Skip to main content

Advertisement

SpringerLink
Log in

Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature

  • Review Article
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

Juvenile rheumatoid arthritis (JRA) is the most common systemic cause of pediatric uveitis in Europe and North America. Uveitis is commonly perceived as a frequent sequela of JRA and JRA-associated uveitis is commonly considered to have a complicated course with frequent adverse visual outcomes.

Methods

We performed a systematic literature search for series of consecutive patients with JRA (as defined by the American College of Rheumatology criteria) reporting on the frequency of uveitis and/or complications of uveitis, published between January 1980 and December 2004. The main outcome measures were: the cumulative incidence of uveitis in JRA, the cumulative incidence of adverse visual outcome and that of complications in JRA-associated uveitis. Additionally, the influence of gender, presence of antinuclear antibody (ANA) and disease onset subtype to the likelihood of developing uveitis were examined.

Results

Analysis of pooled data from the 26 eligible series suggested a cumulative incidence of uveitis in JRA of 8.3% [95% confidence intervals (CI), 7.5–9.1%]. The cumulative incidence of uveitis varied according to geographic location, being highest in Scandinavia, then the US, then Asia and lowest in India. JRA-associated uveitis was more common in pauciarticular than polyarticular onset patients [odds ratio (OR)=3.2, 95% CI, 2.33–4.36] and in ANA-positive than ANA-negative patients (OR=3.18, 95% CI, 2.22–4.54). Female gender was only a weak risk factor for the development of uveitis in JRA patients (OR=1.69, 95% CI 1.09–2.62) and was not statistically significant after considering disease onset subtypes. In JRA-associated uveitis the cumulative incidence of cumulative incidence of adverse outcome (visual acuity <20/40 OU) was 9.2% (95% CI: 4.7–15.8) of cataracts 20.5% (95% CI: 15.5–26.3), of glaucoma 18.9% (95% CI: 14.4–24.2) and of band keratopathy 15.7% (95% CI: 10.9–21.7).

Conclusion

The cumulative incidence of uveitis in JRA varies according to geographic location, presence of ANA, type of JRA onset and gender. Uveitis, adverse visual outcome, and complications in JRA are less frequent than commonly accepted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Akduman L, Kaplan HJ, Tychsen L (1997) Prevalence of uveitis in an outpatient juvenile arthritis clinic: onset of uveitis more than a decade after onset of arthritis. J Pediatr Ophthalmol Strabismus 34:101–106

    PubMed  CAS  Google Scholar 

  2. American Academy of Pediatrics Section on Rheumatology and Section on Ophthalmology (1992) Guidelines for ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics 92:295–296

    Google Scholar 

  3. Ansell BM, Bywaters EGL (1959) Prognosis in Still's disease. Bull Rheum Dis 9:189–192

    PubMed  CAS  Google Scholar 

  4. Berk AT, Kocak N, Unsal E (2001) Uveitis in juvenile arthritis. Ocul Immunol Inflamm 9:243–251

    Article  PubMed  CAS  Google Scholar 

  5. Berntson L, Fasth A, Andersson-Gare B, Herlin T, Kristinsson J, Lahdenne P, Marhaug G, Nielsen S, Pelkonen P, Rygg M (2002) The influence of heredity for psoriasis on the ILAR classification of juvenile idiopathic arthritis. J Rheumatol 29:2454–2458

    PubMed  Google Scholar 

  6. Berntson L, Fasth A, Andersson-Gare B, Kristinsson J, Lahdenne P, Marhaug G, Nielsen S, Pelkonen P, Svensson E (2001) Construct validity of ILAR and EULAR criteria in juvenile idiopathic arthritis: a population based incidence study from the Nordic countries. J Rheumatol 28:2737–2743

    PubMed  CAS  Google Scholar 

  7. Brewer EJ, Bass JC, Baum J, Cassidy JT, Fink C, Jacobs J, Hanson V, Levinson JE, Schaller J, Stillman JS (1977) Current proposed revision of JRA criteria. Arthri Rheum 20:195–199

    Google Scholar 

  8. Boone MI, Moore TL, Cruz OA (1998) Screening for uveitis in juvenile rheumatoid arthritis. J Pediatr Ophthalmol Strabismus 35:41–43

    PubMed  CAS  Google Scholar 

  9. Bowyer SL, Roettcher PA, Higgins GC, Adams B, Myers LK, Wallace C, Rennebohm R, Moore TL, Pepmueller PH, Spencer C, Wagner-Weiner L, Rabinovich E, Passo M, Lovell DJ, Madson K, McCurdy D, Zemel L, Schinkler KN, Szer I, Kurtin P, Lindsley C (2003) Health status of patients with juvenile rheumatoid arthritis at 1 and 5 years after diagnosis. J Rheumatol 30:394–400

