Abstract
Purpose: :
To identify risk factors associated with relapse of uveitis in patients with juvenile idiopathic arthritis (JIA) - associated chronic or recurrent uveitis following treatment with immunomodulatory therapy (IMT) and a drug free remission of 1 year.
Methods: :
Retrospective chart review of 30 patients with JIA associated uveitis, who were successfully treated with IMT to a state of corticosteroid-free remission, and subsequently remained in remission following discontinuation of IMT for a period of at least 1 year. In subsequent follow up, some patients had relapse of uveitis while others continued to be in remission. Remission was defined as <1+ cells in the anterior chamber or vitreous. Relapse was defined as ≥ 1+ cells in the anterior chamber or vitreous. We compared patients in remission with those who relapsed, in an effort to evaluate risk factors associated with the relapse.
Results: :
Out of 30 patients, 17 (56.7%) remained in remission while 13 (43.3%) relapsed. The patients in the remission group received IMT earlier (median of 9 months, inter-quartile range [IQR] 6-12 months) in the course of disease from diagnosis as compared to patients in the relapse group (median of 78 months, IQR 36-120 months) (Mann-Whitney test, p = 0.0004). Moreover, the patients in the remission group had received treatment with IMT at a younger age (median age 6 years, IQR 4-9 years) as compared to the relapse group (median age 11years, IQR 8-15 years) (Mann-Whitney test, p = 0.04). None of the other factors studied revealed significant association with the relapse of uveitis.
Conclusions: :
Patients with uveitis associated with JIA treated with IMT earlier in the course of disease and at a younger age have less likelihood of relapse of the uveitis following discontinuation of the IMT after a 2 year period of quiescence on IMT.
Keywords: uvea • inflammation • immunomodulation/immunoregulation