Uveitis associated with juvenile idiopathic arthritis and chronic idiopathic uveitis in children: A retrospective cohort study.

BACKGROUND

Chronic idiopathic uveitis (CIU) and juvenile idiopathic arthritis-associated uveitis (U-JIA) are both vision-threatening conditions that share similar autoimmune mechanisms, but treatment approaches differ significantly. In managing U-JIA, various treatment options are employed, including biological and non-biological disease-modifying anti-rheumatic drugs. These drugs are effective in clinical trials. Given the lack of established diagnostic and treatment guidelines as well as the limited number of therapeutic options available, patients with CIU frequently do not receive optimal and timely immunosuppression. This study highlighted the necessity for additional research to develop novel diagnostic techniques, targeted therapies, and enhanced treatment outcomes for young individuals with CIU.

AIM

To compare the characteristics and outcomes of U-JIA and CIU.

METHODS

A retrospective cohort study analyzed data from 110 pediatric patients (under 18 years old) with U-JIA and 40 pediatric patients with CIU. Data was collected between 2012 and 2023. The study focused on demographic, clinical, treatment, and outcome variables.

RESULTS

The median onset age of arthritis was 6.4 years (2.7 years; 9.3 years). In 28.2% of cases uveitis preceded the onset of arthritis. In 17.3% of cases it occurred simultaneously. In 53.6% of cases it followed arthritis. Both groups had similar onset ages, antinuclear antibodies/human leukocyte antigen positivity rates, and ESR levels, with a slight predominance of females (60.9% 42.5%, = 0.062), and higher C-reactive protein levels in the U-JIA group. Anterior uveitis was more prevalent in patients with U-JIA ( = 0.023), although the frequency of symptomatic, unilateral, and complicated forms did not differ significantly. The use of methotrexate (83.8% 96.4%) and biologics (64.7% 82.1%) was comparable, as was the rate of remission on methotrexate treatment (70.9% 56.5%) and biological therapy (77.8% 95%), but a immunosuppressive treatment delay in CIU observed. Patients with CIU were less likely to receive methotrexate [hazard ratio (HR) = 0.48, = 0.005] or biological treatment (HR = 0.42, = 0.004), but they were more likely to achieve remission with methotrexate (HR = 3.70, = 0.001).

CONCLUSION

Treatment of uveitis is often limited to topical measures, which can delay systemic therapy and affect the outcome. Methotrexate and biological agents effectively manage eye inflammation. It is essential to develop standardized protocols for the diagnosis and management of uveitis, and collaboration between rheumatologists and ophthalmologists is needed to achieve optimal outcomes in the treatment of CIU.