SAT0521 RISK FACTORS FOR THE OCCURRENCE OF UVEITIS IN THE PATIENTS WITH OLIGOARTICULAR JUVENILE IDIOPATHIC ARTHRITIS. (June 2019) - Sözeri, Betül
Abstract : Background: Oligoarticular (oligo) onset juvenile idiopathic arthritis (JIA) is defined as 4 or fewer affected joints within 6 mo of disease onset. This JIA subtype typically involves large joints. Patients who develop arthritis in 4 joints after the first 6 mo are considered to have extended oligo JIA, and have a worse prognosis. Chronic uveitis is a common and serious comorbid condition of juvenile idiopathic arthritis, with insidious presentation and potential to cause blindness. Knowledge of clinical associations will improve risk stratification. Objectives: We aim to analyzed identification of the incidence of oligo articular JIA-associated uveitis and its risk factors is essential to optimize early detection. Methods: We enrolled 185 patients who were diagnosed with oligo JIA and seen at our clinic. Visual acuity was recorded in logMAR. LogMAR is the logarithmic representation of visual acuity. Visual impairment was stratified by severity as logMAR >0.3 (worse than 6/12) or ≥ 1.0 (6/60 or worse). Results: A total of 185 oligo JIA patients were included in this study (61.6% female, 65.9% ANA positive). 32 of all patients (72.2%) developed uveitis within follow-up. The median age (IQR) at diagnosis was 89 (42-131.5) months, median follow-up of 24.5 (10-29) months. At disease onset, 12% of all patients were examined small joint arthritis (defined as involvement of any of the metatarsophalangeal or proximal or distal interphalangeal joints of the foot, or metacarpophalangeal or proximal or distal interphalangeal joints of the hand). 7 out of 35 (20%) patients with oligo onset JIA involving only small joints developed extended arthritis (>4 joints), compared to 15 out of 150 (10%) of patients with only large joint oligo onset JIA [p<0.01]. 10 of 32 patients with uveitis had small joints involvement (p<0.01) Of these, 18 (56%) patients developed uveitis after enrollment while 14 (44%) patients had uveitis before first JIA symptoms. 58.8% of patients (n=8) developed uveitis with in first two years of JIA while 41.2 patients had uveitis developed up to 2 years. Uveitis was associated with positive ANA (p<0.001) and small joint involvement. In contrast, young age (< 7 years) at oligo JIA diagnosis, female sex, extended oligo JIA and used systemic steroid were not finding associated with uveitis. Of the 57 affected eyes, posterior synechiae (n=20) was the predominant complication on presentation. During the follow-up period new complications were seen in 11 eyes (13%). Posterior synechiea (6 eyes, 7, 5%) was the most frequent complication observed followed by cataract (3 eyes, 3, %) and glaucoma (2 eyes, 2, 5%). At the presentation, 8 patients (25%) had visual acuity loss to > 0.3 LogMAR (6/12) and to ≥1.0 LogMAR (6/60). However, 3 (0.09%) patients had visual acuity loss end of the follow up time. Biologically were used in 75% of JIA patients while 8 (25%) children with JIA did not require any biologic treatment. Systemic and topical steroids treatment were gradually tapered and discontinued in all patients after initiation of biologics. In JIA associated uveitis patients, biologic therapy was used in 24/32 (75%) at the follow up time (infliximab in 9, adalimumab in eleven, and tocilizumab in one patient) and 9 children (37.5%) required ≥2 biologics over the follow up period. Conclusion: The patients with oligo JIA who had present antinuclear antibodies, and small joint involvement should be particularly close observation. References: [1] Rheumatology (Oxford). 2018Dec26. doi: 10.1093/rheumatology/key406 [2] Reumatologia. 2018;56(3):149-154. doi: 10.5114/reum.2018.76902 Disclosure of Interests: None declared