Male Gender and Poor Visual Outcome in Uveitis Associated With Juvenile Idiopathic Arthritis

doi:10.1016/j.ajo.2010.01.014

American Journal of Ophthalmology

Volume 149, Issue 6, June 2010, Pages 987-993

https://doi.org/10.1016/j.ajo.2010.01.014 Get rights and content

Purpose

To analyze visual outcome in uveitis associated with juvenile idiopathic arthritis (JIA) according to age of onset of uveitis, gender, and initial manifestation of JIA.

Design

Retrospective nonrandomized interventional case series.

Methods

Visual outcome of 117 affected eyes (65 patients) with JIA-associated uveitis was noted at onset of uveitis and after 1, 3, and 5 years. Visual outcome was analyzed according to gender, age of onset of JIA-associated uveitis (<7 years and >7 years), and initial manifestation of JIA (as uveitis or as arthritis). Linear and logistic regression with generalized estimating equation (GEE) was performed.

Results

Median age of onset of uveitis was 4.2 years (range 1.5–16). Female-to-male ratio was 3:1. In 15 children (23%) uveitis was diagnosed before arthritis. Visual acuity of boys was significantly worse at 1 and 3 years of follow-up (both P ≤ .03) but not at 5 years of follow-up (P = .45). Until 3 years after the diagnosis of uveitis, children with atypical initial manifestation of JIA (uveitis before arthritis) had significantly worse visual acuity compared with children in whom uveitis debuted after arthritis (all P ≤ .05). No difference in vision between younger-onset (<7 years) and older-onset (>7 years) groups was noted. Blindness was independently associated with male gender (odds ratio [OR] = 6.61; 95% CI: 1.02–42.98; P = .048).

Conclusions

Male gender was an independent risk factor for poor visual prognosis in JIA-associated uveitis. Children in whom uveitis is being diagnosed before arthritis have significantly worse vision until 3 years after uveitis onset.

Section snippets

Patients and Methods

The same database as our other study on complications in JIA-associated uveitis.¹² The medical records of 65 pediatric patients (117 affected eyes) with uveitis associated with JIA or ANA-positive anterior uveitis were reviewed. The diagnosis of JIA was based on the criteria of the International League against Rheumatism.13, 14 All patients were examined by a pediatric rheumatologist who confirmed the diagnosis of JIA in 65 patients.

Evaluation of uveitis was made according to the criteria of

General Characteristics of the Study Population

One hundred seventeen eyes (65 patients) were affected by JIA-associated uveitis, with available data of BCVA over a period longer than 1 year of follow-up. Table 1 presents general clinical characteristics of the whole study population with analysis of subgroups, according to age of onset of uveitis, gender, and initial manifestation of JIA. The typical manifestation of JIA-associated uveitis as chronic or recurrent anterior uveitis was observed in 116 eyes (99%), and in 1 eye (1%) panuveitis

Discussion

This study demonstrates a trend toward worse visual outcome in boys with JIA-associated uveitis. Furthermore, in our series male gender was an independent factor associated with blindness in JIA-associated uveitis. The unfavorable prognostic role of male gender has been previously suggested by several authors; however, these studies mainly showed the effect of the male gender on the development of complications in the course of JIA-associated uveitis.18, 19, 20 Recent results of Holland and

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Cited by (52)

