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Rheumatology Advance Access originally published online on April 2, 2007
Rheumatology 2007 46(6):1015-1019; doi:10.1093/rheumatology/kem053
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines

A. Heiligenhaus1, M. Niewerth2, G. Ganser3, C. Heinz1, K. Minden2,4 and German Uveitis in Childhood Study Group*

1Department of Ophthalmology at St. Franziskus Hospital, Muenster; University of Duisburg-Essen, 2German Rheumatism Research Center, Berlin, 3Department of Paediatric Rheumatology, Josef-Stift, Sendenhorst and 4Children's Hospital, Helios Klinikum Berlin-Buch, Germany.

Correspondence to: A. Heiligenhaus, MD, Department of Ophthalmology at St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany. E-mail: arnd.heiligenhaus{at}uveitis-zentrum.de


  Abstract

Objectives. To analyse the prevalence and complications of uveitis and their predictors in a large cohort of patients with juvenile idiopathic arthritis (JIA).

Methods. Data of 3271 JIA patients as classified by International League of Associations for Rheumatology (ILAR) criteria included in a national database during 1 yr were analysed.

Results. Uveitis prevalence was 12% of all JIA patients. The most frequent were oligoarthritis extended (25%) and persistent (16%). JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs 7.0 yrs) or ANA-positive (86% vs 42%) than the patients without uveitis. Predictors of uveitis included age at onset (P= 0.03) and ANA-positivity (P< 0.01) besides the presence of a certain JIA subgroup (P= 0.04). Uveitis was clinically silent in 75% of the oligoarthritis but in none of the enthesitis-related arthritis patients. The median onset of uveitis was 5.5 months after arthritis manifestation. In 73%, 77% and 90%, uveitis developed within 1, 2 and 4 yrs after arthritis, respectively. Anterior uveitis was the most common anatomic type of uveitis (83%). Uveitis complications at mean follow-up of 5.6 yrs were common (56%), and predictors for complications included presence of complications at first visit (P< 0.001) and uveitis manifestation before arthritis (P= 0.001), but not ANA positivity.

Conclusions. The JIA subgroups markedly differ with respect to the prevalence and course of associated uveitis. Ophthalmological screening should be initiated early after arthritis onset and the intervals be related to the JIA subgroup. A modification of the current screening guidelines is suggested.

KEY WORDS: Uveitis, Iridocyclitis, Prevalence, Juvenile idiopathic arthritis, National paediatric rheumatological database

*Uveitis in Childhood Study Group: Society of Paediatric Rheumatology (GKJR)—G. Ganser (Sendenhorst), G. Horneff (St. Augustin), T. Niehues (Duesseldorf), K. Minden (Berlin); Society of Paediatric Rheumatology Nordrhein Westfalen—S. Fahl (Sendenhorst), D. Föll (Muenster), M. Frosch (Muenster), G. Ganser (Sendenhorst), S. Kastner (Bonn), I. Kleine, E. Lainka (Essen), E. Lilienthal (Bochum), K. Mönkemöller (Koeln), J. Ndagijimana (Duesseldorf), U. Neudorf (Essen), T. Niehues (Duesseldorf), M. Roth (Muenster), N. Wagner (Dortmund), R. Wieland (Essen); Uveitis centres—M. Becker (Heidelberg), A. Heiligenhaus (Muenster), C. Heinz (Muenster), T. Hudde (Wolfsburg), U. Pleyer (Berlin), K.-P. Steuhl (Essen), S. Thurau (Muenchen), M. Zierhut (Tuebingen).

Submitted 20 June 2006; revised version accepted 7 February 2007.
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