Abstract
Purpose :
The impact of treatment on children with juvenile idiopathic arthritis (JIA) and uveitis is understudied. We aim to evaluate the effect of adalimumab (ADA) on the quality of life (QoL) and mental health of pediatric uveitis and JIA patients.
Methods :
This is a prospective IRB approved study of patients with pediatric uveitis and JIA on ADA. Patients, if able, and parent proxies completed PROs pre- and post-ADA: Pediatric Quality-of-Life Inventory (PedsQL: overall QoL), Childhood Health Assessment Questionnaire (CHAQ: physical function), Effect of Youngster’s Eyesight on QoL (EYE-Q: uveitis related), and the Revised Childhood Anxiety and Depression Scale (RCADS). Scores were compared pre-ADA and post- ADA in those who discontinued and continued ADA by Mann-Whitney U Test.
Results :
29 patients at Cincinnati Children’s Hospital were included. 16 patients (55%) were diagnosed with JIA, 6 (21%) with uveitis, and 7 (24%) with both. At baseline pre-ADA, patients and parent proxies who discontinued ADA had worse overall QoL (83 vs 71, P=0.024), physical disability (0.25 vs 0.74, P=0.006), and depression and anxiety (42 vs 49, P=0.014) but not VR-QoL than those who continued ADA. Post-ADA (5.6 m, range 2.3-17.7), patients and parent proxies who discontinued ADA had significantly worse overall QoL (PedsQL, 86 vs 73, P=0.007), vision related QoL (EYE-Q, 96% vs 77%, P=0.014), and physical disability (CHAQ, 0.21 vs 0.69, P=0.006), but not anxiety and depression (RCADS, 45 vs 49, P=0.158).
Conclusions :
Patients who discontinued ADA had consistently poorer QoL metrics and physical disability throughout the disease course than those who were able to continue ADA. As QoL, physical disability, and mental health scores were worse prior to starting ADA in those who later fail treatment, our data suggests that these domains of wellness may be important for screening. Further, vision related-QoL was worse at follow up in those who failed ADA, which may reflect severe uveitis requiring drug escalation. The impact of a severe uveitis course and treatment response warrant further assessment in a larger study to understand effects of uveitis and improve patient outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.