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Kwon, Baek, Park, Kim, and Park: Clinical Manifestation of Juvenile Idiopathic Arthritis Associated Uveitis in Korea
Original Article

J Korean Ophthalmol Soc 2013;54(12):1838-1843.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.12.1838

Clinical Manifestation of Juvenile Idiopathic Arthritis Associated Uveitis in Korea

Soon Il Kwon, MD1, Sung Uk Baek, MD1, In Won Park, MD, PhD1, Kwang Nam Kim, MD, PhD2, Chan Kee Park, MD, PhD3,

1Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea

2Department of Pediatrics, Hallym University College of Medicine, Anyang, Korea

3Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Chan Kee Park, MD, PhD Department of Ophthalmology, The Catholic University Seoul St. Mary’s Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea, Tel: 82-2-2258-6200, Fax: 82-2-599-7405, E-mail: ckpark@catholic.ac.kr

Received 16 May 20134 July 2013       Accepted 4 November 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the incidence and clinical characteristics of juvenile idiopathic arthritis (JIA)-associated uveitis in Korea and to identify the risk factors for developing uveitis and poor visual outcome.

Methods

We performed a retrospective chart review of 149 patients who were diagnosed as JIA between January 2001 and December 2012. Patients were classified based on the International League of Associations for Rheumatology (ILAR) criteria and the incidence and clinical course of uveitis according to each subtype was investigated. We also evaluated the risk factors for poor prognostic outcomes.

Results

The present study included 79 males and 70 females and the mean age was 7.42 ± 3.82 years. In 13 patients (8.6%), uveitis manifested evenly among JIA subtypes, including 5 patients with oligoarthritis type, 4 patients with polyarthritis rheumatoid negative type, and 4 patients with systemic type. Anti-nuclear antibody (ANA) was detected more in the uveitic group (46.13%). The characteristics of uveitis were acute (85%), bilateral (85%), and anterior uveitis (92%). Chronic uveitis occurred in only 2 patients who had uveitis at an early age (mean age of 5 years) and had severe anterior chamber reaction at presentation. Poor visual outcome was associated with band keratopathy and posterior synechiae preceded by the chronic uveitis.

Conclusions

JIA-associated uveitis occurred evenly in each subtype. Uveitis was increased in the presence of ANA. Most uveitis showed good visual outcomes but in cases of early uveitis onset and with severe anterior chamber reaction at pre-sentation the risk of chronic uveitis increased resulting in poor visual outcomes.

Keywords: ANA, Juvenile idiopathic arthritis, Risk factor, Uveitis

References

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Table 1.
Characteristics of all JIA patients
Subtype of JIA Sex (male:female) Mean age at diagnosis of JIA RF (+) n (%) ANA (+) n (%) HLA B27 (+) n (%)
Oligoarthritis persistent 14:22 8.80 ± 4.39 3 (8.3) 9 (25) 11 (30.6)
Oligoarthritis extended 12:8 6.67 ± 5.04 3 (15) 6 (30) 5 (25)
Polyarticular RF(+) 1:4 8.50 ± 6.36 5 (100) 3 (60) 0 (0)
Polyarticular RF(-) 17:16 5.89 ± 2.80 0 (0) 13 (39.4) 6 (18.2)
Systemic 28:20 6.75 ± 3.07 2 (6.1) 6 (12.5) 5 (10.4)
Enthesitis related arthritis 5:0 8.67 ± 1.15 0 (0) 0 (0) 4 (57.1)
Total 79:70 7.42 ± 3.82 13 (8.6) 36 (24.8) 28 (20.1)

Values are presented as mean ± SD.

JIA = juvenile idiopathic arthritis; RF = rheumatoid factor; ANA = antinuclear antibody; HLA = human leukocyte antigen.

Table 2.
The Characteristics of uveitis patients
No. Sex Age Dx of JIA (years) JIA subtype RF ANA HLA B27 Initial BCVA Last BCVA Type of uveitis Bi/uni Ocular Cx
1 M 17 5 Oligo. (PE) ‐ ‐ ‐ B)20/20 B)20/20 AAU Bilat.  
2 F 10 3 Poly RF(‐) ‐ ‐ ‐ B)20/20 B)20/20 AAU Bilat.  
3 F 17 12 Oligo (PE) + + ‐ B)20/20 B)20/20 APU Bilat. IOP↑
4 F 19 15 Syst ‐ + ‐ B)20/20 B)20/20 AAU Bilat.  
5 M 20 6 Enthe ‐ ‐ + B)20/20 B)20/20 AAU Bilat.  
6 F 10 4 Syst ‐ + ‐ B)20/20 B)20/20 AAU Uni.  
7 M 18 9 Enthe ‐ ‐ ‐ B)20/20 B)20/20 AAU Uni. IOP↑
8 F 15 5 Syst ‐ ‐ ‐ B)20/20 B)20/20 AAU Bilat.  
9 M 13 10 Oligo (PE) ‐ ‐ ‐ B)20/20 B)20/20 AAU Bilat. Cataract
10 M 12 8 Syst ‐ + ‐ B)20/20 B)20/20 AAU Bilat.  
11 M 16 13 Oligo (Ex) ‐ ‐ ‐ B)20/20 B)20/20 AAU Bilat.  
12 M 7 2 Oligo (Ex) ‐ + ‐ B)20/20 20/20 CAU Bilat. PS
                  20/40     Band KP
13 F 12 5 Poly (RF‐) ‐ + ‐ B)20/20 20/40 CAU Bilat. PS
                  20/40     IOP↑
                        Band KP

JIA = juvenile idiopathic arthritis; RF = rheumatoid factor; ANA = antinuclear antibody; HLA = human leucocyte antigen; BCVA = best corrected visual acuity; Bi/Uni = bilateral/unilateral; Cx = complication; Oligo(PE) = oligoarthritis persistent type; Oligo(Ex) = oligoarthritis extended type; Poly RF(-) = polyarthritis RF(-) type; Syst = systemic type; Enthe = enthesitis related arthritis; AAU = acute anterior uveitis; APU = acute posterior uveitis; CAU = chronic anterior uveitis; IOP↑ = elevated intraocular pressure; PS = posterior synechiae; Band KP = band keratopathy.

Table 3.
The relationship of ANA or HLA-B27 to uveitis
  Uveitis (+) Uveitis (-) p-value*
ANA(+) 6 36 0.04
ANA(-) 7 113  
HLA-B27(+) 1 28  
HLA-B27(-) 12 121 0.283

ANA = antinuclear antibody; HLA = human leukocyte antigen.

* Chi-square test (p < 0.05).

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