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Visual outcomes remain good in uveitis associated with juvenile idiopathic arthritis
J AAPOS. 2008;12(6):539-545.
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Good visual outcomes and low complication rates were found in most uveitic patients with juvenile idiopathic arthritis who were followed for at least 1 year at a single center.
A retrospective review of 1,081 patients with juvenile idiopathic arthritis showed that 142 of those patients developed uveitis after being followed for an average of 6.3 years (range, 0.1 to 23.2 years).
Chronic anterior uveitis occurred in 97 children (68.3%), acute anterior occurred in 23 (16.2%), recurrent anterior occurred in 17 (12%) and panuveitis occurred in five (3.5%).
The study authors found a statistically significant difference (P < .0001) between complication rates in uveitic eyes treated with oral prednisone (59.1%) and those not treated with oral prednisone (15.6%). Secondary complications occurred in 53 of the 142 cases (37.3%), with the most common being cataract.
At last follow-up, best corrected visual acuity data were available for 175 eyes; 159 eyes (90.8%) were 20/40 or better, six eyes of four patients had impaired visual acuity and 10 eyes of 10 patients were blind.
My experience in patients with juvenile idiopathic arthritis-associated uveitis mirrors that of Sabri and colleagues in that good long-term vision depends most directly upon prompt and complete control of the uveitis, which often requires use of both corticosteroids and non-corticosteroid immunosuppressive agents. While anti-tumor necrosis factor agents need to be used with caution, given the risk of drug-associated adverse events, these agents appear to provide benefit for some patients. Cataract surgery should only be done in patients with juvenile idiopathic arthritis once the inflammation has been well-controlled for 3 to 6 months.
– Emmett T. Cunningham, MD
OSN Retina/Vitreous Board Member