Clinical Characteristics and Treatment Outcomes of Juvenile Idiopathic Arthritis Associated Uveitis

Abstract

Purpose: To assess treatment outcomes in juvenile idiopathic arthritis (JIA) associated uveitis, including corticosteroid-sparing control of inflammation with immunomodulatory therapy (IMT) and relapse rates upon discontinuation of therapy.

Methods: We conducted a retrospective cohort study of patients with JIA-associated uveitis seen at the University of Illinois at Chicago and F.I. Proctor Foundation uveitis clinics between 1988 and 2011. Information collected included control of ocular inflammation and relapse rates upon discontinuation of treatment. Steroid-sparing control of inflammation was defined as ≤0.5+ anterior chamber cells, no active retinal/choroidal lesions, prednisone dose ≤10 mg and prednisolone acetate dose ≤3 times/day.

Results: Of 66 patients with JIA-associated uveitis, 89% were female. Median follow-up was 854 days (interquartile range (IQR) 189-2280 days). Median age at onset of JIA was 2 years, and that of uveitis was 4 years. The most common type of JIA was oligoarticular (67%). Eighty-five percent had anterior uveitis, 11% had anterior and intermediate uveitis, and 96% had a chronic course of disease. Fifty-one patients (77%) received corticosteroid-sparing IMT either as sole or combination therapy, including methotrexate (67%), adalimumab (21%), and infliximab (17%). Steroid-sparing control of inflammation was achieved in 15/21 (71.4%) of patients on methotrexate as sole therapy, 10/11 (91%) patients on infliximab, and 6/13 (46.2%) on adalimumab. Attempts were made to discontinue treatment in 14/51 (27.5%) patients on IMT. Median duration of quiescence on IMT prior to attempting to taper or stop was 413 days (IQR 88-595). Ten (66.7%) of these patients experienced relapse, with a median time to relapse of 329 days (IQR 213-344). There was no difference in the duration of controlled inflammation on IMT in patients who relapsed vs. those that did not (p=.89).

Conclusions: Steroid-sparing control of inflammation was achieved in the majority of patients. However, attempts to stop IMT were often unsuccessful. This highlights the need for continued follow-up of patients after discontinuation of therapy for presumed remission, and for further research into predictors for successful discontinuation of systemic IMT in patients with JIA-associated uveitis.

Keywords: 746 uveitis-clinical/animal model • 557 inflammation • 462 clinical (human) or epidemiologic studies: outcomes/complications