Atamyıldız Uçar Sıla, Tunce Eray, Koçkar Alev, Kardeş Esra, Sözeri Betül
From the Departments of Pediatric Rheumatology.
Ophthalmology, Umraniye Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye.
J Clin Rheumatol. 2025 Aug 1;31(5):e58-e65. doi: 10.1097/RHU.0000000000002248. Epub 2025 Jun 2.
To evaluate the timing of uveitis onset in patients with oligoarticular juvenile idiopathic arthritis (oJIA) and to identify clinical characteristics associated with its development.
This medical records review study included 611 oJIA patients followed for at least 6 months between August 2016 and February 2024. Patients were classified as with uveitis (n = 96, 15.7%) or without uveitis (n = 515, 84.3%). Uveitis cases were further stratified by timing: group 1 (n = 65, 10.6%) developed uveitis after arthritis onset, whereas group 2 (n = 31, 5.1%) were diagnosed with uveitis at their first ophthalmologic evaluation. Demographics, clinical features, and treatment characteristics were compared across groups.
Uveitis occurred in 15.7% of oJIA patients. Patients with uveitis had a significantly younger age at arthritis onset with a median of 4.3 years (interquartile range [IQR], 1.9-9.3 years), compared with those without uveitis (8.5 years; IQR, 5-11.5 years) ( p < 0.001), and had a higher antinuclear antibody positivity rate (70.8% vs. 45.6%, p < 0.001). Methotrexate was the predominant initial treatment for oJIA, and the median duration of usage was 13 months (IQR, 6.8-26 months) until the onset of uveitis. Among the 81 patients who received etanercept as their initial biologic, 14 (17.3%) developed uveitis during the follow-up period. A total of 25 patients (26%) had ocular complications, with a significantly higher proportion observed in those with uveitis at their initial examination (n = 14, 45.1%) compared with those who develop uveitis after arthritis onset (n = 11, 16.9%) ( p = 0.003).
Our study highlights younger age at oJIA diagnosis and antinuclear antibody positivity as significant risk factors for uveitis development. Uveitis in oJIA may occur before, concurrently with or after arthritis onset. Early recognition, routine screening, and timely therapeutic escalations are essential to improve outcomes in patients with oJIA-associated uveitis.
评估少关节型幼年特发性关节炎（oJIA）患者葡萄膜炎发病的时间，并确定与其发生相关的临床特征。
这项病历回顾研究纳入了2016年8月至2024年2月期间随访至少6个月的611例oJIA患者。患者被分为患有葡萄膜炎组（n = 96，15.7%）和未患有葡萄膜炎组（n = 515，84.3%）。葡萄膜炎病例根据发病时间进一步分层：第1组（n = 65，10.6%）在关节炎发病后发生葡萄膜炎，而第2组（n = 31，5.1%）在首次眼科评估时被诊断为葡萄膜炎。对各组的人口统计学、临床特征和治疗特征进行比较。
15.7%的oJIA患者发生葡萄膜炎。与未患葡萄膜炎的患者相比，患葡萄膜炎的患者关节炎发病时年龄显著更小，中位数为4.3岁（四分位间距[IQR]，1.9 - 9.3岁），而未患葡萄膜炎的患者为8.5岁（IQR，5 - 11.5岁）（p < 0.001），且抗核抗体阳性率更高（70.8%对45.6%，p < 0.001）。甲氨蝶呤是oJIA的主要初始治疗药物，使用至葡萄膜炎发病的中位持续时间为13个月（IQR，6.8 - 26个月）。在81例初始使用依那西普作为生物制剂的患者中，14例（17.3%）在随访期间发生葡萄膜炎。共有25例患者（26%）出现眼部并发症，初始检查时患有葡萄膜炎的患者中观察到的比例显著高于关节炎发病后发生葡萄膜炎的患者（n = 14，45.1%对n = 11，16.9%）（p = 0.003）。
我们的研究强调oJIA诊断时年龄较小和抗核抗体阳性是葡萄膜炎发生的重要危险因素。oJIA中的葡萄膜炎可能在关节炎发病之前、同时或之后发生。早期识别、常规筛查和及时的治疗升级对于改善oJIA相关葡萄膜炎患者的预后至关重要。
