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Abstract
Purpose:To determine the ocular manifestations of juvenile idiopathic arthritis (JIA) and its relation to its disease activity. To analyze the prevalence and complications of uveitis and their predictors in JIA. Methods: Fifty eight JIA patients and 20 age and sex matched healthy controls were included in this study; all JIA patients were recruited from Rheumatology and paediatric department. All patients were undergone complete rheumatological and ophthalmic examination including visual acuity, slit lamp examination of the anterior segment, dry eye evaluation using Rose Bengal stain and Schirmer test. Fundus examination and fundus photography were done to the suspected cases Results: Sixteen patients (27.6%) had ocular manifestations. Most of JIA were asymptomatic 49 (84.48%) for ocular manifestation. Nine patients (15.5%) complained of ocular manifestations in the form of blurring of vision, burning sensation and eye dryness. Patients with ocular abnormalities had an earlier disease onset and longer disease duration than those without any lesions (p<0.001). There was a highly statistically significant difference between patients and controls as regarding all ocular lesions, which was significantly higher in the patients group. Meanwhile, the most common ocular manifestation of JIA is uveitis (17.2%), five patients had keratoconjunctivitis Sicca, 8 patients had visual field defects, also four had macular edema, two had cataract and two had increase intraocular pressure. Conclusion: Ocular manifestations including sight threatening complications are not rare in patients with JIA. Uveitis is the most common ocular lesion. Therefore, continuous ophthalmologic examinations are needed in young people with JIA.
Highlights
Juvenile idiopathic arthritis is an autoimmune, non-infective, inflammatory joint disease of more than 3 months duration in children less than 16 years of age
The diagnosis of arthritis was made according to International League of Associations for Rheumatology (ILAR) classification and the diagnosis of uveitis was made according to the International Uveitis Study Group guidelines [9,10]
The mean age of the juvenile idiopathic arthritis (JIA) patients was 10.2 ± 3.2 years, ranging from 6 to 19 years, while that of the controls was 9.80 ± 6.46 years ranging from 5-16 y, the mean age at onset and disease duration of JIA patients was 6.9 ± 2.2 ranging from 4-13 years, and 38.5 ± 32.8 ranging from 6 to 116 months respectively (Table 1)
Summary
Juvenile idiopathic arthritis is an autoimmune, non-infective, inflammatory joint disease of more than 3 months duration in children less than 16 years of age. The disease commonly occurs in children from the ages of 7 to 12, but it may occur in adolescents as old as 15 years of age, as well as in infants [1]. It is a subset of arthritis seen in childhood, which may be transient and self-limited or chronic. The intraocular inflammation seen in JIA patients is typically bilateral non granulomatous uveitis with chronic course [7]. The common causes of visual impairment in JIA are complicated cataract and band shaped keratopathy (BSK). Other complications associated with JIA are epiretinal membrane, macular hole, hypotony with ciliary body shutdown or atrophy [8]
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