Determining Risk for New-Onset Uveitis in Juvenile Idiopathic Arthritis

Young age (<7 years) and a positive antinuclear antibody (ANA) test are both independent predictors of new-onset uveitis in patients with juvenile idiopathic arthritis (JIA), which supports vigilant surveillance for uveitis for ≥5 years following a diagnosis of JIA, according to the results from  a large prospective independent cohort study published in Arthritis Care & Research.

The investigators sought to estimate the yearly incidence of new-onset uveitis following a JIA diagnosis and to identify associated risk factors, utilizing data from the Research in Arthritis in Canadian Children Emphasizing Outcomes cohort. All data were reported every 6 months for 2 years, then annually for 5 years. Data from study visits completed through June 30, 2011 were evaluated.

A total of 1183 patients enrolled within 6 months of JIA diagnosis met study inclusion criteria. Mean patient age at diagnosis was 9.0 years and the median study follow-up period was 35.2 months. Of the 1183 participants, 87 developed uveitis after study enrollment.

In the initial 5 years, the incidence of new-onset uveitis was 2.8% annually (95% CI, 2.0%-3.5%). Although the annual incidence decreased during follow-up, it remained at 2.1% in the fifth year (95% CI, 0%-4.5%), although the CIs overlapped.

Uveitis was significantly associated with young age (<7 years) at diagnosis of JIA (hazard ratio [HR], 8.29; P <.001), female gender (HR, 1.80; P =.02), positive ANA test (HR, 3.20; P <.001), rheumatoid factor-negative polyarthritis (HR, 1.65; P =.002), and oligoarthritis (HR, 2.45; P =.002). On multivariable analysis, only young age at JIA diagnosis and positive ANA test were independent predictors of uveitis.

The major strengths of this study included the prospective inception cohort design and the designation of time of JIA diagnosis as the point of reference. It is possible, however, that since the data were collected by protocol for study visits at 6-month intervals in the first 2 years and then annually for 5 years, uveitis diagnosed in the months prior to a study visit may not have been reported.

The investigators concluded that priority for uveitis screening should be given to children with JIA who are <7 years and have a positive ANA test.

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Reference

Lee JJY, Duffy CM, Guzman J, et al; ReACCh-Out Investigators. Prospective determination of the incidence and risk factors of new-onset uveitis in juvenile idiopathic arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort [published online October 15, 2018]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23783