Juvenil İdiyopatik Artrit ile İlişkili Üveitli Hastaların Romatolojik Açıdan Değerlendirilmesi

Year 2022, Volume: 16 Issue: 5, 374 - 377, 20.09.2022

Esra Bağlan , Semanur Özdel , Kübra Özdemir Pınar Çakar Özdal Mehmet Bülbül

https://doi.org/10.12956/tchd.1009885

Abstract

Amaç: Jüvenil idiyopatik artritin (JİA) en yaygın eklem dışı bulgusu olan üveit, en sık olarak oligoartiküler tip ve poliartiküler romatoid faktör (RF) negatif JİA’lı çocuklarda bulunur. Bu çocukların pediatrik romatologlar ve oftalmologlar tarafından yakın takibi, tedavisiz kalan vakalarda körlük riski nedeniyle önemlidir. Bu çalışmanın amacı JİA’lı çocuklarda üveit sıklığını, demografik özelliklerini ve komplikasyonlarını değerlendirmektir.

Gereç ve Yöntemler: Ocak 2017-Temmuz 2021 tarihleri arasında SBÜ Dr Sami Ulus Kadın Doğum Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi hastane bilgi veri tabanından elde edilen hastaların demografik, klinik ve sonuç verileri geriye dönük olarak incelendi. Çocukların yaşı ve cinsiyeti, takip süresi, artrit başlangıç yaşı, JİA alt tiplerinin dağılımı, üveit başlangıç yaşı, tanı yaşı, üveit lokalizasyonu, özellikleri, semptomları, laboratuvar parametreleri ve kullanılan ilaçlar değerlendirildi.

Bulgular: Çalışmaya alınan 473 JİA’lı çocuğun 34’ünde (%7.1) üveit görüldü. JIA’nın en yaygın formu, kalıcı oligoartiküler formdu. Tüm JIA hastalarında artrit başlangıç yaşı ile karşılaştırıldığında, JIA ile ilişkili üveiti olan hastalarda artrit başlangıç yaşı daha düşüktü (5.94±5.143 ve 7.83±4.62 yıl). Antinükleer antikor pozitifliği, JIA ile ilişkili üveiti olan çocuklarda tüm JIA hastalarımıza kıyasla daha yaygındı (%19’a karşı %47.1). Bir hastada artrit ve üveit aynı anda teşhis edildi. 3 hastada (%8.8) posterior sineşi, 5 hastada (%14.7) katarakt, 2 hastada (%5.9) glokom ve bir gözde (%2.9) körlük saptandı.

Sonuç: Üveit, JİA’nın en sık görülen eklem dışı komplikasyonudur ve geri dönüşü olmayan görme kaybına yol açabilen komplikasyonlara sahiptir. Bu çalışmada JİA hasta popülasyonumuzda üveit tanısı alan hastalarımızı değerlendirmeyi amaçladık. Bu çocuklara bir an önce teşhis koymak ve uygun şekilde tedavi etmek; hem pediatrik romatologların hem de oftalmologların ortak çabasını gerektirmektedir.

Keywords

Göz bozuklukları, Jüvenil idiopatik artriti, Üveiti

Evaluation of Patients with Juvenile Idiopathic Arthritis- Associated Uveitis from Rheumatology Perspective

Abstract

Objective: Uveitis, the most common extra-articular manifestation of juvenile idiopathic arthritis (JIA), is most commonly found in children with oligoarticular type and polyarticular rheumatoid factor (-) JIA. Close follow-up of these children by pediatric rheumatologists and ophthalmologists is important because of the risk of blindness if these cases are untreated. This study aims to evaluate the frequency of uveitis, demographic characteristics, and complications in children with JIA.

Material and Methods: Among the patients with JIA who were followed up at the Pediatric Rheumatology Clinic of Dr Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital between January 2017 and July 2021, those with uveitis were included in the study. Location of uveitis, laterality, age at onset of uveitis, complications of uveitis, duration of follow up, laboratory findings, medications used, and status of uveitis at the time of data collection were obtained from the patients’ files.

