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Madalyonun Diğer Yüzü: Juvenil İdiyopatik Artritli Hastalarda Üveit

Year 2023, Volume: 17 Issue: 5, 369 - 374, 25.09.2023
https://doi.org/10.12956/tchd.1279814

Abstract

Amaç: Juvenil idiyopatik artrit (JİA), eklem iltihabı ve doku hasarına neden olan çocukluk çağı romatizmal bir hastalıktır. Enfeksiyöz olmayan üveit, JİA’nın en sık görülen eklem dışı belirtisidir. Bu çalışmanın amacı, JIA’lı hastalarda üveit oluşumunda ve tekrarlamasında rol oynayan risk faktörlerini değerlendirmek ve artrit ile üveit aktivitesi arasındaki ilişkiyi belirlemektir.
Gereç ve Yöntemler: Bu retrospektif, kesitsel çalışmaya Türkiye’deki bir sevk merkezinden üveiti olan/olmayan JIA hastaları dahil edildi. Hastalık aktivitesini değerlendirmek için Juvenil Artrit Hastalık Aktivite Skoru kullanıldı ve artrit ve üveit için ayrı ayrı hesaplandı.
Bulgular: Üveit 195 JIA hastasının 26’sında (%13.3) görüldü. 26 JIA-U hastasının 19’unda (%73) oligoartiküler alt tip vardı. Üveitli JİA’nın tanı ortanca yaşı üveitsiz JİA’ya göre daha gençti (p=0.015). Oligoartiküler JİA üveit nüksü ile ilişkili bulunmuştur (p=0.021). Tekrarlayan üveiti olan hastalarda artrit ve üveitin ortaya çıkış yaşı anlamlı olarak daha gençti (sırasıyla p=0.041, p=0.002). Üveit başlangıcındaki medyan JADAS27 skoru tekrarlayan grupta daha düşüktü (p=0.038).
Sonuç: Erken yaş, üveit oluşumu ve nüksü için önemli bir risk faktörüdür. Hastalık seyri sırasında, düşük hastalık aktivitesine sahip hastalarda da üveit gelişebileceğini unutmamak önemlidir.

