Uveitis has 'significant impact' on vision-related quality of life, visual function in JIA
Uveitis has a “significant impact” on visual functioning and vision-related quality of life among children with juvenile idiopathic arthritis, according to data published in Arthritis Care & Research.
“Most forms of uveitis in the United States are not attributable to infection,” Joseph McDonald, MD, of the Cincinnati Children’s Hospital Medical Center, and colleagues wrote. “Juvenile idiopathic arthritis (JIA) is the most common systemic disease association. Uveitis without concomitant systemic disease is known as idiopathic uveitis and has a similar incidence as JIA-associated uveitis (JIA-U). In pediatric uveitis, the ophthalmic examination remains the primary method to assess disease status and guide therapy.”
“Intraocular inflammation (presence of inflammatory cells and flare) represents disease activity, visual acuity (VA) indicates level of vision impairment, and presence of ocular complications denotes ocular damage,” they added. “These measures, however, likely underestimate the true impact of disease on the child, since they do not account for the effect of vision impairment and the burden of chronic disease management on a child’s quality of life (QOL) and functioning. ... Characterizing QOL outcomes in children with uveitis could complement clinical assessment and improve disease management.”
To analyze the health-related quality of life, mental health, physical disability, vision-related functioning and vision-related quality of life among children with JIA, JIA-associated uveitis and other noninfectious uveitis, McDonald and colleagues conducted a cross-sectional study of 549 participants at four sites. Study centers included the Cincinnati Children’s Hospital Medical Center, Emory University in Atlanta, Children’s Mercy Hospital in Kansas City, Missouri, and the University of California Los Angeles. Patients aged 5 to 18 years were enrolled during regular visits from Nov. 30, 2011, to Sept. 27, 2019.
In all, 332 patients with JIA, 124 with JIA-associated uveitis and 93 with other uveitis were included in the study. Participants and their parents completed the Pediatric Quality of Life Inventory Version 4.0 (PedsQL), the Revised Childhood Anxiety and Depression Scale (RCADS), the Childhood Health Assessment Questionnaire (CHAQ) and the Effects of Youngsters’ Eyesight on Quality of Life (EYE-Q) questionnaire. The researchers used the provided answers to compare characteristics and patient‐reported outcome measures (PROMs) based on diagnosis.
According to the researchers, children with JIA‐associated uveitis demonstrated worse EYE‐Q scores compared with those with JIA only. Among all participants with uveitis, those with anterior uveitis experienced fewer ocular complications and better EYE‐Q scores, but worse CHAQ and PedsQL physical summary scores, compared with those with non‐anterior disease. In participants with anterior uveitis, those with JIA‐associated uveitis demonstrated worse PedsQL physical summary and CHAQ scores than anterior uveitis only. Lastly, EYE‐Q scores were worse among patients with bilateral uveitis and more visual impairment.
The researchers reported no differences in RCADS scores among the groups.
“We described a large cohort of pediatric uveitis patients and provided a comprehensive outcome assessment including traditional outcome measures in uveitis such as VA, disease activity, and ocular complications,” McDonald and colleagues wrote. “The results were bolstered by the inclusion of PROMs measuring general HR-QOL, VRF, VRQOL, physical disability and mental health. We demonstrated the importance of implementing a vision and uveitis-specific measure, which was able to not only distinguish those patients with uveitis but also differentiate those with bilateral disease and vision impairment.”
“The use of PROMs allows us to more accurately describe the effect that uveitis had on the everyday life of a child suffering from this disease,” they added. “Larger and more diverse cohorts are needed to study the impact of visual impairment and ocular complications on QOL and functioning.”