Uveitis Associated with Juvenile Arthritis May Continue Into Later Life

Angelika Skarin, PhD

New findings suggest uveitis associated with juvenile idiopathic arthritis may be active into midlife or longer, supporting the need for regular ophthalmic check-ups throughout life in this cohort of patients.

In a third follow-up of a patient cohort with juvenile arthritis-associated uveitis, investigators reported ocular complications and vision loss increased up to 40 years after diagnosis

“Our data support previous findings indicative of a possible higher mortality rate in adult patients with juvenile arthritis than in the rest of the population,” wrote study author Angelika Skarin, PhD, Department of Ophthalmology, Clinical Sciences Lund, Skåne University Hospital.

The results were part of the third follow-up study of a cohort of 55 patients with juvenile arthritis-associated uveitis. Investigators reported 49% of patients had active uveitis at 24 years after onset and an increase in the prevalence of cataract and glaucoma were seen between 7 and 24 years.

Of the original 55 patients, only 30 consented to participate in the present follow-up study. From this population, 26 reported having ophthalmic medical records covering the years 2016-2017. At the time of the study, the mean age was reported as 46.9 years, while the mean duration of joint disease was 42.9 years and the mean time from onset of uveitis was 40.7 years.

In this follow-up, investigators reported uveitis was active in 43.4% (n = 13 of 30), corresponding to 23.6% (n = 13 of 55) of the original cohort. Further, data show 20 of 30 (66.6%) of the participants had cataracts or had undergone cataract surgery in one or both eyes.

In a comparison of data from previous follow-up of the cohort, a total of 61.8% (n = 34 of 55) patients were reported to have had cataracts or had undergone cataract surgery at any of the 3 follow-ups. Moreover, a total of 16 of 55 (29.0%) patients in the original cohort were reported to have glaucoma or ocular hypertension and a total of 7 of 55 (12.7%) have visual impairment in both eyes at any of the 3 follow-ups.

At a mean of 40.7 years after uveitis onset, investigators reported 20% of the patients in the original uveitis cohort were deceased (n = 11). They noted in 4 of the 11 deceased individuals, rheumatic disease was stated as the main cause of death and a contributory factor in 3 patients.

They additionally noted that modern treatments for juvenile arthritis are seemingly successful in reducing the acute and severe consequences of joint disease and uveitis, but do not appear to reduce the incidence of uveitis significantly.

“Prospective studies of adult juvenile idiopathic arthritis patients are needed to clarify better how both systemic and topical eye treatments should be optimized to reduce the risk of visual impairment,” Skarin added.

The study, “Uveitis associated with juvenile arthritis: a continued cohort study 40 years after uveitis onset,” was published in Pediatric Rheumatology.