References

  • Heiligenhaus A, Heinz C, Edelsten C, Kotaniemi K, Minden K. Review for disease of the year: epidemiology of juvenile idiopathic arthritis and its associated uveitis: the probable risk factors. Ocul Immunol Inflamm 2013;21:180–91.
  • Moradi A, Amin RM, Thorne JE. The role of gender in juvenile idiopathic arthritis-associated uveitis. J Ophthalmol 2014;2014:461078.
  • Clarke SL, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J 2016;14:27.
  • Kaisu K, Anneli S, Anni K, Kimmo A. Recent advances in uveitis of juvenile idiopathic arthritis. Surv Ophthalmol 2003;48:489–502.
  • Ezzahri M, Amine B, Rostom S, Rifay Y, Badri D, Mawani N, et al. The uveitis and its relationship with disease activity and quality of life in Moroccan children with juvenile idiopathic arthritis. Clin Rheumatol 2013;32:1387-91.
  • Kotaniemi K, Kotaniemi A, Savolainen A. Uveitis as a marker of active arthritis in 372 patients with juvenile idiopathic seronegative oligoarthritis or polyarthritis. Clin Exp Rheumato 2002;20:109–12.
  • Zak M, Fledelius H, Pedersen FK. Ocular complications and visual outcome in juvenile chronic arthritis: a 25-year follow-up study. Acta Ophthalmol Scand 2003;81:211-15.
  • Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004;31:390-92.
  • Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005;140:509-16.
  • Consolaro A, Giancane G, Schiappapietra B, Davì S, Calandra S, Lanni S, et al. Clinical outcome measures in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2016;14:23.
  • Wallace CA, Huang B, Bandeira M, Ravelli A, Giannini EH. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheum 2005;52:3554-62.
  • Yalçındağ FN, Güngör SG, Değirmenci MFK, Sarıgül Sezenöz A, Özçakar ZB, Baskın E, et al. The Clinical Characteristics of Pediatric Non-Infectious Uveitis in Two Tertiary Referral Centers in Turkey. Ocul Immunol Inflamm 2021;29:282-89.
  • Sahin S, Acari C, Sonmez HE, Kilic FZ, Sag E, Dundar HA, et al. Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER. Pediatr Rheumatol Online J 2021;19:134.
  • Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007;369:767-78.
  • Lee JJY, Duffy CM, Guzman J, Oen K, Barrowman N, Rosenberg AM, et al. ReACCh-Out Investigators. Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort. Arthritis Care Res (Hoboken). 2019;71:1436-43.
  • Calandra S, Gallo MC, Consolaro A, Pistorio A, Lattanzi B, Bovis F, et al. Female sex and oligoarthritis category are not risk factors for uveitis in Italian children with juvenile idiopathic arthritis. J Rheumatol 2014;41:1416-25.
  • Tappeiner C, Klotsche J, Sengler C, Niewerth M, Liedmann I, Walscheid K et al. Risk Factors and Biomarkers for the Occurrence of Uveitis in Juvenile Idiopathic Arthritis: Data From the Inception Cohort of Newly Diagnosed Patients With Juvenile Idiopathic Arthritis Study. Arthritis Rheumatol 2018;70:1685-94.
  • Heiligenhaus A, Klotsche J, Tappeiner C, Sengler C, Niewerth M, Liedmann I, et al. Predictive factors and biomarkers for the 2-year outcome of uveitis in juvenile idiopathic arthritis: data from the Inception Cohort of Newly diagnosed patients with Juvenile Idiopathic Arthritis (ICON-JIA) study. Rheumatology (Oxford) 2019;58:975-86.
  • Dana MR, Merayo-Lloves J, Schaumberg DA. Visual outcomes prognosticators in juvenile rheumatoid arthritis-associated uveitis. Foster CS Ophthalmology 1997;104:236-44.
  • Marelli L, Romano M, Pontikaki I, Gattinara MV, Nucci P, Cimaz R, et al. Long Term Experience in Patients With JIA-Associated Uveitis in a Large Referral Center. Front Pediatr 2021;9:682327.
  • Papasavvas I, Herbort CP Jr. Granulomatous Features in Juvenile Idiopathic Arthritis-Associated Uveitis is Not a Rare Occurrence. Clin Ophthalmol 2021;8:1055-9.
  • Grassi A, Corona F, Casellato A, Carnelli V, Bardare M. Prevalence and outcome of juvenile idiopathic arthritis-associated uveitis and relation to articular disease. J Rheumatol 2007;34:1139-45.
  • Liebling EJ, Faig W, Chang JC, Mendoza E, Moore N, Vicioso NL, et al. Temporal Relationship Between Juvenile Idiopathic Arthritis Disease Activity and Uveitis Disease Activity. Arthritis Care Res (Hoboken) 2022;74:349-54.
  • Rypdal V, Glerup M, Songstad NT, Bertelsen G, Christoffersen T, Arnstad ED, et al. Nordic Study Group of Pediatric Rheumatology. Uveitis in Juvenile Idiopathic Arthritis: 18-Year Outcome in the Population-based Nordic Cohort Study. Ophthalmology 2021;128:598-608.
  • Papadopoulou C, Kostik M, Böhm M, Nieto-Gonzalez JC, Gonzalez-Fernandez MI, Pistorio A, et al. Methotrexate therapy may prevent the onset of uveitis in juvenile idiopathic arthritis. J Pediatr 2013;163:879-84.
  • Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken) 2019;71:703-16.

