Uveitis In Juvenile Idiopathic Arthritis Research Articles

Autoantibodies Predictive of Uveitis in Juvenile Idiopathic Arthritis (Aperture): a proof of concept study

Method: Nucleic Acid Programmable Protein Array (NAPPA) enables the production of multiple proteins from DNA templates which are immobilized on a solid phase. These can then be probed for the presence of autoantibodies in patient’s serum. NAPPA slides with 2200 genes were produced. PubMed search identified ∼60 genes associated with uveitis pathology and ∼30 genes associated with arthritis development. The remaining ∼2100 genes were randomly identified from a ∼12 000 human gene collection (http://dnasu.asu.edu) (Fig. 1). The arrays were then probed using plasma from JIA patients with (n = 20) and without uveitis (n = 20) and from healthy age and sex matched controls (n = 20). Results: Quantitative reproducibility of NAPPAs was demonstrated with > 0.95 intra-array and inter-array correlations. Differences in the levels of potential autoantibodies were revealed between JIA patients with and without uveitis. Patients were segregated into two clinical subtypes with distinct antibody signatures by unsupervised hierarchical cluster analysis. Conclusion: The NAPPA platform has the potential to identify novel autoantibodies that robustly forecast the development of uveitis in children with Juvenile idiopathic arthritis. This predictive tool could enable the development of a more appropriate, effective and efficient clinical management algorithm.

Pathophysiology of JIA-associated Uveitis

Juvenile idiopathic arthritis (JIA)-associated uveitis is an intriguing manifestation of JIA and an important contributor of long-term damage. Its pathophysiology is still poorly understood. This review summarizes current concepts. JIA is both a multifactorial and polygenetic disease. In the past 2 decades, multiple studies have indicated that the genetic contribution to both JIA and JIA-associated uveitis is modest. From an ophthalmological point of view, much of the pathophysiological data is derived from studies in experimental uveitis animal models. The pathophysiology of the arthritic manifestations of JIA has been studied extensively in humans. These studies have focused on the principal cells of the adaptive immune system, in particular different subsets of regulatory and effector T cells, as well as on antigen presenting cells or dendritic cells. With advancing technology and advancing knowledge of the underlying mechanisms of JIA-associated uveitis, new targets for therapy might evolve in the coming years.

Bilateral Panuveitis at Etanercept Initiation for Juvenile Idiopathic Arthritis

Introduction: Uveitis is a well-known extra-rheumatological manifestation of juvenile idiopathic arthritis (JIA). Tumor necrosis factor has been used to treat uveitis associated with inflammatory diseases. A new onset uveitis under anti-TNF therapy is uncommon. Case presentation : A 12-years-old male, affected since the age of six years, by a severe form of polyarticular JIA. When etanercept was started, he presented panuveitis bilaterally, so we switched to infliximab with good response. Conclusions : The TNF soluble receptor could be considered as a possible promoter in inducing endogenous new onset uveitis in JIA.

A13: The Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh Out) Cohort: Prospective Determination of the Incidence of New Onset Uveitis in Juvenile Idiopathic Arthritis

