Risk for uveitis occurrence in juvenile idiopathic arthritis (JIA) and predictive factors for the 2-years outcome: Data from the Inception Cohort of Newly diagnosed patients with JIA (ICON-JIA) study

Abstract

Purpose : To prospectively analyze predictors for occurrence and clinical course of uveitis in newly diagnosed juvenile idiopathic arthritis (JIA).

Methods : Patients with JIA (n=957) were enrolled in the Inception Cohort of Newly diagnosed patients with JIA (ICON-JIA) study within the first year after JIA diagnosis. Demographic and clinical parameters were documented at baseline, 3-monthly during the first year and 6-monthly afterwards. Serum samples were collected at each visit, and serum S100A12 levels were measured by ELISA. Multivariate Cox-regression analysis was performed to evaluate the impact of demographic, clinical, laboratory and therapeutic parameters on onset and two-years uveitis outcome.

Results : Mean age at JIA onset was 7.1 ± 4.6 years, 67.1% of patients were female and 56.6% ANA positive. In 61 patients, uveitis was present before JIA diagnosis, and occurred in another 60 patients during follow up (FU; mean 39 months). Risk factors for uveitis onset were young age at JIA onset (HR 1.19, p<0.0001), oligoarthritis (HR 1.22, p<0.0001) and ANA positivity (HR 2.34, p=0.004). Predictors for uveitis onset during FU were high cJADAS10 scores (HR 1.05, p=0.031), S100A12 levels >250ng/ml (HR 2.74, p=0.001) and ESR >20 mm/h (HR 2.32, p=0.005) at baseline. Uveitis inactivity was achieved in 78.9% and 89.5% of patients at 1- and 2-years FU, respectively. Predictors for uveitis quiescence (≥6 months) were uveitis onset after age of 5 years (OR 3.00; p=0.02), lower cJADAS10 (OR 0.78; p<0.0001), low anterior chamber (AC) cell-grade (OR 2.50; p=0.001), and adalimumab treatment (OR 5.10; p=0.001) at visit before attaining uveitis inactivity. Age <5 years at uveitis onset (OR 12.5, p=0.03) and cJADAS10 >4.5 (OR 5.54; p<0.03) were predictors for subsequent uveitis reactivation (n=13, 23%). Ocular complications were present in 27.8% at baseline, and in 28.2% and 34.0% at 1- and 2-year FU, respectively. AC cell grades ≥1+ (HR 4.00; p=0.086) and AC tyndall ≥1+ (HR 6.73; p=0.041) correlated with presence of uveitis-related complications.

Conclusions : Beside demographic risk factors, JIA disease activity scores and biomarkers can help to identify patients at risk for uveitis onset. Clinical characteristics and treatment are additional predictors for the 2-years outcome of uveitis.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.