青少年特发性关节炎相关性葡萄膜炎：台湾一项全国性基于人群的研究。
Juvenile idiopathic arthritis-associated uveitis: a nationwide population-based study in Taiwan.
机构信息
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
出版信息
PLoS One. 2013 Aug 5;8(8):e70625. doi: 10.1371/journal.pone.0070625. Print 2013.
OBJECTIVE
The 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.
METHODS
A 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.
RESULTS
The 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).
CONCLUSIONS
The 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.
目的
幼年特发性关节炎（JIA）的发病率和患病率在世界各地差异很大，但东亚的数据却很缺乏。葡萄膜炎是 JIA 的一个严重致残因素。本研究旨在分析台湾 JIA 的发病率和患病率，以及 JIA 相关葡萄膜炎的特征。
方法
本研究采用基于人群的队列研究，使用台湾全民健康保险研究数据库，对每位患者从 1999 年至 2009 年进行个体跟踪，通过国际疾病分类诊断代码来确定 JIA 和葡萄膜炎的诊断。多变量逻辑回归用于确定 JIA 患者葡萄膜炎的风险因素和并发症。
结果
研究队列有 2636 例 JIA，包括幼年类风湿关节炎（57.7%）、附着点炎相关关节炎（39.2%）和银屑病关节炎（3.1%）。JIA 和 JIA 相关葡萄膜炎的年平均发病率分别为 4.93（范围 3.93-6.23）和 0.25（范围 0.12-0.37）/10 万人口，JIA 的平均期间患病率为 33.8/10 万人口。葡萄膜炎发生在 4.7%的 JIA 患者中，而 JIA 相关葡萄膜炎并发白内障（11.2%）和青光眼（24.8%）。附着点炎相关关节炎与葡萄膜炎显著相关（OR：3.47；95%CI：2.24-5.37）（p<0.0001）。JIA 之前诊断的葡萄膜炎是青光眼或白内障并发症的最重要危险因素（OR：3.54；95%CI：1.44-8.72）（p=0.006）。
结论
JIA 的发病率较低，但 JIA 相关葡萄膜炎的发病率正在上升。台湾 JIA 患者中男性比例较高，ERA 与葡萄膜炎之间的强关联是其独特之处。关节炎前诊断的葡萄膜炎是发生并发症的重要危险因素。对于 JIA 或病因不明的葡萄膜炎患儿，需要进行持续的眼科随访。
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