type of intraocular inflammation and is observed predominantly in antinuclear antibody (ANA)-positive girls with oligoarticular JIA. Because of the insidious nature of the disease, several complications, including posterior synechia, cataract, band keratopathy, glaucoma, and macular edema, may be present even at first presentation. The presence of complications at the time of diagnosis and the long period of chronic inflammation are considered the most important risk factors for the development of further complications. JIA-associated uveitis has a blinding potential which is often underappreciated. The disease and its complications are not confined to childhood only, with patients continuing to suffer even in adult hood. Therefore, an aggressive treatment as soon as the diagnosis has been made should be started in order to improve the visual prognosis. An earlier institution of immunosuppressive therapy with less tolerance for even a low-grade intraocular inflammation is the best approach in JIA patients. Despite the use of new therapeutic agents and advances in surgical treatment of ocular complications, JIA-associated uveitis still has a severe course and blinding potential in some patients. Besides a prompt and aggressive treatment, routine ophthalmologic examinations, awareness of worse prognostic factors, early referral to uveitis subspecialists before permanent ocular damage develops, and collaboration between rheumatologists and ophthalmologists are all crucial in improving the visual prognosis.