Bison Henry S, Janetos Timothy M, Gao Hans M, Zhang David L, Song Jessica, Bohnsack Brenda L
From the Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago (H.S.B., T.M.J., H.M.G., D.L.Z., J.S., B.L.B.); Department of Ophthalmology, Northwestern University Feinberg School of Medicine (H.S.B., T.M.J., H.M.G., D.L.Z., J.S., B.L.B.), Chicago, Illinois, USA.
From the Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago (H.S.B., T.M.J., H.M.G., D.L.Z., J.S., B.L.B.); Department of Ophthalmology, Northwestern University Feinberg School of Medicine (H.S.B., T.M.J., H.M.G., D.L.Z., J.S., B.L.B.), Chicago, Illinois, USA.
Am J Ophthalmol. 2023 Mar;247:70-78. doi: 10.1016/j.ajo.2022.11.010. Epub 2022 Nov 11.
To determine uveitis incidence in juvenile idiopathic arthritis (JIA) patients treated with disease-modifying antirheumatic drugs (DMARD) medications, and to evaluate uveitis risk-stratification protocols.
Retrospective clinical cohort study.
Medical records of patients with JIA seen by ophthalmology at a single institution from April 2014 to April 2022 and ≥18 months' follow-up were reviewed. Exclusion criteria included uveitis history prior to study period, Still disease, or <18 months' follow-up. Patient characteristics, medications, and uveitis status were recorded. Factors associated with uveitis development were analyzed and statistically significant metrics used to determine empiric risk-stratification criteria. These criteria and American College of Rheumatology (ACR) risk-stratification guidelines were applied retroactively to determine predictive power.
One hundred eighty-four patients met inclusion criteria and were included. Twenty-one new cases of uveitis developed during the study period. There were no statistically significant differences between no DMARD treatment, methotrexate (MTX), and etanercept (ETA) groups in uveitis incidence, whereas the adalimumab (ADA) and other biologics groups had no uveitis cases. Under the empirically determined criteria, the ratio of uveitis incidence between high- and low-risk groups was 8.21 (2.68-33.55; P < .0001), whereas it was 1.90 (0.72-4.93; P = .15) under the ACR criteria.
Patients on MTX, ETA, and no DMARD treatment were comparable in JIA-associated uveitis incidence, whereas there were no new cases with ADA or other biologics. Further, we found increased predictive power in the empiric criteria in comparison to current ACR risk stratification.
