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J. Abbott, T. R. Southwood, W. Thompson, P. I. Murray, S. Rauz; Reclassification of Juvenile Idiopathic Arthritis Using the ILAR Criteria: An Impact on Screening for Uveitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3891.
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To reclassify children with juvenile idiopathic arthritis (JIA) from the pre-International League of Associations for Rheumatology (pre-ILAR) to the revised ILAR criteria (Durban 1997), with particular attention to the frequency of chronic anterior uveitis (CAU). To examine the relationship between serum anti-nuclear antibody (ANA) levels and the presence of uveitis in patients classified using the ILAR criteria.
Multi-centre cross-sectional cohort study of United Kingdom children with JIA (n=1038)
Pauciarticular juvenile chronic arthritis (JCA) was the largest pre-ILAR group (n=502, 100%). They were mostly reclassified according to the ILAR criteria as either persistent (n=291, 58.0%) or extended (n=149, 29.7%) oligoarthritis. Reclassifying using the ILAR criteria, CAU was significantly associated with oligoarthritis (OR 3.04, p <0.001), asymmetrical arthritis (1.84, p=0.009), and ANA sero-positivity (OR 10.55, p<0.001 respectively). The extended oligoarthritis group had the largest proportion of children with CAU (17.9%). The next highest frequencies of CAU were found in the persistent oligoarthritis, and polyarthritis rheumatoid factor (RF) negative groups (15.8, and 6.7% respectively). Both the systemic and enthesitis-related groups had no uveitis. The following four ANA positive groups had rates of uveitis over 10%: persistent (27.9%) and extended (32.8%) oligoarthritis, RF negative polyarthritis (13.7%) and psoriatic (12.5%). An intermediate group (CAU rate 1-10%) entirely consisted of ANA-negative serology; oligoarthritis (7.4%), psoriatic (2.6%) and undifferentiated (5%). The remainder had no cases of CAU whether ANA positive or negative (systemic, RF positive polyarthritis and enthesitis-related).
Current ILAR terminology needs to be applied to future uveitis screening guidelines. Our data suggests that the ILAR groups: systemic, RF positive polyarthritis, and enthesitis-related, JIA do not require screening for uveitis in populations similar to that studied.
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