Regular eye exam reminders bolster uveitis awareness in families with juvenile arthritis
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Eye exam reminders at every visit are associated with higher uveitis knowledge among patients with juvenile idiopathic arthritis and their parents, according to data published in Pediatric Rheumatology.
“In addition to joint inflammation, 10–20% of children with JIA develop chronic anterior uveitis,” Ashley M. Cooper, MD, of Children’s Mercy Kansas City and the University of Missouri-Kansas City School of Medicine, and colleagues wrote. “Although JIA-associated uveitis is often asymptomatic early in the disease course, it can lead to visual compromise through the development of cataracts, glaucoma, macular edema, band keratopathy and inflammatory membranes in up to 70% of patients.”
“Ballenger et al. examined barriers to uveitis screening at a single center, where 37% of patients with JIA were nonadherent to the recommended screening interval, and over one-fourth of patients were not familiar with the recommended frequency of eye exams,” they added. “A detailed assessment of patient knowledge about the complications of uveitis and the exam components which are necessary to adequately screen for uveitis was not included in that study.”
To analyze knowledge about uveitis complications and screening recommendations among patients with JIA and their families, Cooper and colleagues, together with members of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Uveitis Workgroup, conducted a survey. Participants were patients with JIA aged 14 years and older, as well as parents of patients with JIA, recruited from Children’s Mercy Kansas City, Children’s National Hospital, in Washington, D.C., and Children’s Healthcare of Atlanta/Emory University. Participants were also enrolled online through the PARTNERS collaborative.
The survey included six demographic questions, six arthritis/uveitis history questions and nine uveitis knowledge questions. The researchers calculated an overall knowledge score, as a composite measure, by summing the number of correct individual knowledge questions, resulting in a range of zero to nine. They additionally used ANOVA, chi-square and Fisher’s exact tests to determine relationships between survey questions and demographic variables. In all, 33 patients and 111 parents completed the survey.
According to the researchers, 17.4% of respondents reported a history of uveitis, while 89.6% reported that they had heard of uveitis. The mean composite knowledge score was 6.46±2.6 out of nine. Respondents with a history of uveitis, either in themselves (P=.01) or in their children (P<.01), demonstrated higher composite knowledge scores than those without said history.
In addition, parents of patients whose rheumatologists reminded them about eye exams at every visit demonstrated higher knowledge of the risk for blindness (P=.04), the risk for uveitis when arthritis is controlled (P=.02), and the need for ongoing eye exams when off medication (P=.01), compared with those who were reminded at some visits or not at all. Parents of patients who received reminders at every visit also demonstrated a higher overall knowledge score (P=.02).
“Patients and parents of patients with JIA were aware of uveitis, but the depth of knowledge varied,” Cooper and colleagues wrote. “Factors associated with a higher knowledge about uveitis complications and screening recommendations were a personal history of uveitis and eye exam reminders at every rheumatology visit. Incorporating standardized and frequent education about uveitis into rheumatology clinic appointments may be an effective strategy to improve knowledge about uveitis and subsequently visual outcomes in JIA patients, as early diagnosis and treatment is critical for retention of vision.”
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