Purchase this article with an account.
Sarah Syeda, Nakhoul Nakhoul, Buraa Kubaisi, C. Stephen Foster; Long-term outcomes in Juvenile idiopathic arthritis-associated uveitis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):525.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Juvenile idiopathic arthritis (JIA)-associated uveitis is an indolent yet serious condition with poor visual prognosis. Our purpose is to present long-term clinical outcomes in patients treated with immunomodulatory therapy (IMT) in the long-term.
A retrospective analysis of JIA-associated uveitis patients presenting between 2005 to 2016 with a minimum of 3 years follow-up was conducted. Information collected included presenting and final visual acuities (VA), development of band keratopathy, cataract and glaucoma, IMT used as well as side effects. Remission was defined as successful inflammation-free weaning off of IMT.
A total of 61 patients with JIA-associated uveitis were identified, 88.5% were female. Mean age at presentation of 38 of patients not in remission (NR) was 16.2 years (range 3-44 years), and mean follow-up was 106.1 months SEM=4.69. Of the 23 patients in the remission group, mean age at presentation was 13.5 years (range 4-39), and mean follow-up 105.4 months SEM=6.67. VA differed minimally amongst the two groups, with 81.6% of 76 eyes of NR patients presenting with VA better than 20/80, compared to 84.8% of 46 eyes of remission patients. At final follow up, these proportions remained stable. Band keratopathy developed in 39.5% of NR patient eyes and in 41.3% of those in remission. NR patient eyes had a higher occurrence of cataracts (75% compared to 63%), furthermore, 54% of NR eyes underwent cataract surgery compared to 35% of the remission group. Development of glaucoma occurred in 27 eyes of the NR group and 14 of the remission group affected. The number of IMTs used differed between the two groups with 39.1% of the remission group requiring monotherapy compared to 7.9% of the NR group, conversely, 47.4% of the NR group required therapy with 4-10 IMTs. Of the group that achieved remission, 6 did so on methotrexate, 4 on mycophenolate mofetil, 3 on chlorambucil and dual therapy. Only18 patients in our study endured side effects, all non-serious.
While IMT-free remission in JIA-associated uveitis may be difficult to achieve, long-term preservation of visual acuity emphasizes the benefit of IMT. The number of IMTs used to control inflammation appears to be a negative predictive factor for achieving drug-free remission in the long-term. This study highlights a population of patients who require further research to identify and address factors impeding drug-free remission.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only