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幼年特发性关节炎相关性葡萄膜炎患儿的视力预后

Visual outcomes in children with juvenile idiopathic arthritis-associated uveitis.

作者信息

Kump Leila I, Castañeda René A Cervantes, Androudi Sofia N, Reed George F, Foster C Stephen

机构信息

Massachusetts Eye Research and Surgery Institute, Cambridge, Massachusetts, USA.

出版信息

Ophthalmology. 2006 Oct;113(10):1874-7. doi: 10.1016/j.ophtha.2006.05.016. Epub 2006 Aug 1.

Abstract

PURPOSE

To analyze visual outcomes in children affected by juvenile idiopathic arthritis (JIA)-associated uveitis.

DESIGN

Retrospective interventional case series.

PARTICIPANTS

Eighty-nine children with JIA-associated uveitis.

METHODS

Charts of children with JIA-associated uveitis were reviewed.

MAIN OUTCOME MEASURE

Change in patients' visual acuities (VAs).

RESULTS

Of 269 children with uveitic syndromes referred, 89 (33%) had JIA-associated uveitis. The process was bilateral in 76 children. Seventy-three patients were female, and 84% of patients were Caucasian. Mean age of onset of uveitis was 5.7 years. Mean follow-up was 2.96 years. Antinuclear antibody positivity was detected in 56 patients, 44 of them female. Patients with JIA-associated uveitis developed numerous complications in the course of their disease: of 165 affected eyes, 105 (64%) developed cataracts, 33 (20%) developed increased intraocular pressure, and 76 (46%) developed band keratopathy; posterior synechiae were present in 96 (58%). Of 89 children, 73% were treated with immunomodulators, 40% were treated with nonsteroidal antiinflammatory agents alone or in combination with immunomodulators, and 21% were treated with topical and/or systemic steroids. Of 65 children who required immunomodulation, only one chemotherapeutic agent was used in 30, two agents in 21, and > or =3 in 14. Visual acuities of 65 children (122 eyes) were documented and compared at standard intervals. By mixed-models linear regression, improvement in VA of 0.03 logarithm of the minimum angle of resolution units per year was not found to be statistically significant (standard error, 0.02, P = 0.089).

CONCLUSIONS

Juvenile idiopathic arthritis-associated uveitis is a sight-threatening disease. However, much of the children's vision can be preserved if patients are treated appropriately.

摘要

目的

分析幼年特发性关节炎(JIA)相关葡萄膜炎患儿的视力预后。

设计

回顾性干预病例系列研究。

参与者

89例JIA相关葡萄膜炎患儿。

方法

对JIA相关葡萄膜炎患儿的病历进行回顾。

主要观察指标

患者视力(VA)的变化。

结果

在转诊的269例葡萄膜炎综合征患儿中,89例(33%)患有JIA相关葡萄膜炎。该过程在76例患儿中为双侧性。73例患者为女性,84%的患者为白种人。葡萄膜炎的平均发病年龄为5.7岁。平均随访时间为2.96年。56例患者检测到抗核抗体阳性,其中44例为女性。JIA相关葡萄膜炎患者在疾病过程中出现了许多并发症:在165只受累眼中,105只(64%)发生了白内障,33只(20%)眼压升高,76只(46%)发生了带状角膜病变;96只(58%)存在后粘连。89例患儿中,73%接受了免疫调节剂治疗,40%单独或联合免疫调节剂接受了非甾体类抗炎药治疗,21%接受了局部和/或全身类固醇治疗。在65例需要免疫调节的患儿中,30例仅使用了一种化疗药物,21例使用了两种药物,14例使用了≥3种药物。在标准间隔时间记录并比较了65例患儿(122只眼)的视力。通过混合模型线性回归分析,未发现每年最小分辨角对数单位的视力提高0.03具有统计学意义(标准误差为0.02,P = 0.089)。

结论

幼年特发性关节炎相关葡萄膜炎是一种威胁视力的疾病。然而,如果患者得到适当治疗,大部分患儿的视力可以得到保留。

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