Uveitis and Visual Impairment

Ocular involvement in JIA is a particular problem and can take many forms. An acutely painful red eye may be seen in the anterior uveitis associated with enthesis-related JIA. Sicca syndrome is known to be associated with

Table 6 Percentage of Patients in Each Subset with Prosthetic Joints

Total % patients with

Table 6 Percentage of Patients in Each Subset with Prosthetic Joints

Total % patients with

Any large joint

Hip

Knee

JIA subset

prosthesis

prosthesis

prosthesis

Systemic

75.0

59.6

30.8

Oligo-arthritis

13.3

13.3

6.6

Extended oligo-arthritis

38.1

32.7

23.6

RhF -ve polyarthritis

56.1

51.2

34.1

RhF +ve polyarthritis

64.9

61.3

40.5

Enthesis-related

34.4

28.1

9.4

Psoriatic

15.4

15.4

7.7

All JIA

49.4

43.1

25.6

Source: Adapted from Ref. 3.

Source: Adapted from Ref. 3.

rheumatoid factor positive polyarthritis JIA, as it is in adult rheumatoid arthritis. The most common problem in the oligo-arthritis JIA subset is occult anterior uveitis, which affects around 20% of individuals. Because it is asymptomatic, it can easily be missed without appropriate screening with slit lamp examination. Untreated, it can cause blindness in up to 10% of affected patients. Topical corticosteroids and mydriatics are effective in the majority of patients, but intra-ocular injections or systemic corticosteroids are often required to prevent the formation of posterior synechiae between the lens and the iris. In severe refractory cases, immunosuppressive drugs such as methotrexate may be necessary to control the uveitis.

About 80% to 90% of patients with uveitis are positive for ANA. ANA-positive girls presenting with oligo-articular disease below the age of two years have up to a 95% likelihood of developing chronic anterior uveitis. Uveitis can cause other forms of eye pathology such as glaucoma and cataracts. Iatrogenic cataract formation from long-term steroid use may also be troublesome in patients requiring oral corticosteroids for disease control.

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