Clinical Course and Outcome in Pediatric Idiopathic Chronic Anterior Uveitis
2022, American Journal of Ophthalmology
Citation Excerpt :
All patients were seen by a pediatric rheumatologist, and patients whose CAU was caused by infection, neoplasm, or trauma were excluded. The JIA-U patients were selected from a previously reported dataset24,25 (for patients who were diagnosed with uveitis prior to 2010) and a new dataset (with patients who were diagnosed with uveitis from 2010 through 2020) and were age-matched and matched to the date of uveitis diagnosis in the iCAU cohort. The maximum time interval of the date of uveitis diagnosis between 2 matched patients was 2 years.
To examine the clinical course and outcome in children with idiopathic chronic anterior uveitis (iCAU), and to compare the results with those of age-matched children with juvenile idiopathic arthritis−associated uveitis (JIA-U).
Retrospective cohort study.
Data regarding ocular complications, visual acuity, and systemic treatment were retrospectively collected for 2 patient groups that were matched regarding age and year of uveitis diagnosis. Outcome was evaluated using survival analysis.
The iCAU and JIA-U groups included 48 patients with 83 affected eyes and 48 patients with 73 affected eyes, respectively. Multivariate analyses showed that iCAU was associated with a higher prevalence of posterior synechiae (adjusted hazard rate [aHR] = 3.63; P < .001) and cataract surgery (aHR = 2.90; P = .006). Baseline visual acuity was worse in the iCAU group compared to the JIA-U group (20/25 vs 20/20, respectively; P < .001), but improved in the iCAU group after 5 years (20/20 vs 20/20, respectively; P = .052). At the 5-year follow-up, the younger children with iCAU (≤8 years of age at diagnosis) had a higher prevalence of posterior synechiae (aHR = 2.56; P = .007), secondary glaucoma (aHR = 16.0; P = .020), and cataract surgery (aHR = 4.79; P = .004) compared to older children with iCAU (≥9 years at diagnosis).
Vision-threatening ocular complications are more common in children with iCAU compared to children with JIA-U, particularly in cases in which the onset of uveitis occurred at ≤8 years of age. However, the long-term vision of these children can be improved with adequate treatment.
Uveitis in Juvenile Idiopathic Arthritis: 18-Year Outcome in the Population-based Nordic Cohort Study
2021, Ophthalmology
Citation Excerpt :
Well-established ophthalmologic screening programs9,10 may also contribute to the reduced ocular complications, presumably by earlier diagnosis before complications have occurred and timely treatment of the ocular inflammation. We did not find a significant association between the development of ocular complications and male gender or young age at the onset of uveitis.21,41 However, we confirmed that developing uveitis before JIA, having a short duration between onset of JIA and diagnosis of uveitis, and having ANA positivity are risk factors for developing ocular complications.
To assess the long-term outcome of uveitis in juvenile idiopathic arthritis (JIA).
Population-based, multicenter, prospective JIA cohort, with a cross-sectional assessment of JIA-associated uveitis (JIA-U) 18 years after the onset of JIA.
A total of 434 patients with JIA, of whom 96 had uveitis, from defined geographic areas of Denmark, Finland, Norway, and Sweden.
Patients with onset of JIA between January 1997 and June 2000 were prospectively followed for 18 years. Pediatric rheumatologists and ophthalmologists collected clinical and laboratory data.
Cumulative incidence of uveitis and clinical characteristics, JIA and uveitis disease activity, ocular complications, visual outcome, and risk factors associated with the development of uveitis-related complications.
Uveitis developed in 96 (22.1%) of 434 patients with JIA. In 12 patients (2.8%), uveitis was diagnosed between 8 and 18 years of follow-up. Systemic immunosuppressive medication was more common among patients with uveitis (47/96 [49.0%]) compared with patients without uveitis (78/338 [23.1%]). Active uveitis was present in 19 of 78 patients (24.4%) at the 18-year visit. Ocular complications occurred in 31 of 80 patients (38.8%). Short duration between the onset of JIA and the diagnosis of uveitis was a risk factor for developing ocular complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1–1.8). Patients with a diagnosis of uveitis before the onset of JIA all developed cataract and had an OR for development of glaucoma of 31.5 (95% CI, 3.6–274). Presence of antinuclear antibodies (ANAs) was also a risk factor for developing 1 or more ocular complications (OR, 3.0; 95% CI, 1.2–7.7). Decreased visual acuity (VA) <6/12 was found in 12 of 135 eyes (8.9%) with uveitis, and 4 of 80 patients (5.0%) with JIA-U had binocular decreased VA <6/12.
Our results suggest that uveitis screening should start immediately when the diagnosis of JIA is suspected or confirmed and be continued for more than 8 years after the diagnosis of JIA. Timely systemic immunosuppressive treatment in patients with a high risk of developing ocular complications must be considered early in the disease course to gain rapid control of ocular inflammation.
Review of proteomics approach to eye diseases affecting the anterior segment
2020, Journal of Proteomics
Citation Excerpt :
Diagnosis of JIA is made based on a clinical criteria that relies heavily on joint signs and symptoms. Interestingly, around 25% of children with JIA develop uveitis prior to arthritis making the diagnosis of JIA even more challenging [134,135]. Two proteomic studies have assessed the proteomic change in patients with JIA associated uveitis [136,137].
