Asymptomatic uveitis follows JIA into adulthood

A clinical study has confirmed that asymptomatic uveitis associated with juvenile idiopathic arthritis (JIA) persists into adulthood—often with continuing arthritis. Sight remains good overall despite some complications, but development of the condition in early adulthood in some patients suggests that routine eye examinations throughout adolescence are advisable.

Asymptomatic uveitis was present in 19 patients, acute uveitis in six, and 98 patients had no history of eye inflammation. Mean age to diagnosis of JIA was 4.3 (range 1.5–16.8) years, and asymptomatic uveitis developed shortly after in most cases whereas acute uveitis developed much later (mean age at diagnosis 10 (range 2.6–23.5) v 20 (14.5–22) years, respectively). Patients with asymptomatic uveitis had developed arthritis at a significantly earlier age than those without (4.3 v 2.7 years), and a higher proportion were HLA B27 positive. They also tended to show active arthritis at clinical evaluation (risk ratio (RR) 1.45 (1.42 after correction for HLA B27 antigen)). Complications of asymptomatic uveitis amounted to secondary glaucoma in four and cataract in five patients but sight remained good with treatment.

The study took place at a tertiary referral centre for JIA in Helsinki, Finland, in 123 patients born between 1976 and 1980, whose JIA was diagnosed between 1976 and 1995, who had comprehensive clinical re-evaluation some 6–23 years (mean 19.3 years for asymptomatic uveitis and 15.5 years for non-uveitis) from first diagnosis of arthritis.

Asymptomatic uveitis and JIA often coincide, but until now the connection has been tenuous because arthritis activity has been poorly recorded.