    PubMed  Google Scholar 

  10. Brooks P (2001) Report of the sixth joint WHO/ILAR task force meeting on rheumatic diseases, January 16, 2000, Geneva, Switzerland. J Rheumatol 28:2540–2543

    PubMed  CAS  Google Scholar 

  11. Carvounis PE, Herman DC, Cha SS, Burke JP (2005) Ocular manifestation of juvenile rheumatoid arthritis in Olmsted county, MN: a population-based study. Graefe's Arch Clin Exp Ophthalmol 243:217–221

    Article  Google Scholar 

  12. Cassidy JT, Levinson JE, Bass JC, Baum J, Brewer EJ, Fink CW, Hanson V, Jacobs JC, Masi AT, Schaller JG, Fries JF, McShane D, Young D (1986) A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthri Rheum 29:274–281

    Article  CAS  Google Scholar 

  13. Chalom EC, Goldsmith DP, Koehler MA, Bittar B, Rose CD, Ostrov BE, Keenan GF (1997) Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. J Rheumatol 24:2031–2034

    PubMed  CAS  Google Scholar 

  14. Chandrasekaran AN, Rajendran CP, Madhavan R (1996) Juvenile rheumatoid arthritis- Madras experience. Indi J Pediatr 63:501–510

    CAS  Google Scholar 

  15. Chen CS, Robertson D, Hammerton ME (2004) Juvenile arthritis-associated uveitis: visual outcomes and prognosis. Can J Ophthalmol 39:614–620

    PubMed  Google Scholar 

  16. Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS (1997) Visual outcomes prognosticators in juvenile rheumatoid arthritis-associated uveitis. Ophthalmology 104:236–244

    PubMed  CAS  Google Scholar 

  17. De Inocencio J, Giannini EH, Glass DN (1993) Can genetic markers contribute to the classification of juvenile rheumatoid arthritis? J Rheumatol 20:S12–S17

    Google Scholar 

  18. European League Against Rheumatism. EULAR Bulletin No. 4: Nomenclature and classification of arthritis in children. Basel: National Zeitung AG; 1977.Wood P (1978) Nomenclature and classification of arthritis in children. In: Munthe E (ed) The care of Rheumatic Children. EULAR publications, Basel, p 47

  19. Flato B, Lien G, Smerdel A, Vinje O, Dale K, Johnston V, Sorskaar D, Moum T, Ploski R, Fore O (2003) Prognostic factors in juvenile rheumatoid arthritis: a case-control study revealing early predictors and outcome after 14.9 years. J Rheumatol 30:386–393

    PubMed  Google Scholar 

  20. Fledelius H, Zak M, Pederson FK (2001) Refraction in juvenile chronic arthritis: a long-term follow-up study, with emphasis on myopia. Acta Ophthalmol Scand 79:237–239

    Article  PubMed  CAS  Google Scholar 

  21. Foeldvari I, Biddle M (2000) Validation of the proposed ILAR classification criteria for juvenile idiopathic arthritis. International League of Associations for Rheumatology. J Rheumatol 27:1069–1072

    PubMed  CAS  Google Scholar 

  22. Fong DS, Raizman MB (1993) Spontaneous hyphema associated with anterior uveitis. Br J Ophthalmol 77:635–638

    Article  PubMed  CAS  Google Scholar 

  23. Foster S, Havrlikova K, Baltatzis S, Christen WG, Merayo-Lloves J (2000) Secondary glaucoma in patients with juvenile rheumatoid arthritis-associated iridocyclitis. Acta Ophthalmol Scand 78:576–579

    Article  PubMed  CAS  Google Scholar 

  24. Foster CS, Barrett F (1993) Cataract development and cataract surgery in patients with juvenile rheumatoid arthritis-associated iridocyclitis. Ophthalmology 100:809–817

    PubMed  CAS  Google Scholar 

  25. Fujikawa S, Masahiko O (1997) Clinical analysis of 570 cases with juvenile rheumatoid arthritis: results of a nationwide retrospective study in Japan. Acta Paediatrica Japonica 39:245–249

    PubMed  CAS  Google Scholar 

  26. Giannini EH, Brwer EJ, Kuzmina N, Shaikov A, Maximov A, Vorontsov I, Fink C, Newman AJ, Cassidy JT, Zemel LS (1992) Methotrexate in resistant juvenile rheumatoid arthritis. Results of the USA-USSR Double blind, placebo-controlled trial. N Engl J Med 326:1043–1049

