New model may help assess chronic uveitis risk in juvenile idiopathic arthritis
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A validated prognostic tool using common clinical markers could help clinicians evaluate patients with juvenile idiopathic arthritis for chronic uveitis risk, according to data published in Arthritis & Rheumatology.
“The reason why we started this study is that patients with JIA are nowadays still classified as having a ‘high,’ ‘moderate’ or ‘low’ risk for developing chronic uveitis according to current screening guidelines,” Joeri W. van Straalen, MSc, of the department of pediatric immunology and rheumatology at Wilhelmina Children's Hospital, in the Netherlands, told Healio. “These are of course subjective terms that could be interpreted differently by each individual and it would be an improvement to work with objective, more specific predicted probabilities.”
To develop a hazard model to aid in the prognostic evaluation of the risk for chronic uveitis in patients with JIA, van Straalen and colleagues used data from the International Pharmachild registry. To be included in the registry, children are required to be diagnosed with JIA according to criteria set forth by the International League of Associations for Rheumatology and be receiving current or prior treatment with NSAIDs, corticosteroids or conventional synthetic or biological disease-modifying antirheumatic drugs. The registry includes patients from 31 countries.
The researchers locked in data for analysis purposes on May 3, 2019, and patients were only included in the analysis if they had two or more registered and eligible visits. The goal of the new tool was to predict the 2-, 4- and 7-year risk for new onset chronic uveitis following the onset of JIA. The researchers identified the potential factors of uveitis prediction via expert agreement and literature. Data for each patient, including sex, age at time of JIA onset, category of disease, status of presence of antinuclear antibodies, human leukocyte antigen B27 status, family history of related diseases and geographic region were collected.
The researchers additionally collected data on methotrexate and adalimumab cessation prior to uveitis onset to investigate its potential role as a protective agent, but that information was not used to inform the model. The model was validated against two JIA inception cohorts.
The model was developed using data from a total of 5,393 patients. According to the researchers, valid predictor variables included age at the time of JIA onset (HR = 0.83; 95% CI, 0.77-0.89), antinuclear antibody positivity (HR = 1.59; 95% CI, 1.06-2.38) and category of disease. The HR for oligoarticular, psoriatic and undifferentiated diseases compared with rheumatic fever polyarthritis (1.4; 95% CI, 0.91-2.16). The performance of the model was “acceptable,” the researchers wrote.
“Pediatric rheumatologists can use the validated prediction model to easily obtain predicted probabilities for developing new-onset chronic uveitis at 2, 4 and 7 years of JIA disease duration,” van Straalen said. “Such predicted probabilities can be used as guidance in determining ophthalmological screening frequencies, to inform — and perhaps comfort — patients and parents, and provide rationale for starting methotrexate or adalimumab therapy.”
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