Idiopathic uveitis presents different characteristics and outcome from juvenile idiopathic arthritis- related uveitis

Andrade, Renata Lopes Francisco de; Zamora, Yuslay Fernández; Barbosa, Cassia Maria Passarelli Lupoli; Fraga, Melissa Mariti; Nicácio, Aline Alencar; Muccioli, Cristina; Terreri, Maria Teresa

doi:10.37039/1982.8551.20240019

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Revista Brasileira de Oftalmologia

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Original Article • Rev. bras.oftalmol. 83 • 2024 • https://doi.org/10.37039/1982.8551.20240019 copy

Idiopathic uveitis presents different characteristics and outcome from juvenile idiopathic arthritis- related uveitis

Uveíte idiopática apresenta características e desfecho diferentes da uveíte associada à Artrite Idiopática Juvenil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe the clinical features and outcomes of patients with uveitis associated with juvenile idiopathic arthritis (JIA) and idiopathic uveitis.

Methods:

This was an observational, retrospective study, conducted in a tertiary center. Patients under 18 years old who experienced at least one episode of uveitis and followed between 2000 and 2019 were included.

Results:

A total of 82 patients were included, of whom 43 had idiopathic uveitis and 39 had uveitis associated with JIA. Anterior uveitis was the primary site of ocular inflammation (76.8%) and occurred in 24 and 39 patients with idiopathic uveitis and uveitis associated with JIA arthritis, respectively (p=0.02). The complete response to corticotherapy was more frequent in uveitis associated with JIA (p=0.001). Total and partial responses to biological disease modifying antirheumatic drugs were more frequent in uveitis associated with JIA (p=0.025) and idiopathic uveitis (p=0.045), respectively. There were 203 complications: cataracts were more frequently present in idiopathic uveitis (p=0.05), while synechiae was more frequent in uveitis associated with JIA (p=0.02).

Conclusion:

Idiopathic uveitis and uveitis associated JIA frequently follow a chronic course and an increased risk of visual loss in childhood. The uveitis associated with JIA showed better response to systemic corticotherapy and total response to biologic disease modifying antirheumatic drugs more frequently.

Keywords:
Uveitis; Arthritis, juvenile; Eye diseases; Blindness

		IU (n=43)	JIA-U (n=39)	Total (n=82)	p-value
Demographic data
	Female	29 (67.4)	33 (84.6)	62 (75)	0
	Current age, Years	16 ± 4.9	17± 8	16±6.5	0.640
	Age at uveitis diagnosis, years	7.3±2.7	6.5±4.9	6.9±3.2	0.290
	Age at JIA diagnosis, years	NA	5.7±3.5	NA	NA
Clinical data
Arthritis as first manifestation		NA	30 (76.9)	NA	NA
Clinical course of uveitis^* * In one patient with juvenile idiopathic arthritis it was not possible to determine the clinical course of uveitis. IU: idiopathic uveitis; JIA-U: uveitis associated to juvenile idiopathic arthritis; JIA - juvenile idiopathic arthritis; NA: not applicable; ANA: antinuclear antibody.
	Acute	2 (4.7)	5 (12.8)	7 (8.5)	0.190
	Chronic	28 (65.1)	22 (56.4)	50 (61.0)	0.670
	Recurrent	13 (30.2)	11 (28.2)	24 (29.3)	0.910
Primary site of uveitis
	Anterior	24 (55.8)	39 (100)	63 (76.8)	0.020
	Intermediate	16 (37.2)	0	16 (19.5)	0.0001
	Posterior	0	0	0	NA
	Panuveitis	3 (7.0)	0	3 (3.7)	0.090
Positive ANA		20 (46.5)	28 (71.8)	48 (58.3)	0.130
	Female	14 (32.6)	25 (89.3)	39 (47.6)	<0.001

