The Association of Race With Childhood Uveitis

Abstract

Purpose To identify risk factors for a severe uveitis course among children with non-infectious uveitis. Design Retrospective cohort study Method This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3-6 months (2011-2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African American and non-Hispanic White children only. Results Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African American and White children showed an increased prevalence of VA ≤20/200 in non-Hispanic African Americans (18/25 (72%) vs. 4/43 (9%)). Non-Hispanic African Americans were more likely to be diagnosed at an older age (p=0.030), have intermediate uveitis (p=0.026), bilateral disease (p=0.032), a history of VA ≤20/50 (p=0.002), VA ≤20/200 (p<0.001), and a higher rate of complications (p<0.001). On multivariable analysis, non-Hispanic African American race was a significant predictor of blindness (OR=31.6, 95% CI (5.9– 168.5), p<0.001), after controlling for uveitis duration. Non-Hispanic African Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic Whites when controlling for uveitis type and duration. Conclusions There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African American children with non-juvenile idiopathic arthritis associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations.

Traumatic Intralenticular Neovascularization in a HLA B27+ Pediatric Patient

“…As such, the HLA B27+ status in our patient could have contributed to the overall inflammatory process and be linked to the patient's previous presentation for anterior uveitis. The greater association of unique complications with uveitis in African-American patients is noteworthy to our case [27].…”

“…However, compared to Caucasian children, uveitis in African-American children is markedly associated with a more severe visual prognosis [27] and bilateral eye disease, with more frequent complications such as development of cataracts, glaucoma, synechiae, band keratopathy and cystoid macular edema and also an increased rate of development of unique complications [27]. Poorer outcomes were especially observed in African-American children with non-JIA associated uveitis [27]. In the case of clinically manifest Ankylosing Spondylitis (AS) associated with HLA B27+ status, African populations have higher overall disease activity and progression with more comorbidities [28,29] and poorer visual outcomes in case of uveitis [30] and were more likely to present with hypopyon [30].…”

“…HLA B27 associations with Ankylosing Spondylitis (AS) and other related pathologies are lower in African populations compared to European populations with the prevalence of HLA alleles being exceedingly rare (<1%) [25], especially in Central African populations [26] similar to our patient. However, compared to Caucasian children, uveitis in African-American children is markedly associated with a more severe visual prognosis [27] and bilateral eye disease, with more frequent complications such as development of cataracts, glaucoma, synechiae, band keratopathy and cystoid macular edema and also an increased rate of development of unique complications [27]. Poorer outcomes were especially observed in African-American children with non-JIA associated uveitis [27].…”

Incidence and predictors of Uveitis in juvenile idiopathic arthritis in a Nordic long-term cohort study

“…The reported prevalence of uveitis in JIA varies highly, and ethnic and geographic differences seem to exist. Recent publications show a prevalence of 8–25% in most Caucasian populations [ 6 , 7 ], while some studies from other continents show lower percentage of uveitis, 1 to 7% [ 8 , 9 ]. Young age at onset of arthritis and presence of ANA were predictors of uveitis in most studies [ 3 , 10 – 12 ].…”

Patterns of intermediate uveitis in children presenting at a tertiary eye care center in South India

“…There appear to be racial differences in the outcomes of children with uveitis. [ 21 ] The variation in disease severity prompts the use of individually tailored immunosuppressive regimens.…”