Juvenile idiopathic arthritis without uveitis: ¿Is there any alteration in macular central thickness?

Abstract

Purpose: Juvenile Idiopathic Arthritis (JIA) is the most prevalent rheumatic disease during childhood and also the most common cause of secondary uveitis, as well as the most frequent extra-articular manifestation in JIA. Macular edema is an unusual but relevant occurrence in patients affected with JIA-associated uveitis; moreover, some evidence suggests that an increase in macular thickness (MT) can be observed in the apparently uninvolved fellow eye of JAI patients with unilateral uveitis. The purpose of this study is to determine the presence of increased MT in JIA patients without uveitis as compared to healthy controls.

Methods: This prospective, case-control, cross-sectional study was carried out in a large public multi-specialty hospital in Guadalajara, Mexico. Patients with JIA were referred from the rheumatology department to our ophthalmology center where the participants gave a signed consent form to participate in the study. This non-interventional study was granted by the local IRB. All subjects underwent a comprehensive ophthalmologic assessment; in addition, central retina was scanned using a time-domain device (Stratus OCT; Carl Zeiss Meditec). Values from the macular sectors on the retinal thickness tabular output (Fast Macular Thickness Map) were collected and analyzed. For the purpose of this study analysis only cases with no current clinical manifestations of uveitis or past history of ocular inflammation were included.

Results: Thirty eyes from 15 patients with JIA and 60 eyes from 30 age- and gender-matched controls were included. Mean age was 10.7 ± 3.5 years; gender distribution was 46.7% female and 53.3% male. For cases, the range of time between diagnosis of JIA and the first ophthalmologic examination was 0.5 - 9.0 years. The most common type of JIA was the persistent oligoarticular (14.3%); only 28.6% of the patients had disease activity at the moment of the study. Mean central MT for JIA patients was 239.4 ± 17.9 microns and for controls was 238.3 ± 25.4 microns (p = 0.823, Student’s t test); sectorial analysis demonstrated no statistical differences between cases and controls neither (p > 0.05).

Conclusions: Comparisons of central and sectorial MT measured by Stratus OCT between JIA patients without uveitis and controls demonstrated no difference. Predominance of disease inactivity has to be ruled out as a possible explanation for such finding.

Keywords: 585 macula/fovea • 556 infant vision • 550 imaging/image analysis: clinical