Long Term Experience in Patients With JIA-Associated Uveitis in a Large Referral Center

Abstract

Objectives: To describe demographic, clinical and therapeutic findings of a large cohort of patients with JIA-associated uveitis in a nationwide referral pediatric rheumatology and uveitis center in Northern Italy.Methods: Retrospective study of 125 patients with JIA-associated uveitis followed from 2009 to 2019. Demographic and rheumatologic features including JIA ILAR classification, age at onset, and laboratory data were recorded. Ocular findings collected were: anatomic location of uveitis, laterality, type, recurrence rate, visual acuity, ocular complications, and local therapy. Systemic therapy with conventional and biologic immunosuppressants, occurrence of adverse events, and duration of treatments were recorded.Results: One hundred and twenty-five patients with JIA-associated uveitis were followed for a meantime of 9.2 (±1.7) years. Oligoarticular JIA was present in 92.8% of patients and anterior uveitis in 96%. The most common ocular complications recorded in our sample were posterior synechiae (37.6%), cataract (20.8%), band keratopathy (19.2%), glaucoma (7.2%), and macular edema (5.6%). Conventional immunosuppressants were used in 75.2% of patients with a mean duration of 9.1 years (±5.4), while biologics were administered in 47.2% of them for a period of 5.4 years. Adverse events (AE) were seen in 23% of patients being treated with Methotrexate, in 10.4% of patients treated with Adalimumab, in 38.5% of patients in therapy with Infliximab, and in 14.3% of patients being treated with Tocilizumab. No AE were reported in patients treated with Golimumab, Certolizumab, Abatacept and Rituximab.Conclusions: An aggressive treatment approach for patients with JIA-associated uveitis ensured a low number of ocular complications with a good safety profile.

Sociodemographic Factors and Comorbidities Including Hyperparathyroidism Are Associated With an Increased Risk of Band Keratopathy: A Population-Based Study in Taiwan

“…Our findings showed that iridocyclitis is indeed an independent risk factor of band keratopathy development (adjusted OR, 9.509; 95% CI, 7.183–12.589; P < 0.001, Table 2 ). This finding is consistent with that in previous reports, which showed that band keratopathy was a common ocular complication (19.2%–38%) in patients with Juvenile idiopathic arthritis-associated uveitis ( 4 , 35 , 36 ). The exact pathophysiology of band keratopathy is unknown, but it may be associated with phosphate breakdown due to pH changes on the ocular surface.…”

“…Histological analysis of affected corneas shows a fine granular calcification in the superficial cornea including the Bowman’s membrane and deep-situated calcium plaques involving the anterior stroma ( 1 , 3 ). A variety of factors are associated with band keratopathy, including chronic ocular conditions such as uveitis ( 4 , 5 ), silicon oil retention ( 6 , 7 ) and phthisis bulbi; and systemic condition such as diabetes mellitus (DM), chronic kidney disease (CKD) ( 8 ), elevated serum phosphate levels and increased serum calcium levels that are possibly related to secondary hyperparathyroidism ( 9 – 11 ).…”

Uveitis Is a Risk Factor for Juvenile Idiopathic Arthritis' Significant Flare in Patients Treated With Biologics

“…Uveitis and arthritis might have similar pathogenesis related to immune cell activation and TNF-a hyperproduction ( 18 , 19 ). Both arthritis and uveitis respond well to methotrexate and TNF-a inhibitors (adalimumab and infliximab) ( 20 ). Earlier prescription of methotrexate and biologics may decrease the incidence of uveitis ( 21 – 23 ).…”

Identification of molecular patterns and diagnostic biomarkers in juvenile idiopathic arthritis based on the gene expression of m6A regulators

“…As modern medicine advances by leaps and bounds, the prognosis of JIA has improved dramatically. However, certain children are afflicted with severe complications such as loss of joint function, lifelong eye damage owing to uveitis, and macrophage activation syndrome (MAS), which may be fatal ( 5 , 6 ). Therefore, effective early diagnostic biomarkers or models of JIA are highly sought after.…”

“…The role of N 6 -methyladenosine modification in immunity is increasingly being appreciated. However, the landscape of m 6 A regulators in juvenile idiopathic arthritis (JIA) is poorly understood.…”