Background/Purpose:Previous studies of uveitis in Juvenile Idiopathic Arthritis (JIA) patients have reported prevalence and not incidence. The ReACCh Out cohort, a large inception cohort of newly diagnosed JIA patients provided the opportunity to prospectively ascertain the true incidence of new onset uveitis. The objectives of this study were to determine the overall incidence rate and its trajectory over time.Methods:ReACCh Out recruited newly diagnosed JIA patients between January 2005 and December 2010, from 16 Canadian centres across the country. Prospective data was collected every 6 months for the first 2 years, then yearly. Data was collected on numerous clinical and laboratory measures including the diagnosis of uveitis and its complications, determined by an ophthalmologist. A Poisson model was used to estimate the overall incidence rate. A Kaplan‐Meier plot was used to evaluate the time from diagnosis of JIA to the time of diagnosis of new onset uveitis.Results:1104 patients with newly diagnosed (≤6 months) JIA with ≥1 follow‐up visit were reviewed. Patients were predominantly female (63%), age at diagnosis was 9.3 (3.9, 13.0) years. Time from diagnosis to enrollment was 0.3 (0, 1.6) months. Follow‐up to last visit or study end was 34.2 (21.5, 48) months. 23 patients whose uveitis status was not available, were excluded. 77 patients with new onset uveitis were identified during the study period. The overall incidence rate of new cases of uveitis following the diagnosis of JIA was 2.9% per year (95% confidence interval 2.3–3.6). Following the trajectory of new cases of uveitis over time, the incidence of new cases showed a slow decline over time (Figure ). Importantly, new cases of uveitis occurred as far out from diagnosis as the end of the study period. Kaplan‐Meier plots were also used to evaluate age at diagnosis of new onset uveitis and gender. Results support previously identified risk factors for uveitis including younger age (<5 years) and female gender. The frequency of uveitis occurred in the JIA patients in the following distribution according to subtype: oligoarthritis (43, 56%), polyarthritis RF negative (18, 23%), polyarthritis RF positive (1, 1%), psoriatic (4, 5%), ERA (1, 1%), systemic (1, 1%) and undifferentiated (9, 12%).Time (confidence intervals) from diagnosis of JIA to diagnosis of new onset uveitisimageConclusion:In a large inception cohort of newly diagnosed JIA patients followed prospectively, the overall incidence rate of new cases of uveitis was 2.9% per year. The slow decrease in incidence over time and the development of new cases of uveitis years later, highlight the importance of ongoing and long term surveillance.

A123: HLA Associations in a Matched Cohort of Juvenile Idiopathic Arthritis Children With and Without Uveitis

Background/Purpose:Studies have shown that HLA‐DRB1*8, 11 and 13 are strong risk alleles for various juvenile idiopathic arthritis (JIA) subtypes. There are few studies investigating the role of HLADRB1 alleles in children with uveitis. Our objective is to determine the association of these alleles with uveitis in a matched cohort of children with JIA and JIAassociated uveitis (JIA‐U). We will also explore associations with uveitis complications and the need for antitumor necrosis factor (TNF) agents.Methods:We matched children with JIA and JIA‐U on race, ethnicity, sex, age at arthritis diagnosis, and JIA subtype. We included Non‐Hispanic White (NHW) controls. We performed high‐resolution HLADRB1 genotyping. Odds ratios and 95% confidence intervals are presented. In some instances, exact confidence intervals and p‐value are provided due to small sample sizes.Results:There were 373 controls, 43 children with JIA‐U and 48 with JIA of whom 37 were matched. Each matched group had 29 (78.4%) females and 28 children with oligoarticular (6 extended, 22 persistent) and 9 polyarticular rheumatoid factor (RF) negative JIA.In our matched analysis comparing children with JIA‐U and JIA, there was a difference in the frequency of carriage of DRB1*11 (35.1% vs. 18.9%) and both DRB1*11 and DRB1*13 alleles (16.2% vs. 2.7%) which approached significance, reflecting our modest sample size (OR 2.32, p = 0.116 and OR 6.97, p = 0.107, respectively).In comparison with controls, children with JIA and JIA‐U had increased odds of having DRB1*8 (OR 5.54, p < 0.001 and OR 9.00, p < 0.001, respectively) and DRB1*13 (OR 2.38, p = 0.005 and OR 2.40, p = 0.007). Additionally, compared to controls, children with JIA and JIA‐U had greater odds of having at least one of the following: DRB1*8, 11 or 13 (OR 4.27, p < 0.001 and OR 5.37, p < 0.001) and DRB1*11 or 13 (OR 2.30, p = 0.006 and OR 2.29, p = 0.010). Only children with JIA‐U had increased odds of having DRB1*11 (OR = 2.22, p = 0.024), and carriage of both DRB1*11 and 13 (OR 9.92, p < 0.001).No increase in allele frequency was noted with regards to ocular complications or the use of anti‐TNF agents in children with JIA‐U. Comparison of HLA‐DRB1 in children with JIA and JIA‐U HLA Configuration % OR p value Matched JIA (N = 37) vs JIA‐U (N = 37) JIA (N = 48) vs controls JIA‐U (N = 43) vs controls DRB1*8 21.6% vs. 27.0% 22.9% vs. 5.1% 32.6% vs. 5.1% OR 1.34 OR 5.54 OR 9.00 P=NS P<0.001 P <0.001 DRB1*11 18.9% vs. 35.1% 18.9% vs. 16.4% 30.2% vs. 16.4% OR 2.32 OR 1.18 OR 2.22 P=0.116 P=NS P=0.024 DRB1*13 54.1% vs. 54.1% 41.7% vs. 23.1% 41.9% vs. 23.1% OR 1.000 OR 2.38 OR 2.40 P=NS P=0.005 P=0.007 DRB1*8, 11 or 13 78.4% vs. 81.1% 75.0% vs. 41.3% 79.1% vs. 41.3% OR 1.18 OR 4.27 OR 5.37 P=NS P <0.001 P <0.001 DRB1*11 or 13 64.9% vs. 62.2% 58.3% vs. 37.8% 58.1% vs. 37.8% OR 1.12 OR 2.30 OR 2.29 P=NS P=0.006 P=0.010 DRB1*11/8 2.7% vs. 5.4% 4.2% vs. 1.1% 4.7% vs. 1.1% OR 2.06 OR 3.95 OR 4.50 P=NS P=NS P=NS DRB1*11/13 2.7% vs. 16.2% 2.1% vs. 1.6% 14.0% vs. 1.6% OR 6.97 OR 1.30 OR 9.92 P=0.107 P=NS p<0.001 DRB1*13/8 2.7% vs. 5.4% 2.1% vs. 0.5% 7.0% vs. 0.5% OR 2.06 OR 3.95 OR 13.91 P=NS P=NS P=0.009 NS = not significantConclusion:This is the first matched analysis of children with JIA and JIA‐U. Carriage of both DRB1*11 and 13 appear to increase the risk for developing uveitis. Further studies should be conducted in a larger matched cohort of children with JIA, and the role of HLA in the risk for ocular complications and severe disease should be considered.