The Other Side of the Coin: Uveitis in Patients with Juvenile Idiopathic Arthritis

Year 2023, Volume: 17 Issue: 5, 369 - 374, 25.09.2023
https://doi.org/10.12956/tchd.1279814

Abstract

Objective: Juvenile idiopathic arthritis (JIA) is a childhood rheumatic disease that causes joint inflammation and tissue damage. Non-infectious uveitis is the most common extra-articular manifestation of JIA.The aim of this study is to evaluate the risk factors that play a role in occurrence and recurrence of uveitis and, to determine the relationship between arthritis and uveitis activity in patients with JIA.
Material and Methods: This retrospective, cross sectional study included JIA patients with/without uveitis from a referral center in Turkey. The Juvenile Arthritis Disease Activity Score was used to evaluate the disease activity and calculated for arthritis and uveitis separately.
Results: Uveitis was seen in 26 (13.3%) of 195 JIA patients. Of 26 JIA associated uveitis (JIA-U) patients, 19 (73%) had an oligoarticular subtype. The median age at diagnosis of JIA with uveitis was younger than without uveitis (p=0.015). Oligoarticular JIA was found to be associated with recurrence of uveitis (p=0.021). The occurrence age of arthritis and uveitis was significantly younger in patients with recurrent uveitis (p=0.041, p=0.002, respectively). The median JADAS27 score at the onset of uveitis was lower in the recurrent group (p=0.038).
Conclusion: Early age is a significant risk factor for occurrence and recurrence of uveitis. It is important to remember that, during the disease course, patients with low disease activity may also develop uveitis.

References

  • Heiligenhaus A, Heinz C, Edelsten C, Kotaniemi K, Minden K. Review for disease of the year: epidemiology of juvenile idiopathic arthritis and its associated uveitis: the probable risk factors. Ocul Immunol Inflamm 2013;21:180–91.
  • Moradi A, Amin RM, Thorne JE. The role of gender in juvenile idiopathic arthritis-associated uveitis. J Ophthalmol 2014;2014:461078.
  • Clarke SL, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol Online J 2016;14:27.
  • Kaisu K, Anneli S, Anni K, Kimmo A. Recent advances in uveitis of juvenile idiopathic arthritis. Surv Ophthalmol 2003;48:489–502.
  • Ezzahri M, Amine B, Rostom S, Rifay Y, Badri D, Mawani N, et al. The uveitis and its relationship with disease activity and quality of life in Moroccan children with juvenile idiopathic arthritis. Clin Rheumatol 2013;32:1387-91.
  • Kotaniemi K, Kotaniemi A, Savolainen A. Uveitis as a marker of active arthritis in 372 patients with juvenile idiopathic seronegative oligoarthritis or polyarthritis. Clin Exp Rheumato 2002;20:109–12.
  • Zak M, Fledelius H, Pedersen FK. Ocular complications and visual outcome in juvenile chronic arthritis: a 25-year follow-up study. Acta Ophthalmol Scand 2003;81:211-15.
  • Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004;31:390-92.
  • Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005;140:509-16.
  • Consolaro A, Giancane G, Schiappapietra B, Davì S, Calandra S, Lanni S, et al. Clinical outcome measures in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2016;14:23.
  • Wallace CA, Huang B, Bandeira M, Ravelli A, Giannini EH. Patterns of clinical remission in select categories of juvenile idiopathic arthritis. Arthritis Rheum 2005;52:3554-62.
  • Yalçındağ FN, Güngör SG, Değirmenci MFK, Sarıgül Sezenöz A, Özçakar ZB, Baskın E, et al. The Clinical Characteristics of Pediatric Non-Infectious Uveitis in Two Tertiary Referral Centers in Turkey. Ocul Immunol Inflamm 2021;29:282-89.
  • Sahin S, Acari C, Sonmez HE, Kilic FZ, Sag E, Dundar HA, et al. Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER. Pediatr Rheumatol Online J 2021;19:134.
  • Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007;369:767-78.
  • Lee JJY, Duffy CM, Guzman J, Oen K, Barrowman N, Rosenberg AM, et al. ReACCh-Out Investigators. Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort. Arthritis Care Res (Hoboken). 2019;71:1436-43.
  • Calandra S, Gallo MC, Consolaro A, Pistorio A, Lattanzi B, Bovis F, et al. Female sex and oligoarthritis category are not risk factors for uveitis in Italian children with juvenile idiopathic arthritis. J Rheumatol 2014;41:1416-25.
  • Tappeiner C, Klotsche J, Sengler C, Niewerth M, Liedmann I, Walscheid K et al. Risk Factors and Biomarkers for the Occurrence of Uveitis in Juvenile Idiopathic Arthritis: Data From the Inception Cohort of Newly Diagnosed Patients With Juvenile Idiopathic Arthritis Study. Arthritis Rheumatol 2018;70:1685-94.
  • Heiligenhaus A, Klotsche J, Tappeiner C, Sengler C, Niewerth M, Liedmann I, et al. Predictive factors and biomarkers for the 2-year outcome of uveitis in juvenile idiopathic arthritis: data from the Inception Cohort of Newly diagnosed patients with Juvenile Idiopathic Arthritis (ICON-JIA) study. Rheumatology (Oxford) 2019;58:975-86.
  • Dana MR, Merayo-Lloves J, Schaumberg DA. Visual outcomes prognosticators in juvenile rheumatoid arthritis-associated uveitis. Foster CS Ophthalmology 1997;104:236-44.
  • Marelli L, Romano M, Pontikaki I, Gattinara MV, Nucci P, Cimaz R, et al. Long Term Experience in Patients With JIA-Associated Uveitis in a Large Referral Center. Front Pediatr 2021;9:682327.
  • Papasavvas I, Herbort CP Jr. Granulomatous Features in Juvenile Idiopathic Arthritis-Associated Uveitis is Not a Rare Occurrence. Clin Ophthalmol 2021;8:1055-9.
  • Grassi A, Corona F, Casellato A, Carnelli V, Bardare M. Prevalence and outcome of juvenile idiopathic arthritis-associated uveitis and relation to articular disease. J Rheumatol 2007;34:1139-45.
  • Liebling EJ, Faig W, Chang JC, Mendoza E, Moore N, Vicioso NL, et al. Temporal Relationship Between Juvenile Idiopathic Arthritis Disease Activity and Uveitis Disease Activity. Arthritis Care Res (Hoboken) 2022;74:349-54.
  • Rypdal V, Glerup M, Songstad NT, Bertelsen G, Christoffersen T, Arnstad ED, et al. Nordic Study Group of Pediatric Rheumatology. Uveitis in Juvenile Idiopathic Arthritis: 18-Year Outcome in the Population-based Nordic Cohort Study. Ophthalmology 2021;128:598-608.
  • Papadopoulou C, Kostik M, Böhm M, Nieto-Gonzalez JC, Gonzalez-Fernandez MI, Pistorio A, et al. Methotrexate therapy may prevent the onset of uveitis in juvenile idiopathic arthritis. J Pediatr 2013;163:879-84.
  • Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken) 2019;71:703-16.
There are 26 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Nilüfer Tekgöz 0000-0002-2235-4489

