Journal List > J Rheum Dis > v.25(1) > 1064377

Pyo, Lee, and Kim: Prevalence, Risk Factors, and Expression of Human Leukocyte Antigen-DRB1 in Juvenile Idiopathic Arthritis-associated Uveitis

Abstract

Objective

This study investigated the prevalence and risk factors of juvenile idiopathic arthritis (JIA)-associated uveitis (JIA-U) in a pediatric tertiary center in Korea. In addition, this study examined whether a specific HLA-DRB1 allele could be a predictive risk factor of uveitis in JIA.

Methods

The pediatric rheumatology and ophthalmology medical records for JIA between March 2006 and March 2016 were analyzed retrospectively. A total of 233 were enrolled in this study.

Results

Of 233 patients, 31 developed uveitis (13.3%): 14 oligoarticular, three polyarticular, six systemic, seven enthesitis-related, and one un-differentiated-type JIA. In oligoarticular JIA, 26.4% developed uveitis. The percentage of females with JIA-U was 54.8%, and the median age of the onset of JIA was 7.02 years in JIA-U. Antinuclear antibody (ANA) positivity in oligoarticular JIA-U was 57.1%. Of the 31 JIA-U cases, 26 (83.9%) were clinically asymptomatic when diagnosed. The allele frequency of HLA-DRB1*09 of the total JIA-U was higher than that of JIA without uveitis. HLA-DRB1*09 and HLA-DRB1*12 were higher in oligoarticular JIA-U than in JIA without uveitis.

Conclusion

Korean JIA-U has different features from JIA-U in Western countries. The sex ratio and age of JIA onset showed no significant differences in Korean JIA-U. The ANA positivity was more common in JIA-U than in JIA without uveitis only in oligoarticular type JIA. These differences might be due to genetic factors, particularly HLA-DRB1. These results suggest HLA-DRB1*09 and HLA-DRB1*12 in oligoarticular JIA to be risk factors for JIA-U in Korea. This is the first study to analyze the association between HLA-DRB1 and JIA-U in Korea.

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Figure 1.
Distribution of age at time of diagnosis of arthritis in 233 patients with juvenile idiopathic arthritis (JIA).
jrd-25-58f1.tif
Figure 2.
Human leukocyte antigen (HLA)-DRB1 phenotype frequencies in juvenile idiopathic arthritis-associated uveitis (JIA-U) and juvenile idiopathic arthritis (JIA) without uveitis. *p-value<0.05.
jrd-25-58f2.tif
Figure 3.
Human leukocyte antigen (HLA)-DRB1 phenotype frequencies of oligoarticular juvenile idiopathic arthritis (JIA) in juvenile idiopathic arthritis-associated uveitis (JIA-U) and JIA without uveitis. *p-value<0.05.
jrd-25-58f3.tif
Table 1.
Subtypes of JIA-U and JIA without uveitis
JIA subtype JIA-U (n=31) JIA without uveitis (n=202) Total JIA (n=233) p-value
Oligoarticular 14 (45.2) 39 (19.3) 53 (22.7) 0.001*
Polyarticular 3 (9.7) 46 (22.8) 49 (21.0) 0.096
Systemic 6 (19.4) 58 (28.7) 64 (27.5) 0.277
Psoriatic 0 (0) 1 (0.5) 1 (0.4) 1.0
Enthesitis-related 7 (22.6) 43 (21.3) 50 (21.5) 0.870
Undifferentiated 1 (3.2) 15 (7.4) 16 (6.9) 0.702

Values are presented as number (%). JIA-U: juvenile idiopathic arthritis-associated uveitis, JIA: juvenile idiopathic arthritis.

* p<0.05.

Table 2.
Characteristics of JIA-U and JIA without uveitis
Characteristic JIA-U (n=31) JIA without uveitis (n=202) p-value
Oligoarticular (n) 14 39  
Female 10 (71.4) 28 (71.8) 1.000
Age at JIA diagnosis (yr) 3.4 (0.5∼13.6) 4.3 (0.8∼14.3) 0.262
Interval of diagnosis between JIA and JIA-U 3.3 (0.8∼10.2) NA NA
ANA positivity 8 (57.1) 10 (25.6) 0.033*
Polyarticular (n) 3 46  
Female 3 (100.0) 32 (69.6) 0.548
Age at JIA diagnosis 10.2 (10.0∼11) 6.7 (1.3∼14.2) 0.094
Interval of diagnosis between JIA and JIA-U 3.8 (0.9-8.7) NA NA
ANA positivity 2 (66.7) 22 (47.8) 0.609
Systemic (n) 6 58  
Female 2 (33.3) 26 (44.8) 0.688
Age at JIA diagnosis (yr) 6.0 (1.4∼9.1) 5.3 (1.0∼15.3) 0.440
Interval of diagnosis between JIA and JIA-U 6.3 (0.3∼11.3) NA NA
ANA positivity 0 (0) 9 (15.5) NA
Enthesitis-related (n) 7 43  
Female 1 (14.2) 4 (9.3) 0.546
Age at JIA diagnosis (yr) 9.6 (6.2∼15.7) 9.8 (3.5∼15.8) 0.722
Interval of diagnosis between JIA and JIA-U 8.1 (1.0∼12.7) NA NA
ANA positivity 0 (0) 7 (16.3) NA
Total JIA (n) 31 202  
Female 17 (54.8) 101 (50.0) 0.616
Age at JIA diagnosis (yr) 7.02 (0.5∼15.7) 7.25 (0.8∼15.8) 0.440
Interval of diagnosis between JIA and JIA-U 4.0 (0.3∼12.7) NA NA
ANA positivity in JIA 10 (32.2) 56 (27.7) 0.602

Values are presented as number (%) or median (range). JIA-U: juvenile idiopathic arthritis-associated uveitis, JIA: juvenile idiopathic arthritis, ANA: antinuclear antibody, NA: not available.

* p<0.05.

Table 3.
Initial ocular signs and symptom in JIA-U
Characteristic JIA-U (n=31)
Signs and symptoms (n=5) Ocular pain and/or redness 5
Change in vision 2
Photophobia 2
Asymptomatic (n=26)  

JIA-U: juvenile idiopathic arthritis-associated uveitis.

Table 4.
Frequency of complications of JIA-U
Complication JIA-U (n=8)
Synechiae 4
Band keratopathy 5
Cataract 2
Glaucoma Hypopyon 1 2
Near blindness 2

JIA-U: juvenile idiopathic arthritis-associated uveitis.

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