Papasavvas Ioannis, Herbort Carl P
Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.
Clin Ophthalmol. 2021 Mar 8;15:1055-1059. doi: 10.2147/OPTH.S299436. eCollection 2021.
Juvenile idiopathic arthritis (JIA)-associated uveitis is the most common form of intraocular inflammation with systemic involvement in childhood. Textbooks tend to describe it as non-granulomatous anterior uveitis. Here, we report the percentage of granulomatous features in JIA-related uveitis among patients at a uveitis referral center.
We conducted a retrospective study of all patients with JIA-related uveitis who were seen at the Center for Ophthalmic Specialized Care in Lausanne between 2000 and 2020. The sample comprised pediatric patients with bilateral anterior uveitis diagnosed as JIA-related with positive antinuclear antibody (ANA) titers. Exclusion criteria were a positive Mantoux or Quantiferon test or elevated serum lysozyme and/or angiotensin converting enzyme (ACE) levels. The presence of one of the following features qualified the uveitis as granulomatous: granulomatous keratic precipitates (KPs) of mutton-fat type, smaller granulomatous KPs, or Koeppe nodules. The amount of inflammation was measured using laser flare photometry.
Thirty-eight patients were identified (mean age 13.34 ± 2.71 years; all female). In 12 patients (31.5%), the uveitis presented granulomatous features at presentation or during follow-up in at least one eye. Two of the 12 (16%) granulomatous patients had only light or no systemic involvement. The mean flare was 136.3±149 ph/ms, which is much higher than granulomatous uveitis entities of other origin reported in the literature.
JIA related uveitis can have a granulomatous presentation in about one third of patients with the Oligoarticular type and ANA positive, seen in a uveitis referral center. The presence of granulomatous features in bilateral uveitis in ANA-positive pediatric patients should not exclude the diagnosis of JIA-related uveitis, even in the absence of systemic involvement, as this entity presents a much more severe uveitis than other granulomatous anterior uveitis entities.
幼年特发性关节炎（JIA）相关葡萄膜炎是儿童期最常见的伴有全身受累的眼内炎症形式。教科书往往将其描述为非肉芽肿性前葡萄膜炎。在此，我们报告葡萄膜炎转诊中心患者中JIA相关葡萄膜炎的肉芽肿特征百分比。
我们对2000年至2020年期间在洛桑眼科专科护理中心就诊的所有JIA相关葡萄膜炎患者进行了一项回顾性研究。样本包括诊断为JIA相关且抗核抗体（ANA）滴度阳性的双侧前葡萄膜炎儿科患者。排除标准为结核菌素试验或全血γ干扰素释放试验阳性，或血清溶菌酶和/或血管紧张素转换酶（ACE）水平升高。以下特征之一的存在使葡萄膜炎符合肉芽肿性：羊脂状肉芽肿性角膜后沉着物（KP）、较小的肉芽肿性KP或科佩结节。使用激光 flare 光度计测量炎症程度。
共确定38例患者（平均年龄13.34±2.71岁；均为女性）。12例患者（31.5%）的葡萄膜炎在就诊时或随访期间至少一只眼中出现肉芽肿特征。12例肉芽肿性患者中有2例（16%）仅有轻度全身受累或无全身受累。平均flare为136.3±149 ph/ms，远高于文献报道的其他来源的肉芽肿性葡萄膜炎。
在葡萄膜炎转诊中心，约三分之一少关节型且ANA阳性的患者中，JIA相关葡萄膜炎可呈肉芽肿性表现。ANA阳性儿科患者双侧葡萄膜炎中存在肉芽肿特征不应排除JIA相关葡萄膜炎的诊断，即使无全身受累，因为该疾病比其他肉芽肿性前葡萄膜炎更严重。