		IU (n=43)	JIA-U (n=39)	Total (n=82)	p-value
Corticotherapy
	Topical corticosteroids	38 (88.4)	32 (82.1)	70 (85.4)	0.620
	Systemic corticosteroids	30 (69.8)	19 (48.7)^* * Three patients with uveitis associated with juvenile idiopathic arthritis used corticosteroid therapy for arthritis and not for uveitis;	49 (58.8)	0.560
Response to systemic corticosteroids		n=30	n=18^† † one patient did not have data on the response to corticotherapy.	n=48
	Total	2 (6.7)	10 (55.6)	12 (25)	0.001
	Partial	28 (93.3)	6 (33.3)	34 (70.8)	0.010
	No response	0	2 (11.2)	2 (4.2)	0.060
Patients using synthetic DMARDs		n=38	n=38	n=76
	Methotrexate	37 (97.4)	34 (89.5)	71 (93.4)	0.480
	Cyclosporine	9 (23.8)	8 (21.0)	17 (22.4)	0.680
	Leflunomide	1 (2.6)	8 (21.0)	9 (11.8)	0.020
	Azathioprine	0	1 (2.6)	1 (1.3)	0.330
Number of synthetic DMARDs/patients		n=38	n=38	n=76
	One	34 (89.5)	21 (55.3)	55 (72.4)	0.070
	Two	4(10.5)	13 (34.2)	17 (22.4)	0.020
	Three or more	0	4 (10.4)	4 (5.3)	0.040
Response to synthetic DMARDs/patients		n= 38	n= 38	n= 76
	Total	21 (55.3)	20 (52.6)	41 (53.9)	0.870
	Partial	15 (39.5)	13 (34.2)	28 (36.8)	0.700
	No response	0	4 (10.5)	4 (5.3)	0.040
	No information	2 (5.3)	1 (2.6)	3 (4.0)	0.560
Patients using biological DMARDs		n=8	n=15	n=23
	Adalimumab	8 (100)	13 (86.7)	21 (91.3)	0.640
	Infliximab	3 (37.5)	4 (26.7)	7 (30.4)	0.120
	Etanercept	1 (12.5)	4 (26.7)	5 (21.7)	0.520
	Tocilizumab	1 (12.5)	3 (20.0)	4 (17.4)	0.720
	Abatacept	0	2 (13.0)	2 (8.7)	0.310
Number of biological DMARDs/patients		n=8	n=15	n=23
	One	4 (50.0)	9 (60.0)	13 (56.5)	0.760
	Two	4 (50.0)	3 (20.0)	7 (30.4)	0.210
	Three or more	0	3 (20.0)	3 (13.0)	0.200
Response to biological DMARDs/patient		n=8	n=15	n=23
	Total	3 (37.5)	7 (46.7)	10 (43.5)	0.025
	Partial	4 (50.0)	4 (26.7)	8 (34.8)	0.045
	No response	1 (12.5)	3 (20.0)	4 (17.4)	0.150
	No information	0	1 (6.6)	1 (4.3)	NA

Complications		IU (n=144 complications)	JIA-U (n=59 complications)	Total (n=203 complications)	p-value
Band keratopathy		36 (25.0)	15 (25.4)	51 (25.1)	0.950
Cataract		34 (23.6)	13 (22.0)	47 (23.2)	0.050
Anterior/ posterior synechiae		23 (16.0)	19 (32.2)	42 (20.7)	0.020
Glaucoma/ eye hypertension		15 (10.4)	3 (5.0)	18 (8.9)	0.240
Macular edema		11 (7.6)	1 (1.7)	12 (6.0)	0.110
Retinal detachment		7 (4.9)	5 (8.6)	12 (6.0)	0.330
Epiretinal membrane		4 (2.8)	0	4 (2.0)	0.200
Choroidal neovascular membrane		3 (2.1)	0	3 (2.0)	0.200
Posterior capsule opacity		3 (2.1)	2 (3.4)	5 (2.5)	0.590
Vitreous hemorrhage		3 (2.1)	0	3 (1.5)	0.260
Phthisis bulbi		3 (2.1)	1 (1.7)	4 (2.0)	0.850
Optic atrophy		1 (0.7)	0	1 (0.5)	0.520
Visual loss
	VA less than 20/400	13/86 (15.1)	8/78 (10.3)	21/164 (12.8)	0.670
	Total blindness	4 (2.8)	3 (5.1)	7 (3.4)	0.430

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[1] Corresponding author: Renata Lopes Francisco de Andrade Rua Dr. Bacelar, 173, 12° andar. Zip code: 01026-000 – São Paulo, São Paulo, Brazil E-mail: drarenatalf@gmail.com