Uveitis in Children

Uveitis is reported to be the most common extra-articular manifestation in spondyloarthritis (SpA); however, its prevalence and characteristics are not well established. To perform a systematic literature review in order to examine these topics. A systematic literature analysis was conducted in the Medline database up to October 2006 and in the abstracts of rheumatology scientific meetings for the years 2004, 2005 and 2006. A hand search of references was also performed. Articles were analysed if they reported the prevalence or characteristics of uveitis in SpA. Data abstraction was standardised. Statistical analysis was mainly descriptive. Among the 957 articles selected by the search, 126 articles (29,877 patients) allowed a calculation of the prevalence of uveitis in SpA; 36 articles (1989 patients) described its characteristics. The mean (SD) prevalence of uveitis was 32.7 (0.5)%; it varied with the type of SpA--for example, 33.2 (0.8)% for ankylosing spondylitis versus 25.1 (2.3)% for psoriatic arthritis. This prevalence increased with mean disease duration and was higher in HLA-B27-positive patients with an odds ratio of 4.2. Uveitis was acute in 88.7 (2.5)%, anterior in 90.5 (2.0)%, unilateral in 87.3 (2.8)%. Recurrence occurred in 50.6 (2.6)% and a reduction of visual acuity was observed in 8.3 (3.8)%. The prevalence of uveitis varies with disease duration and according to the type of SpA. Reduction of visual acuity is not exceptional. Because of recent promising data about the effects of anti-tumour necrosis factor therapy on uveitis flares in SpA, it was important to determine this baseline prevalence.

To analyse the prevalence and complications of uveitis and their predictors in a large cohort of patients with juvenile idiopathic arthritis (JIA). Data of 3271 JIA patients as classified by International League of Associations for Rheumatology (ILAR) criteria included in a national database during 1 yr were analysed. Uveitis prevalence was 12% of all JIA patients. The most frequent were oligoarthritis extended (25%) and persistent (16%). JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs 7.0 yrs) or ANA-positive (86% vs 42%) than the patients without uveitis. Predictors of uveitis included age at onset (P= 0.03) and ANA-positivity (P< 0.01) besides the presence of a certain JIA subgroup (P= 0.04). Uveitis was clinically silent in 75% of the oligoarthritis but in none of the enthesitis-related arthritis patients. The median onset of uveitis was 5.5 months after arthritis manifestation. In 73%, 77% and 90%, uveitis developed within 1, 2 and 4 yrs after arthritis, respectively. Anterior uveitis was the most common anatomic type of uveitis (83%). Uveitis complications at mean follow-up of 5.6 yrs were common (56%), and predictors for complications included presence of complications at first visit (P< 0.001) and uveitis manifestation before arthritis (P= 0.001), but not ANA positivity. The JIA subgroups markedly differ with respect to the prevalence and course of associated uveitis. Ophthalmological screening should be initiated early after arthritis onset and the intervals be related to the JIA subgroup. A modification of the current screening guidelines is suggested.

Eleven family members over four generations have had granulomatous disease of the skin, eyes, and joints. Ten have had arthritis; two had skin, eye, and joint involvement; one had skin and joint disease, and one had iritis only. The disease is transmitted as an autosomal dominant trait and is not associated with HLA-B27. The disease resembles sarcoidosis in some ways but not in others, and is probably a new syndrome. The major long-term problems are iritis and joint contractures.