Abstract
Purpose: To analyze occurrence and risk factors for macular edema (ME) in juvenile idiopathic arthritis-associated uveitis (JIA-U). Methods: Retrospective analysis of patients with JIA-U at a tertiary referral uveitis center between 2000 and 2019. Epidemiological data and clinical findings before ME onset were evaluated. Results: Out of 245 patients, ME developed in 41 (18%) of the 228 JIA-U patients for whom data documentation was complete during the follow-up (mean 4.0 ± 3.8 years). Risk factors (univariable logistic regression analysis) at baseline for subsequent ME onset included older age at initial documentation at institution (hazard ratio, HR 1.19, p < 0.0001), longer duration of uveitis at initial documentation (HR 1.17, p < 0.0001), worse best-corrected visual acuity (BCVA; HR 2.49, p < 0.0001), lower intraocular pressure (IOP; HR 0.88, p < 0.01), band keratopathy (HR 2.29, p < 0.01), posterior synechiae (HR 2.55, p < 0.01), epiretinal membrane formation (HR 6.19, p < 0.0001), optic disc swelling (HR 2.81, p < 0.01), and cataract (HR 4.24, p < 0.0001). Older age at initial documentation at institution (HR 1.55, p < 0.001), worse BCVA (HR 28.56, p < 0.001), and higher laser-flare photometry (LFM) values (HR 1.003, p = 0.01) were independent risk factors for ME manifestation. Patients with ME revealed significant changes in BCVA, LFM, and IOP and new optic disc swelling at 6 and 3 months before ME onset compared to timepoint of ME occurrence (p < 0.05, each). Conclusion: ME is a common complication of JIA-U. Demographic risk factors and courses of IOP, BCVA, and LFM may indicate patients at risk for ME onset.
Highlights
Juvenile idiopathic arthritis (JIA) comprises a group of rheumatoid diseases with onset before 16 years of age [1,2]
JIA was defined according to the International League of Associations for Rheumatology (ILAR) [26], whereas uveitis was classified according to the Standardized Uveitis
Were higher baseline values a risk factor for subsequent macular edema (ME) onset (Tables 1 and 2), but we observed a significant increase in laser-flare photometry (LFM) values in the 6 months before ME onset (Figure 2)
Summary
Juvenile idiopathic arthritis (JIA) comprises a group of rheumatoid diseases with onset before 16 years of age [1,2]. In 9–25% of children, uveitis manifests during the course of disease [3,4,5,6,7]. As uveitis may lead to potentially irreversible vision-threatening complications [4,8,9,10,11,12], identifying patients at risk for such complications is crucial for improving final disease outcome. Macular involvement has been reported in up to 82% of patients with JIA-U when screening with highly sensitive optical coherence tomography (OCT) [13]. Different JIA-U studies have reported that macular edema (ME) becomes manifest in JIA-U [3,4,10,14,15,16]. The blood–retina barriers might break down, for example, due to the release of proinflammatory cytokines [23,24]
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