Visual impairment and blindness is a major health burden worldwide, and major ocular diseases causing visual impairment pertain to the anterior segment of the eye. Anterior segment ocular diseases are common, yet complex entities. Although many treatment options and surgical techniques are available for these ailments, the underlying cause and pathogenesis is still unclear. Finding ways to fundamentally treat these patients and rectify the underlying dysregulations leading to the disease may help cure patients completely without major complications. Proteomics approaches are a novel way to distinguish dysregulated proteins in a variety of biological tissues in a hypothesis-free manner, thus helping to find the responsible pathways leading to a certain disease. The aim of the current study is to review the available knowledge in scientific literature regarding the proteomics studies done on anterior segment eye diseases and suggest potential clinical implications to exploit the results of these studies.
Anterior segment ocular diseases are responsible for a major proportion of visual impairment and blindness worldwide. Although ophthalmologists have several treatment options that can alleviate or control the progression of these diseases, no definite cure is available for most of them. Moreover, because these diseases are progressive, prompt diagnosis is of utmost important. Proteomics studies enable us to identify and quantify the dysregulated proteins in a biological specimen in a hypothesis-free manner. Understanding the dysregulated protein pathways shines a light on the pathogenesis of the disease. Moreover, these dysregulated proteins may act as biomarkers to help in diagnosis and treatment follow-up. Hence, in this article we sought out to review the available scientific literature regarding the proteomics studies of anterior segment ocular diseases and to identify potential applications of proteomic studies in clinic.
Nuclear cataract as an early predictive factor for recalcitrant juvenile idiopathic arthritis-associated uveitis
2016, Journal of AAPOS
To analyze factors predictive of having treatment-resistant uveitis in patients with juvenile idiopathic arthritis (JIA)–associated uveitis.
The medical records of patients diagnosed with JIA-associated uveitis treated at a single tertiary referral center from October 2005 to March 2013 were reviewed retrospectively. The main outcome measures were demographic characteristics, ocular comorbidity, clinical course, treatments, and baseline risk factors associated with poor response to first-line therapies.
A total of 96 patients (175 eyes) were included. Of these, 58 patients (108 eyes) required biologic disease-modifying antirheumatic drugs or alkylating agents for their uveitis during follow-up (recalcitrant group), and 38 patients (67 eyes) did not (nonrecalcitrant group). Eyes of the recalcitrant group tended to have a higher incidence of cataract at baseline (49%; P < 0.0001). In the nonrecalcitrant group, the most frequent complications were cataract (20.9%) and secondary glaucoma (20.9%). The mean number of flares in the recalcitrant group was significantly reduced from 3.7/eye/year prior to cataract surgery to 1.6/eye/year after (P < 0.0001). Nuclear cataract was found to be an independent predictor for a severe course of JIA-associated uveitis. Any other type of cataract, posterior synechiae, male sex, or active uveitis at baseline were not found to be independently associated with recalcitrant uveitis.
Nuclear cataract at baseline evaluation is a risk factor for poor response to first-line therapies in JIA-associated uveitis patients.
The association of race with childhood uveitis
2015, American Journal of Ophthalmology
To identify risk factors for a severe uveitis course among children with noninfectious uveitis.
Retrospective cohort study.
This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3–6 months (2011–2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications, and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African-American and non-Hispanic white children only.
Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African-American and white children showed an increased prevalence of VA ≤20/200 in non-Hispanic African-Americans (18/25; 72% vs 4/43; 9%). Non-Hispanic African-Americans were more likely to be diagnosed at an older age (P = .030) and to have intermediate uveitis (P = .026), bilateral disease (P = .032), a history of VA ≤20/50 (P = .002), VA ≤20/200 (P < .001), and a higher rate of complications (P < .001). On multivariable analysis, non-Hispanic African-American race was a significant predictor of blindness (OR = 31.6, 95% CI 5.9–168.5, P < .001), after controlling for uveitis duration. Non-Hispanic African-Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic whites when controlling for uveitis type and duration.
There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African-American children with non–juvenile idiopathic arthritis–associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations.
Evaluation of Uveitis Induced in Rats by a Type I Collagen Peptide as a Model for Childhood Arthritis-associated Uveitis
2023, Comparative Medicine

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Original articleMale Gender and Poor Visual Outcome in Uveitis Associated With Juvenile Idiopathic Arthritis

Purpose

Design

Methods

Results

Conclusions

Section snippets

Patients and Methods

General Characteristics of the Study Population

Discussion

J AAPOS

Am J Ophthalmol

Ophthalmology

Ophthalmology

Can J Ophthalmol

Am J Ophthalmol

J Cataract Refract Surg

Am J Ophthalmol

Epidemiology of uveitis in children

Int Ophthalmol Clin

Juvenile idiopathic arthritis-related uveitis

Int Ophthalmol Clin

Chronic anterior uveitis in children: clinical characteristics and complications

Am J Ophthalmol

Original article
Male Gender and Poor Visual Outcome in Uveitis Associated With Juvenile Idiopathic Arthritis