Juvenile Idiopathic Arthritis-Associated Uveitis: A Nationwide Population-Based Study in Taiwan

Hsin-Hui Yu,Yu-Tsan Lin,Jyh-Hong Lee,Yao-Hsu Yang,Chang-Ping Lin,Pau-Chung Chen,Li-Chieh Wang,Bor-Luen Chiang

doi:10.1371/journal.pone.0070625

Hsin-Hui Yu, Yu-Tsan Lin + Show 6 more

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https://doi.org/10.1371/journal.pone.0070625

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Abstract

ObjectiveThe incidence and prevalence of juvenile idiopathic arthritis (JIA) vary widely across the world but data in East Asia is lacking. Uveitis is a serious cause of morbidity in JIA. This study aimed to analyze the incidence and prevalence of JIA, and the characteristics of JIA-associated uveitis in Taiwan.MethodsA population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. Each patient was individually tracked from 1999 to 2009 to identify the diagnosis of JIA and uveitis using the International Classification of Diseases diagnostic codes. Multivariate logistic regression was used to determine the risk factors and complications of uveitis in patients with JIA.ResultsThe study cohort had 2636 cases of JIA and included juvenile rheumatoid arthritis (57.7%), enthesitis-related arthritis (ERA) (39.2%), and psoriatic arthritis (3.1%). The average annual incidence of JIA and JIA-associated uveitis were 4.93 (range, 3.93–6.23) and 0.25 (range, 0.12–0.37) cases per 100,000 population, respectively. The average period prevalence of JIA was 33.8 cases per 100,000 population. Uveitis occurred in 4.7% of patients with JIA, while JIA-associated uveitis was complicated by cataract (11.2%) and glaucoma (24.8%). Enthesitis-related arthritis was significantly associated with uveitis (OR: 3.47; 95% CI: 2.24–5.37) (p<0.0001). Uveitis diagnosed before JIA was the most significant risk factor for complications of glaucoma or cataract (OR: 3.54; 95% CI: 1.44–8.72) (p = 0.006).ConclusionsThe incidence of JIA is low but that of JIA-associated uveitis is increasing. Higher percentage of males in patients with ERA and the strong association between ERA and uveitis are unique for children with JIA in Taiwan. Uveitis diagnosed before arthritis is an important risk factor for complications. Continuous ophthalmologic follow-up is needed for children with JIA or uveitis of unknown etiology.

Highlights

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease among children
Outcome has improved over the past 20 years, but for children with JIA, which accounts for 5–81.5% of pediatric uveitis cases, it remains a serious cause of morbidity and loss of vision [8]
Based on the age- and sex-specific incidence rate for 2009 of JIA and arthritis subtypes (Figure 2), the incidence of JIA was low for ages 0–4 and 5–9 years old, but increased with age

Summary

Introduction

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease among children. The 1997 International League of Associations for Rheumatology (ILAR) criteria defined seven subtypes of JIA based on clinical and laboratory parameters: systemic JIA, oligoarticular JIA, rheumatoid factor (RF)-negative polyarticular JIA, RF-positive polyarticular JIA, enthesitis-related arthritis (ERA), psoriatic arthritis (PsA), and undifferentiated JIA [1]. Risk factors include anti-nuclear antibody (ANA) positivity, young age at onset of arthritis (#6 years), female sex, and oligoarthritis [7]. Morbidity of JIA-associated uveitis includes cataracts, glaucoma, band keratopathy, and loss of vision. Outcome has improved over the past 20 years, but for children with JIA, which accounts for 5–81.5% of pediatric uveitis cases, it remains a serious cause of morbidity and loss of vision [8]

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