Juvenile idiopathic arthritis associated uveitis at an Italian tertiary referral center: clinical features and complications

Abstract Purpose: To describe the frequencies and risk factors of ocular complications and poor visual outcomes in children with juvenile idiopathic arthritis (JIA). Methods: Retrospective cohort study, including 69 consecutive children (116 eyes) affected by JIA associated uveitis managed at a tertiary uveitis clinic. Results: The incidence of visual loss to the 20/50 or worse threshold was 0.04/Eye Year (EY) and to the 20/200 or worse threshold was 0.02 /EY. The most common complications at baseline were posterior synechiae (52%), band keratopathy (38%) and cataract (12%). Risk factor for visual acuity of 20/50 or worse threshold included hypotony ( p=0.01; Hazard Ratio (HR) 3.7; IC95% 1.3-10.4); anterior chamber flare>1 (p=0.04;HR1.3;IC95% 0.5-3.4); a positive antinuclear antibody (ANA) (p=0.02;HR1.4;IC95% 0.8-2.4). Hypotony and positive ANA are also associated to the 20/200 or worse threshold (p= 0.03; HR 5.1; IC95% 1.1-23.9 and p= 0.04; HR 1.0; IC95% 0.4-2.3; respectively). Use of immunosuppressive drugs was associated with a reduced risk of visual loss of 20/200 or worse (Odds Ratio 0.14, 95% CI, 0.02-1.29; p=0.04). Conclusions: Loss of vision and ocular complications still occur among children with JIA-related uveitis. Prompt diagnosis and a strict follow up associated to immunosuppressive therapy may decrease the poor visual outcome