Centro Hospitalar Universitário de São João Porto, Portugal
Filipe Pinheiro1, Mariana Leuzinger-Dias2, Bruno Fernandes3, Diogo Fonseca4, Joana Vilaça5, Luís Figueira6 and Iva Brito7, 1Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal, 2Ophtalmology Department, Centro Hospitalar Universitário de São João, Porto, Portugal, 3Rheumatology Deparment, Centro Hospitalar e Universitário de São João, Porto, Portugal, 4Rheumatology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Vila Nova de Gaia, Portugal, 5Paediatrics Department, Hospital de Braga, Braga, Portugal, 6Ophthalmology Department, Centro Hospitalar Universitário de São João, Porto, Portugal, 7Pediatric and Young Adult Rheumatology Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
Background/Purpose: Uveitis is a frequent complication of juvenile idiopathic arthritis (JIA) and juvenile spondyloarthritis (jSpA), and diagnosis is often challenging. The importance of uveitis relates to potential complications, and prognosis depends on early recognition and treatment. The aim of this study is to evaluate the prevalence and risk factors for complications associated with uveitis in patients with JIA and jSpA.
Methods: A longitudinal, monocentric cohort study that included patients diagnosed with JIA and jSpA, who developed uveitis. Demographic, laboratory, and clinical data were collected including complications of uveitis, HLA-B27, antinuclear antibodies, erythrocyte sedimentation rate, C-reactive protein, visual acuity and DMARD treatment. Follow-up was 5 years after uveitis' diagnosis. Comparison between groups (complicated versus uncomplicated uveitis) was evaluated using chi-square, t test and Mann-Whitney test. Logistic regression was performed to determine predictors of complications.
Results: A total of 270 patients were evaluated, of which 37 patients (13.7%) had uveitis and were included in this study. Twenty patients were female (54.1%), age 11.9±8.7 years at diagnosis of jSpA/JIA and 15.3±9.9 years at diagnosis of uveitis. Twenty-seven patients (73.0%) had a diagnosis of JIA (23 with oligoarticular disease) and in 12 patients (32.4%) uveitis was the first manifestation of the rheumatic disease. Fifteen (40.5%) patients exhibited complications during follow-up period, namely cataract (n=11), synechiae and ocular hypertension (n=7), keratopathy (n=6), vitritis (n=3), retinal detachment (n=2), hemovitreous and glaucoma (n=1). Eleven patients (29.7%) underwent ophthalmologic surgery.
Comparisons between complicated versus uncomplicated uveitis patients showed that complications were significantly more frequent in those who had uveitis as the initial presentation (53.3% vs 18.2%, p=0.04), diagnosis of JIA (93.3% vs 59.1%, p=0.03), a younger age at diagnosis of uveitis (8.9 ± 5.7 vs 17.7 ± 10.1, p=0.01) and age at the diagnosis of rheumatic disease (5.4 ± 4.6 vs 14.3 ± 8.7, p=0.01); no significant differences were found between the groups in the other variables studied.
Univariate logistic regression analysis showed that JIA (OR 9.69, CI 1.07-87.44, p=0.04), presentation as uveitis (OR 5.14, CI 1.17-22.69, p=0.03), age at diagnosis of jSpA/JIA (OR 0.88, CI 0.79-0.98, p= 0.02) and age of uveitis (OR 0.90, CI 0.82-0.99, p=0.02) were predictors of complications. When adjusting for age of uveitis, age at diagnosis and JIA, uveitis as first manifestation of rheumatic disease was found to be an independent predictor of complications (OR 101.77, CI 3.08-3358.7, p=0.01)
Conclusion: Ophthalmologic complications of uveitis occur in a significant percentage of patients with JIA and jSpA. The initial presentation of rheumatic disease as uveitis is significantly associated with the occurrence of uveitis complications, so it is essential that there is a collaboration between ophthalmologist and rheumatologist in the diagnosis and treatment of these patients.
Disclosures: F. Pinheiro, None; M. Leuzinger-Dias, None; B. Fernandes, None; D. Fonseca, None; J. Vilaça, None; L. Figueira, None; I. Brito, None.
