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J. D. Keenan, D. A. Goldstein, H. H. Tessler; Granulomatous Inflammation in Juvenile Idiopathic Arthritis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4294.
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The uveitis associated with juvenile idiopathic arthritis (JIA) has typically been described as non-granulomatous. Few previous reports have commented on granulomatous disease in JIA-associated uveitis. This study reports the prevalence of granulomatous disease in a population with JIA-associated uveitis.
Medical records of the Illinois Eye and Ear Infirmary Uveitis Service from 1973 until 2006 were reviewed to identify patients with JIA-associated uveitis. Patients were included if they were diagnosed with JIA by a rheumatologist, and experienced at least 6 weeks of arthritis starting before age 16. Granulomatous disease was defined by the presence of mutton-fat keratic precipitates (KP), Busacca nodules, or "ghost" KP. Student’s t-test and chi square testing were performed to examine associations with demographic variables. Statistical significance was set at p=0.1.
102 patients with JIA-associated uveitis were identified, of which 73 had retrievable medical records. Baseline demographic characteristics revealed that 85% of patients were female, 88% were White, 8% were Black, and 5% were Hispanic. 85% of patients had pauciarticular disease, and the remainder had polyarticular disease. 64% were ANA positive. Granulomatous uveitis was observed in 27% of the population, with 7% exhibiting mutton fat KP, and 20% ghost KP. There was no association between the presence of granulomatous disease and age of uveitis onset (p=0.6), gender (p=0.5), or whether the arthritis was pauciarticular or polyarticular (p=0.6). There was an association between granulomatous disease and ANA status (p=0.09), with 44% of ANA positive patients having granulomatous disease compared to 15% of ANA negative patients. There was an association between granulomatous disease and race, with 67% of Blacks having granulomatous disease compared to 24% of non-Blacks (p=0.02), and 23% of Whites showing granulomatous disease, compared to 56% of non-Whites (p<0.05).
Granulomatous disease was more common in this series of JIA-associated uveitis than previously reported. Granulomatous disease was less common in Whites, more common in Blacks, and more common in ANA positive patients. It is possible that some patients with arthritis and positive ANA titers were categorized as having JIA, when in actuality they had a different disease more consistent with granulomatous uveitis, such as sarcoidosis. However, if sarcoidosis is excluded, the presence of granulomatous disease is not inconsistent with a diagnosis of JIA uveitis.
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