    Article  PubMed  CAS  Google Scholar 

  27. Gupta K, Chintu C, Raghu MB (1981) Juvenile rheumatoid arthritis in Zambian children. East Afr Med J 58:344–353

    PubMed  CAS  Google Scholar 

  28. Haas JP, Truckenbrodt H, Paul C, Hoza J, Scholtz S, Albert ED (1994) Subtypes of HLA-DRB1*03, *08, *11, *12, *13 and *14 in early onset pauciarticular juvenile rheumatoid arthritis (EOPA) with and without iridocyclitis. Clin Exp Rheumatol 12S:7–14

    Google Scholar 

  29. Jain V, Singh S, Sharma A (2001) Keratoconjunctivitis sicca is not uncommon in children with juvenile rheumatoid arthritis. Rheumatol Int 20:159–162

    Article  PubMed  CAS  Google Scholar 

  30. Kadayitcilar S, Eidem B, Tumer B (2003) Uveitis in childhood. J Pediatr Ophthalmol Strab 40:335–340

    Google Scholar 

  31. Kanski JJ (1990) Juvenile arthritis and uveitis. Surv Ophthalmol 34:253–267

    Article  PubMed  CAS  Google Scholar 

  32. Key SN, Kimura SJ (1975) Iridocyclitis associated with juvenile rheumatoid arthritis. Am J Ophthalmol 80:428–429

    Google Scholar 

  33. Khuffash FA, Majeed HA (1988) Juvenile rheumatoid arthritis among Arab children. Scand J Rheumatol 17:393–395

    Article  PubMed  CAS  Google Scholar 

  34. Kodsi SR, Rubin SE, Milojevic D, Ilowite N, Gottlieb B (2002) Time of onset of uveitis in children with juvenile rheumatoid arthritis. J AAPOS 6:373–376

    PubMed  Google Scholar 

  35. Kotaniemi K, Kaipiainen-Seppanen O, Savolainen A, Karma A (1999) A population-based study of uveitis in juvenile rheumatoid arthritis. Clin Exp Rheumatol 17:119–122

    PubMed  CAS  Google Scholar 

  36. Kobayashi T, Tanaka S, Maeda M, Okubo H, Matsuama T, Watanabe N (1993) A study of prognosis in 52 cases with juvenile rheumatoid arthritis. Acta Paediatr Jpn 35:439–446

    CAS  Google Scholar 

  37. Kunnamo I, Kallio P, Pelkonen P (1986) Incidence of arthritis in urban Finnish children. A prospective study. Arthr Rheum 29:1232–1238

    Article  CAS  Google Scholar 

  38. Laxer RM (1993) What's in a name: the nomenclature of juvenile rheumatoid arthritis. J Rheumatol 20:S1–S3

    Google Scholar 

  39. McGill NW, Gow PJ (1987) Juvenile rheumatoid arthritis in Auckland: a long term follow up study with particular reference to uveitis. Aust N Z J Med 17:305–308

    PubMed  CAS  Google Scholar 

  40. Oh KT, Hong KP, Kim TH, Jun JB, Jung SS, Lee IH, Bae SC, Kim SY (1996) High incidence of HLA-B27 and low incidence of ANA in Korean juvenile rheumatoid arthritis: a descriptive cross-sectional study to analyze profiles related to prognosis [abstract]. Arthr Rheum 39:S54

    Google Scholar 

  41. Oren B, Sehgal A, Simon JW, Lee J, Blocker RJ, Biglan AW, Zobal-Ratner J (2001) The prevalence of uveitis in juvenile rheumatoid arthritis. J AAPOS 5:2–4

    Article  PubMed  CAS  Google Scholar 

  42. Paivonsalo-Hietanen T, Tuominen J, Saari KM (2000) Uveitis in children: population based study in Finland. Acta Ophthalmol Scand 78:84–88

    Article  PubMed  CAS  Google Scholar 

  43. Paroli MP, Speranza S, Marino M, Pirraglia MP, Pivetti-Pezzi P (2003) Prognosis of juvenile rheumatoid arthritis-associated uveitis. Eur J Ophthalmol 13:616–621

    PubMed  CAS  Google Scholar 

  44. Petty RE, Smith JR, Rosenbaum JT (2003) Arthritis and uveitis in childhood. A pediatric rheumatology perspective. Am J Ophthalmol 135:879–884

    Article  PubMed  Google Scholar 

  45. Petty RE, Southwood TR, Baum J, Bhettay E, Glass DN, Manners P, Maldonado-Cocco J, Suarez-Almazor M, Orozco-Alcala J, Prieur AM (1998) Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban 1997. J Rheumatol 25:1991–1994

    PubMed  CAS  Google Scholar 

  46. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P (2004) International League of Associations for Rheumatology classification of Juvenile Idiopathic Arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392

    PubMed  Google Scholar 

  47. Pongpanich B, Daengroongroj P (1988) Juvenile rheumatoid arthritis: clinical characteristics of 100 Thai patients. Clin Rheumatol 7:257–261