Elif Çelikel 0000-0003-0129-4410

Fatma Aydın 0000-0003-0306-7473

Zahide Ekici Tekin 0000-0002-5446-667X

Tuba Kurt 0000-0003-3711-8347

Müge Sezer 0000-0002-9254-9935

Vildan Güngörer 0000-0002-9838-2603

Cüneyt Karagöl 0000-0002-2987-1980

Serkan Coşkun 0000-0003-2568-9329

Melike Mehveş Kaplan 0000-0002-8012-2774

Nimet Öner 0000-0003-0403-151X

Merve Cansu Polat 0000-0003-3279-8435

Serkan Özmen 0000-0003-0698-180X

Serdar Sezer 0000-0001-5401-5599

Banu Acar 0000-0002-1808-3655

Early Pub Date June 16, 2023
Publication Date September 25, 2023
Submission Date April 9, 2023
Published in Issue Year 2023 Volume: 17 Issue: 5

Cite

Vancouver Tekgöz N, Çelikel E, Aydın F, Ekici Tekin Z, Kurt T, Sezer M, Güngörer V, Karagöl C, Coşkun S, Kaplan MM, Öner N, Polat MC, Özmen S, Sezer S, Acar B. The Other Side of the Coin: Uveitis in Patients with Juvenile Idiopathic Arthritis. Türkiye Çocuk Hast Derg. 2023;17(5):369-74.


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