Results: Uveitis was observed in 34 (7.1%) of the 473 children with JIA included in the present study. Twenty three patients were female (67.6%). The age at diagnosis of JIA was 5.9±5.1 years, and the age at diagnosis of uveitis was 7.5±4.2 years. The most common form of JIA was the persistent oligoarticular form. Compared with the age of onset of arthritis in all JIA patients, the age of onset of arthritis was lower in patients with JIA-associated uveitis (7.8±4.6 years vs. 5.9±5.1 years). Anatomically, all patients had anterior uveitis. Antinuclear antibody positivity was more common in children with JIA-associated uveitis (47.1%) than all of our patients with JIA (19%). In one of the patients, arthritis and uveitis were diagnosed simultaneously. Posterior synechia was found in three patients (8.8%). Arthritis was the first symptom in 27 patients (79.4%) and uveitis in six patients (17.6%), cataract in five patients (14.7%), glaucoma in two patients (5.9%), and blindness in one eye (2.9%).

Conclusion: Uveitis is the most common extra-articular complication of JIA and has sight-threatening complications which may lead to irreversible visual loss. The findings of this study suggest that the joint effort of pediatric rheumatologists and ophthalmologists is needed to diagnose these children promptly and treat them appropriately.
Key Words: Eye diseases, Juvenile Idiopathic Arthritis, Uveitis

Keywords

Uveitis, Eye diseases, Juvenile Idiopathic Arthritis

References

• 1. Kanski JJ. Uveitis in juvenile chronic arthritis: Incidence, clinical features and prognosis. Eye 1988;2:641–5.
• 2. Sabri K, Saurenmann RK, Silverman ED, Levin A v. Course, complications, and outcome of juvenile arthritis-related uveitis. J AAPOS 2008;12:539–45.
• 3. 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 2019;71:703–16.
• 4. Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS. Visual outcomes prognosticators in juvenile rheumatoid arthritis- associated uveitis. Ophthalmology 1997;104:236–44.
• 5. Edelsten C, Lee V, Bentley CR, Kanski JJ, Graham EM. An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood. Br J Ophthalmol 2002;86:51–6.
• 6. Asproudis I, Felekis T, Tsanou E, Gorezis S, Karali F, Alfantaki S, et al. Juvenile idiopathic arthritis-associated uveitis: Data from a region in western Greece. Clin Ophthalmol 2010;4:343–7.
• 7. Kotaniemi K, Savolainen A, Karma A, Aho K. Recent advances in uveitis of juvenile idiopathic arthritis. Surv Ophthalmol 2003;48:489–502.
• 8. Heiligenhaus A, Niewerth M, Ganser G, Heinz C, Minden K, Ganser G, et al. 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. Rheumatology 2007;46:1015–9.
• 9. Clarke SLN, Sen ES, Ramanan AV. Juvenile idiopathic arthritis-associated uveitis. Pediatric Rheumatology 2016;14:1–11.
• 10. Paroli MP, Abbouda A, Restivo L, Sapia A, Abicca I, Pezzi PP. Juvenile idiopathic arthritis-associated uveitis at an italian tertiary referral center: Clinical features and complications. Ocul Immunol Inflamma 2015;23:74–81.
• 11. Angeles-Han ST, Pelajo CF, Vogler LB, Rouster-Stevens K, Kennedy C, Ponder L, et al. Risk markers of juvenile idiopathic arthritis-associated uveitis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry. Rheumatol 2013;40:2088–96.
• 12. 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 2021;19:134.
• 13. Kasapçopur Ö, Yologlu N, Özyazgan Y, Ercan G, Çaliskan S, Sever L, et al. Uveitis and anti nuclear antibody positivity in children with juvenile idiopathic arthritis. Indian Pediatr 2004;4:1035–9.
• 14. Ravelli A, Felici E, Magni-Manzoni S, Pistorio A, Novarini C, Bozzola E, et al. Patients with antinuclear antibody-positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease. Arthritis Rheum 2005;52: 826–32.
• 15. Çakan M, Yildiz Ekinci D, Karadağ ŞG, Aktay Ayaz N. Etiologic Spectrum and Follow-Up Results of Noninfectious Uveitis in Children: A Single Referral Center Experience. Arch Rheumatol 2019;34:294-300.