A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial)

BackgroundJuvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Children with JIA are at risk of inflammation of the uvea in the eye (uveitis). Overall, 20% to 25% of paediatric uveitis is associated with JIA. Major risk factors for development of uveitis in JIA are oligoarticular pattern of arthritis, an age at onset of arthritis of less than seven years of age, and antinuclear antibody positivity. In the initial stages of mild to moderate inflammation the uveitis is asymptomatic. This has led to current practice of screening all children with JIA for uveitis. Approximately 12% to 38% of patients with JIA develop uveitis in seven years following onset of arthritis. In 30% to 50% of children with JIA-associated uveitis structural complications are present at diagnosis. Furthermore about 50% to 75% of those with severe uveitis will eventually develop visual impairment secondary to ocular complications such as cataract and glaucoma. Defining the severity of inflammation and structural complications in uveitis patients is now possible following Standardised Uveitis Nomenclature (SUN) guidelines, and modified to incorporate the consensus of end point and outcome criteria into the design of randomised trials. Despite current screening and therapeutic options (pre-biologics) 10% to 15% of children with JIA-associated uveitis may develop bilateral visual impairment and certified legally blind. To date, there remains no controlled trial evidence of benefits of biologic therapy.Methods/designThis study will randomise 154 patients aged 2 to 18 years with active JIA-associated uveitis (despite methotrexate (MTX) treatment for at least 12 weeks). All participants will be treated for 18 months, with follow up of 3 years from randomisation (continuing on MTX throughout). All participants will receive a stable dose of MTX and in addition either adalimumab (20 mg/0.8 ml for patients <30 kg or 40 mg/0.8 ml for patients weighing 30 kg or more, subcutaneous (s/c) injection every 2 weeks based on body weight), or placebo (0.8 ml as appropriate according to body weight) s/c injection every 2 weeks.DiscussionThis is the first randomised controlled trial that will assess the clinical effectiveness, safety and cost effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis.Trial registrationISRCTN10065623

Profiling risk factors for chronic uveitis in juvenile idiopathic arthritis: a new model for EHR-based research

