Among patients with juvenile idiopathic arthritis associated with uveitis (JIA-U), a significant temporal association was found between arthritis and uveitis disease activity, according to study results published in Arthritis Care & Research. Researchers also suggested that these results support the referral of these patients to an ophthalmologist for early diagnosis and treatment of the arthritis flare.
The current study aimed at determining the temporal association between arthritis and uveitis activity among children with JIA-U.
In this retrospective, single-center, longitudinal cohort study, the researchers included data from The Children’s Hospital of Philadelphia, Pennsylvania, between July 1, 2013 and December 1, 2019. Young patients (aged ≤21 years) with a diagnosis of JIA and a history of uveitis were eligible for inclusion in the study. Arthritis activity was determined at each rheumatology visit. The primary end point was the presence of active uveitis up to 45 days both before and after each rheumatology visit.
The study cohort included 98 patients (82% girls; median age at JIA diagnosis, 3.3 years). During the follow-up period between 2013 and 2019, there were 1229 rheumatology visits from the study cohort, with evidence for active arthritis in 17%.
Proximate active uveitis within 45 days of a joint exam was documented in 225 visits (18%), including 69 visits (6%) with active uveitis within 45 days of active arthritis. Inactive uveitis occurred within 45 days of inactive arthritis in 625 visits (51%). Overall, concordance between arthritis and uveitis activity was evident in 73% of the time.
Risk for active uveitis within 45 days of a joint exam was 2.5 fold higher with evidence for active arthritis compared with inactive arthritis (odds ratio [OR], 2.47; 95% CI, 1.72-3.54; P <.01). The predicted probability of active uveitis within 45 days of active arthritis was 65% (95% CI, 0.49-0.77), as compared to a predicted probability of 42% (95% CI, 0.28-0.57) in children without active arthritis.
Risk for active uveitis at any time point was lower for patients using a combination of biologic and nonbiologic disease-modifying antirheumatic drugs (OR, 0.45; 95% CI, 0.30-0.68; P <.01), girls (OR, 0.59, 95% CI, 0.39-0.90; P =.01), who were tested HLA-B27-positive (OR, 0.59; 95% CI, 0.35-1.00; P =.05), with enthesitis-related arthritis subtypes (OR, 0.30; 95% CI, 0.16-0.55; P <.01), and polyarticular rheumatoid factor negative subtypes (OR, 0.47; 95% CI, 0.29-0.75; P <.01).
The study had several limitations, including the study design, relatively small sample size, the proportion of missing data, and the lack of performing an eye exam within 45 days of a rheumatology visit.
“[T]his novel work has demonstrated an independent temporal association between uveitis and arthritis activity in patients with JIA-U, with a nearly 2.5-fold higher odds of having active uveitis in the context of active arthritis. This important finding challenges the prior paradigm that uveitis runs a separate course from arthritis, and suggests that an arthritis flare should prompt urgent referral to the ophthalmologist in this population,” the researchers concluded.
Liebling EJ, Faig W, Chang JC, et al. The temporal relationship between juvenile idiopathic arthritis disease activity and uveitis activity. Arthritis Care Res (Hoboken). Published online October 12, 2020. doi:10.1002/acr.24483