Treatment with disease modifying antirheumatic drugs (DMARDs) and biologic disease modifying antirheumatic drugs (bDMARDs) may be effective for preserving vision among children diagnosed with uveitis, according to results of a longitudinal, population-based cohort study published in Pediatric Rheumatology.
While pediatric uveitis typically presents as asymptomatic, it can progress chronically, leading to damage of ocular structures and vision. Data on the long-term treatment effects of uveitis among children are lacking. Investigators assessed clinical characteristics, treatments, disease activity, and visual outcomes among children with with idiopathic uveitis (idio-U) or juvenile idiopathic arthritis associated uveitis (JIA-U).
Children aged less than 16 years presenting to the hospital with idio-U or JIA-U from January 2008 through December 2017 were included in the study. Visual outcomes were assessed via the Snellen chart, with an acuity of less than 0.3 (6/18) indicating impairment. Level of uveitis activity was classified according to Standardization of Uveitis Nomenclature.
A total of 119 children were included in the final analysis. Among them, 23% had idio-U (37% girls) and 77% had JIA-U (65% girls). The mean age at uveitis occurrence was 10 (SD, 3.4) years in the idio-U group vs 5.5 (SD, 3.3) years in the JIA-U group.
Uveitis was located in the anterior portion of the eye in 74% of patients with idio-U and 99% of those with JIA-U (P <.001). Chronic uveitis was diagnosed in 59% of patients with idio-U and 75% of patients with JIA-U.
The majority of patients in both the idio-U and JIA-U groups used topical corticosteroids at uveitis onset (89% and 100%, respectively). The use of systemic corticosteroids was less common (idio-U, 30%; JIA-U, 27%).
Eighty-five percent of patients with JIA-U were treated with DMARDs compared with 33% of patients with idio-U (P <.001). Similarly, bDMARDs were utilized more frequently in the JIA-U group (55%) vs the idio-U group (15%; P <.001).
According to the Snellen chart, 84% of patients overall had normal bilateral visual acuity (acuity >0.8), while 70% and 92% had best-corrected visual acuity greater than 0.8 and 0.5 in their worse eye, respectively. While 5 patients (4%) had visual impairment in one eye, no children had visual impairment in both eyes.
Among the idio-U and JIA-U groups, uveitis activity was 0+ in 81% and 72% of patients, 0.5+ in 19% and 25% of patients, and 1+ in 0% and 3% of patients, respectively. Of the 3 patients (3%) with uveitis activity of 1+, all were in the JIA-U group and were treated with DMARDs or bDMARDs.
Patients who did not receive systemic treatment showed reduced signs of uveitis activity (100% had no cells). A total of 74% of patients who received systemic treatment showed grade 0+ uveitis activity, while 24% showed grade +0.5 uveitis activity.
Siiskonen M, Hirn I, Pesälä R, et al. Encouraging visual outcomes in children with idiopathic and JIA associated uveitis: a population-based study. Pediatr Rheumatol Online J. Published online June 15, 2023. doi.org/10.1186/s12969-023-00841-8