BackgroundJuvenile idiopathic arthritis is the most common rheumatic disease in children. Chronic uveitis is a common and serious comorbid condition of juvenile idiopathic arthritis, with insidious presentation and potential to cause blindness. Knowledge of clinical associations will improve risk stratification. Based on clinical observation, we hypothesized that allergic conditions are associated with chronic uveitis in juvenile idiopathic arthritis patients.MethodsThis study is a retrospective cohort study using Stanford’s clinical data warehouse containing data from Lucile Packard Children’s Hospital from 2000–2011 to analyze patient characteristics associated with chronic uveitis in a large juvenile idiopathic arthritis cohort. Clinical notes in patients under 16 years of age were processed via a validated text analytics pipeline. Bivariate-associated variables were used in a multivariate logistic regression adjusted for age, gender, and race. Previously reported associations were evaluated to validate our methods. The main outcome measure was presence of terms indicating allergy or allergy medications use overrepresented in juvenile idiopathic arthritis patients with chronic uveitis. Residual text features were then used in unsupervised hierarchical clustering to compare clinical text similarity between patients with and without uveitis.ResultsPreviously reported associations with uveitis in juvenile idiopathic arthritis patients (earlier age at arthritis diagnosis, oligoarticular-onset disease, antinuclear antibody status, history of psoriasis) were reproduced in our study. Use of allergy medications and terms describing allergic conditions were independently associated with chronic uveitis. The association with allergy drugs when adjusted for known associations remained significant (OR 2.54, 95% CI 1.22–5.4).ConclusionsThis study shows the potential of using a validated text analytics pipeline on clinical data warehouses to examine practice-based evidence for evaluating hypotheses formed during patient care. Our study reproduces four known associations with uveitis development in juvenile idiopathic arthritis patients, and reports a new association between allergic conditions and chronic uveitis in juvenile idiopathic arthritis patients.

PReS-FINAL-2030: Treatment with leflunomide results in a higher flare rate of chronic uveitis compared to methotrexate in patients with juvenile idiopathic arthritis treated with both drugs

Chronic anterior uveitis is a common complication of juvenile idiopathic arthritis (JIA). Leflunomide is a frequently used alternative to methotrexate in the treatment of joint manifestations of JIA. However, very little is known on the effect of leflunomide treatment on concurrent chronic uveitis in JIA.

Predictive Value of Selected Biomarkers, Polymorphisms, and Clinical Features for Oligoarticular Juvenile Idiopathic Arthritis-associated Uveitis

Purpose: Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA) and is associated with considerable morbidity. The aim of this study was to examine the risk factors associated with uveitis in oligoarticular JIA. Methods: We conducted a chart review of 86 patients with oligoarticular JIA to assess if antinuclear antibody (ANA) status, gender, and age at JIA onset were associated with the development of uveitis. Biomarkers such as cytokine gene polymorphisms, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were also assessed. Results: Twenty-seven patients exhibited oligoarticular JIA-associated uveitis. Only the ESR at arthritis onset and the patient's age at arthritis onset were related to uveitis development in our patient sample. Conclusions: An age-associated risk of uveitis was observed in children younger than 3 years at the time of JIA onset. ESR values at arthritis onset higher than 22 mm/h were also related to uveitis development.

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

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.

AB1119 Leflunomide in the treatment of chronic uveitis in juvenile idiopathic arthritis

BackgroundLeflunomide is a disease modifying drug (DMARD) used in the treatment of juvenile idiopathic arthritis (JIA). Chronic uveitis is a frequent complication of JIA. Methotrexate and other DMARDS have successfully...

SAT0453 Have We Got the Eyes Right? An Audit of Referral Patterns to Opthalmology in JIA

BackgroundUveitis is a complication of Juvenile Idiopathic Arthitis (JIA) and can lead to chronic visual impairment. Each type of JIA has a different prevalence. Oligoarticular onset JIA has a high...

Adalimumab for juvenile idiopathic arthritis-associated uveitis

To assess the long-term outcomes and complications of patients with uveitis from juvenile idiopathic arthritis (JIA) treated with adalimumab. Prospective interventional case series. All patients who underwent treatment with adalimumab for JIA and anterior uveitis were prospectively included in the study. The anterior chamber inflammation was evaluated according to the Standardization of Uveitis Nomenclature criteria. Twenty-one patients (16 females, five males, 38 eyes) were included in the study. Mean age of patients at referral was 11.1 ± 3.8 (5-17) years. Before initiation of treatment, mean duration of arthritis was 7.0 ± 5.5 (median, 6) months, mean duration of uveitis was 7.0 ± 4.4 (median, 7) months. Oligoarticular arthritis was present in 15 cases (71 %), polyarticular arthritis in six cases (28 %). After a mean follow-up of 18.2 ± 7.7 (9-41) months, resolution of anterior chamber inflammation was obtained in 29/38 eyes (76 %). The anterior uveitis flare rate during the 12 months prior to enrollment was 1.6 ± 0.4/year, and was reduced during adalimumab treatment to 0.7 ± 0.3/year (p<0.001). A significant decrease of the number of relapses/month was present after onset of treatment with adalimumab (0.18 ± 0.2 before versus 0.02 ± 0.1 after treatment onset, p<0.001). No significant correlation was found between relapse number and age, sex, type of JIA and doses of previous steroid treatment (p>0.05). Adalimumab showed to be effective and relatively safe for treatment of JIA-associated uveitis.

