The frequency and outcome of uveitis in patients with newly diagnosed juvenile idiopathic arthritis in two 4-year cohorts from 1990-1993 and 2000-2003.

OBJECTIVES: To retrospectively compare the frequency and outcome of uveitis between two cohorts of patients with newly-onset juvenile idiopathic arthritis (JIA) separated by a 10 year interval. METHODS: The diagnosis of JIA was made in 239 patients in 1990-1993 and in 240 patients in 2000-2003 by paediatric rheumatologists at the Rheumatism Foundation Hospital, Heinola, Finland. An ophthalmologist examined all the patients regularly and diagnosed uveitis. The demographics of the patients, type of JIA, frequency, medical treatment and outcome of uveitis were documented. RESULTS: The main outcome measures were the frequency and outcome of uveitis, the number of complications and the best corrected visual acuity (BCVA), need of corticosteroids and other immunosuppressive treatment. The frequency of uveitis was higher (25% vs. 18%) in the earlier cohort. The visual outcome was ≥0.5 in all JIA-uveitis patients except one in the earlier cohort. Complications were fewer (21% vs. 35%) and uveitis was milder according to the Standardisation of Uveitis Nomenclature (SUN) criteria in the later cohort. Remission of uveitis (33% vs. 42%) and arthritis (20% vs. 23%) in JIA-uveitis patients was similar in both cohorts after a follow-up of 6.6 and 5.9 years, respectively. Systemic corticosteroids were more commonly used (25% vs. 7%) in JIA-uveitis patients of the earlier cohort but the use of methotrexate was equal in both cohorts (65% vs. 67%). CONCLUSIONS: In this study with early and aggressive treatment and close monitoring the outcome of JIA-uveitis patients was favourable and visual loss was avoided in most cases.

An evaluation of dry eye symptoms and signs in a cohort of children with juvenile idiopathic arthritis.

OBJECTIVE: To determine the prevalence of dry eye symptoms and signs in children with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: A total of 192 children with JIA: 48 oligo-, 39 extended oligo-, 79 polyarthritis, and 26 with other types of arthritis (eight juvenile spondyloarthritis, five juvenile psoriatic arthritis, three mixed connective tissue diseases, two systemic onset arthritis, and eight undetermined arthritis) were interviewed for dry eye symptoms and tested with Schirmer test with anesthetic. Two thirds of the patients were female and the mean age of the patients was 13.1 years (range 10-16) and the mean duration of arthritis was six years (SD 4, 4). Thirty-one percent of the patients had a history of uveitis. Dry eye was defined as Schirmer test score

Occurrence and management of ocular hypertension and secondary glaucoma in juvenile idiopathic arthritis-associated uveitis: An observational series of 104 patients.

AIMS: To describe the development and management of ocular hypertension (OHT) and secondary glaucoma (SG) in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. PATIENTS AND METHODS: A series of 104 patients with newly diagnosed JIA and associated uveitis was collected in 1989-1996. A re-evaluation was made after mean 9.7 years (range 0.8-15.6 years) follow-up. OHT was diagnosed if intraocular pressure (IOP) had been >/=22 mmHg for longer than 3 months or when a single IOP was >/=30 mmHg despite normal visual field and optic disc. SG was diagnosed in a patient who had optic disc changes and/or visual field defects compatible with glaucoma. RESULTS: OHT or SG developed in 14 patients (14%, 22 eyes). IOP was under control (<22 mmHg) in 2 patients without treatment and in 3 patients with medication. Filtering surgery was performed in 9 patients, 5 of them needed additional glaucoma medication. The binocular visual acuity was 0.5 or better in all patients; in five eyes vision was less than 0.5, but no eye blinded. CONCLUSION: OHT or SG in JIA patients with uveitis is a diagnostic and therapeutic challenge, but if the medical and surgical treatment is timed correctly, the sight can be saved in most patients.