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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).
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.
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.
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 |
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 |
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