Safety and Efficacy of Infliximab and Adalimumab for Refractory Uveitis in Juvenile Idiopathic Arthritis: 1-year Followup Data from the Italian Registry

Safety and Efficacy of Infliximab and Adalimumab for Refractory Uveitis in Juvenile Idiopathic Arthritis: 1-year Followup Data from the Italian Registry

Safety and Efficacy of Infliximab and Adalimumab for Refractory Uveitis in Juvenile Idiopathic Arthritis: 1-year Followup Data from the Italian Registry

To evaluate safety and efficacy of adalimumab (ADA) and infliximab (IFX) for the treatment of juvenile idiopathic arthritis-related anterior uveitis (JIA-AU). Starting January 2007, patients with JIA-AU treated with IFX and ADA were managed by a standard protocol and data were entered into the National Italian Registry (NIR). At baseline, all patients were refractory to standard immunosuppressive treatment and/or were corticosteroid-dependent. Data recorded every 3 months included uveitis course, number/type of ocular complications, drug-related adverse events (AE), treatment change or withdrawal, and laboratory measures. Data of patients treated for at least 1 year were retrieved from the NIR and analyzed using descriptive statistics. Treatment efficacy was based on change in uveitis course and in number of ocular complications. Up to December 2009, data for 108 patients with JIA-AU treated with anti-tumor necrosis factor-α agents were recorded in the NIR and data from 91, with at least 12 months' followup, were included in the study. Forty-eight patients were treated with IFX, 43 with ADA. Forty-seven patients (55.3%) achieved remission of AU, 28 (32.9%) had recurrent AU, and 10 (11.8%) maintained a chronic course. A higher remission rate was observed with ADA (67.4% vs 42.8% with IFX; p = 0.025). Ocular complications decreased from 0.47 to 0.32 per subject. Five patients experienced resolution of structural complications. No patient reported serious AE; 8 (8.8%) experienced 11 minor AE (9 with IFX, 2 with ADA). IFX and ADA appear to be effective and safe for treatment of refractory JIA-related uveitis, with a better performance of ADA in the medium-term period.

TREATMENT APPROACH FOR JUVENILE IDIOPATHIC ARTHRITIS-RELATED UVEITIS: 2012 UPDATE

Chronic anterior uveitis is the most common extra-articular complication of juvenile idiopathic arthritis. It is more frequent in the early onset forms with a higher prevalence in the oligoarticular (40%) than in other juvenile idiopathic arthritis subtypes (5–14%). The risk for severe visual impairment is still high due to the development of sight-threatening complications (synechiae, band keratopathy, cataract, glaucoma, cystoid macular oedema. Treatment is not standardized and requires a complex decision-making process, involving a close collaboration between paediatric ophthalmologist and rheumatologist. Topical therapy alone is often inadequate to control ocular inflammation and bulbar injections are too invasive to perform in children therefore immunosuppressive treatment is often advocated. Low dose methotrexate is the second-line agent mostly used although no controlled studies comparing effects of early to late methotrexate treatment have been reported. Mycophenolate mofetil is effective in controlling inflammation in methotrexate -refractory patients. Its efficacy, however, seems to be more relevant in intermediate or posterior uveitis, than in juvenile idiopathic arthritis uveitis and scleritis. Anti-TNF α agents, namely infliximab and adalimimab showed effectiveness in open-label studies but no wide controlled trials have been reported so far. Adalimimab is as effective as infliximab but has an easier way of administration and a better drug tolerance. Abatacept should be used in anti-TNF refractory patients with juvenile idiopathic arthritis uveitis .