    Article  PubMed  CAS  Google Scholar 

  48. Porkodi R, Subramaniam R, Krishnamurthy V, Madhavan R, Parthiban M, Chandrasekaran AN (1990) Pattern of rheumatic diseases in South India IV. Clinical profile of juvenile rheumatoid arthritis. J Assoc Phys Ind 38:771–773

    CAS  Google Scholar 

  49. Powe NR, Schein OD, Giesen SC, Tielsch JM, Luthra R, Javitt J, Steinberg EP (1994) Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Arch Ophthalmol 112:239–252

    PubMed  CAS  Google Scholar 

  50. Ramsey SE, Bolaria RK, Cabral DA, Malleson PN, Petty RB (2000) Comparison of criteria for the classification of childhood arthritis. J Rheumatol 27:1283–1286

    PubMed  CAS  Google Scholar 

  51. Rosenberg AM, Oen KG (1986) The relationship between ocular and articular disease activity in children with juvenile rheumatoid arthritis and associated uveitis. Arthr Rheum 29:797–800

    Article  CAS  Google Scholar 

  52. Schwartz MM, Simpson P, Kerr KL, Jarvis JN (1997) Juvenile rheumatoid arthritis in African Americans. J Rheumatol 24:1826–1829

    PubMed  CAS  Google Scholar 

  53. Seth V, Kalra SK, Semwal OP, Jain Y (1996) Clinico-immunological profile in juvenile rheumatoid arthritis-an Indian experience. Ind J Pediatr 63:293–300

    Article  CAS  Google Scholar 

  54. Sherry DD, Mellins ED, Wedgwood RJ (1991) Decreasing severity of chronic uveitis in children with pauciarticular arthritis. Am J Dis Child 145:1026–1028

    PubMed  CAS  Google Scholar 

  55. Singh S, Salaria M, Kumar L, Minz R, Data U, Sehgal S (1999) Clinico-immunological profile of juvenile rheumatoid arthritis. Ind Pediatr 36:449–454

    CAS  Google Scholar 

  56. Towner SR, Michet CJ Jr, O'Fallon WM, Nelson AM (1983) The epidemiology of juvenile arthritis in Rochester, Minnesota 1960–1979. Arthr Rheum 26:1208–1213

    Article  CAS  Google Scholar 

  57. Tsitami E, Bozzola E, Magni-Manzoni S, Viola S, Pistorio A, Ruperto N, Martini A, Ravelli A (2003) Positive family history of psoriasis does not affect the clinical expression of juvenile idiopathic arthritis patients with oligoarthritis. Arthritis Rheum 49:488–493

    Article  Google Scholar 

  58. Tugal-Tutkan I, Havrlikova K, Power WJ, Foster CS (1996) Changing pattern in uveitis of childhood. Ophthalmology 103:375–383

    Google Scholar 

  59. Wang FM, Wertenbaker C, Behrens MM, Jacobs JC (1984) Acquired Brown's syndrome in children with juvenile rheumatoid arthritis. Ophthalmology 91:23–26

    PubMed  CAS  Google Scholar 

  60. Wolf MD, Lighter PR, Ragsdale CG (1987) Prognostic factors in the uveitis of juvenile rheumatoid arthritis. Ophthalmology 94:1242–1248

    PubMed  CAS  Google Scholar 

  61. Wu CJ, Huang JL, Yang MH, Yan DC, Ou LS, Ho HH (2001) Clinical characteristics of juvenile rheumatoid arthritis in Taiwan. J Microbiol Immunol Inf 34:211–214

    CAS  Google Scholar 

  62. Zulian F, Martini G, Falcini F, Gerloni V, Zannin ME, Pinello L, Fantini F, Facchin P (2002) Early predictors of severe course of uveitis in oligoarticular juvenile idiopathic arthritis. J Rheumatol 29:2446–2453

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA

    Petros E. Carvounis, David C. Herman, Stephen Cha & James P. Burke

  2. Department of Ophthalmology, The George Washington University, Washington, DC, USA

    Petros E. Carvounis

  3. Department of Ophthalmology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    David C. Herman

  4. Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Stephen Cha & James P. Burke

Authors
  1. Petros E. Carvounis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David C. Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James P. Burke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David C. Herman.

Additional information

Supported by a research grant from the Department of Ophthalmology, Mayo Clinic, Rochester, MN and an unrestricted grant from Research to Prevent Blindness, Inc. New York, New York.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carvounis, P.E., Herman, D.C., Cha, S. et al. Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature. Graefe's Arch Clin Exp Ophthalmo 244, 281–290 (2006). https://doi.org/10.1007/s00417-005-0087-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-005-0087-3

Keywords

Search

Navigation