Clarke Sarah L N, Mageean Katie S, Carlton Henry, Simonini Gabriele, Sharp Gemma C, Relton Caroline L, Ramanan Athimalaipet V
MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
J Ophthalmic Inflamm Infect. 2021 May 24;11(1):15. doi: 10.1186/s12348-021-00247-1.
Juvenile idiopathic arthritis associated uveitis (JIA-U) is the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA) and carries considerable risk to vision. The aim of this systematic review was to synthesise evidence of environmental risk factors for JIA-U and identify risk factors which may be modifiable or used to stratify JIA patients.
This systematic review was carried out in accordance with PRISMA guidelines. Four online databases - Cumulative Index of Nursing and Allied Health Literature, Web of Science, MEDLINE and Embase - were searched from database inception to 12th August 2020. Identified studies were screened by two independent reviewers against pre-defined inclusion and exclusion criteria. Data was extracted from all primary studies meeting inclusion criteria and independently checked.
We identified three studies from 895 unique records which met the inclusion criteria, each examining a different environmental risk factor. This systematic review includes 973, predominantly female, participants with JIA across these three studies. The use of allergy medication or documentation of "allergy"/"allergic" in the medical records was associated with an increased risk of JIA-U in all models presented. Vitamin D sufficiency was associated with reduced risk of JIA-U. There was insufficient evidence to support an association between seasonality and JIA-U.
This review identifies a potential role for allergy and vitamin D in JIA-U. It also illustrates the paucity of data regarding environmental risk factors for JIA-U and highlights the need for further research to both identify additional risk factors and replicate existing findings.
幼年特发性关节炎相关葡萄膜炎（JIA-U）是幼年特发性关节炎（JIA）最常见的关节外表现，对视力有相当大的风险。本系统评价的目的是综合JIA-U环境危险因素的证据，并确定可能可改变或用于对JIA患者进行分层的危险因素。
本系统评价按照PRISMA指南进行。检索了四个在线数据库——护理及相关健康文献累积索引、科学网、医学索引数据库和Embase——从数据库建立至2020年8月12日。由两名独立的审阅者根据预先定义的纳入和排除标准对识别出的研究进行筛选。从所有符合纳入标准的原始研究中提取数据并进行独立核对。
我们从895条独特记录中识别出三项符合纳入标准的研究，每项研究考察一个不同的环境危险因素。本系统评价纳入了这三项研究中的973名JIA患者，其中大多数为女性。在所有呈现的模型中，使用抗过敏药物或病历中记录“过敏”/“变应性”与JIA-U风险增加相关。维生素D充足与JIA-U风险降低相关。没有足够的证据支持季节性与JIA-U之间存在关联。
本评价确定了过敏和维生素D在JIA-U中的潜在作用。它还说明了关于JIA-U环境危险因素的数据匮乏，并强调需要进一步研究以识别其他危险因素并重复现有发现。