KIR-HLA class I combinations in JIA-associated uveitis

Purpose HLA class I-specific killer cell immunoglobulin-like receptors (KIR) gene and HLA gene combinations have been associated with autoimmune uveitis (e.g., birdshot chorioretinopathy (BCR) and Vogt-Koyanagi-Harada syndrome (VKH)). In oligoarticular juvenile idiopathic arthritis (JIA), uveitis is one of the most serious complications, affecting approximately 20% of patients. Multiple studies suggest there are HLA Class II associations with chronic anterior uveitis in JIA; however, there is a paucity of evidence demonstrating Class I associations. Given the importance of HLA Class I and KIR gene combinations in other forms of autoimmune uveitis, we hypothesized that an interplay between these genes may contribute to the pathogenesis of uveitis in JIA. To test this hypothesis, we are: 1) determining HLA Class I and KIR gene associations in children with JIA with and without uveitis and comparing them with healthy controls, and 2) determining associations between clinical course and HLA Class I KIR gene associations.

Timing of uveitis onset in oligoarticular juvenile idiopathic arthritis (JIA) is the main predictor of severe course uveitis

Aim of the present study was to validate a statistical model to predict a severe course of anterior uveitis (AU) in patients with juvenile idiopathic arthritis (JIA). Consecutive patients with newly diagnosed uveitis have been followed for at least 1 year with a standardized protocol. For each patient, demographic, clinical and laboratory characteristics, including time interval between arthritis and uveitis onset, α(2)-globulins level at arthritis onset, number of uveitis relapses/year, ocular complications and therapy and visual acuity, have reported. The validation procedure included the assessment of sensitivity, specificity and efficiency of previously published statistical model (Zulian et al. J Rheumatol 2002; 29: 2446-2453) in a new inception cohort of patients during a short length follow-up. Sixty patients with JIA, followed at 14 paediatric rheumatology-ophthalmology centres in Italy, entered the study. The mean age at arthritis onset was 4.4 years (range 1.2-15.8 years), and the mean interval time between arthritis and uveitis onset was 1.8 years (range: 0.0-14.2 years). After the first AU, patients, followed for a mean of 3.2 years, had a mean of 2.9 uveitis relapses. Twenty-two patients (36.7%) presented at least one complication. Using a probability cut-off value = 0.7, the statistical model revealed 80% sensitivity, 58% specificity and 65% efficiency. The time interval between arthritis and uveitis onset resulted as the main predictor of severe course uveitis in JIA. The statistical model was able to predict the development of a severe course in 8 of 10 patients.

Evidence-based, interdisciplinary guidelines for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis

Uveitis in juvenile idiopathic arthritis (JIA) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first-choice therapy, and immunosuppression is commonly used. However, treatment has not been standardized. Representatives from the German Ophthalmological Society, Society for Childhood and Adolescent Rheumatology, and the German Society for Rheumatology reached consensus on a standardized treatment strategy according to disease severity in the individual patient. The recommendations were based on a systematic literature analysis in MEDLINE and consensus expert meetings. Evidence and recommendations were graded, and an algorithm for anti-inflammatory treatment and final statements confirmed in a Delphi method. An interdisciplinary, evidence-based treatment guideline for JIA uveitis is presented.

Elevated laser flare values correlate with complicated course of anterior uveitis in patients with juvenile idiopathic arthritis

To evaluate the prognostic value of anterior chamber (AC) laser flare (LF) in uveitis associated with juvenile idiopathic arthritis (JIA). Monocentre, retrospective study of 150 JIA children (girls n = 107, 71.3%) with unilateral or bilateral chronic anterior uveitis (statistical analysis of one eye per patient). LF values (KOWA FM-500), visual acuity, intraocular pressure, glaucoma treatment and uveitis complications were investigated longitudinally. Patients were followed up for a mean of 8.7 months (range 1-36). High LF values correlated with poor visual acuity (p < 0.0001). Patients with low LF values (LF ≤ 20 photon units per millisecond) less often required glaucoma medication (p = 0.0005) or surgery (p = 0.01) and showed a lower prevalence of cataract, band keratopathy, posterior synechiae, epiretinal membrane, optic disc oedema and glaucoma/ocular hypertension (p < 0.05, each). Baseline LF > 20 photon units per millisecond was a better prognosticator for the development of subsequent complications than baseline AC cells (p = 0.04). High LF values in patients with JIA uveitis are associated with poor vision and a higher prevalence of uveitis complications.