engleski

Exploring uveitis in early onset ANA positive JIA

Juvenile idiopathic arthritis (JIA) is the most frequent childhood systemic disease affiliated with uveitis, where uveitis occurs in 10-13% of the patients, frequently causing long lasting consequences when unrecognized, untimely or incorrectly treated. Objectives: To explore correlations between age, gender, ANA, RF titer in patients with JIA, occurrence of ocular manifestations and its complications. To examine similarities and differences between patients with different subtypes of JIA and uveitis. Methods: The retrospective study included 31 children treated for JIA and uveitis in the period 2009-2017 at the Department of Paediatrics, UHC Zagreb. The SUN working group classification and grading system were used to evaluate ocular manifestations. Data analysis was executed using R programming language. Results: We followed 31 patients (81% female) suffering from JIA with ocular manifestations. Median age at JIA onset in girls was 2.5 (1-14) years and in boys 8.6 (1- 14.5) years, while girls had median age 4.25 (1-14) years at first ocular manifestation and boys 8.25 (4 -13.5) years. All patients were RF negative. 61% of patients was ANA positive, out of which 88% had onset of JIA before the age of 6 (all girls). Complete remission of uveitis was achieved in two patients treated with topical corticosteroids, with non-steroid anti- inflammatory medication and methotrexate used in one of the patients. Inactive uveitis was most frequently achieved with a combined therapy which included biologics. A patient suffering from uveitis and JIA was found to be significantly more likely to suffer from oligoarthritic subtype (64.5%, CI 45.4-80.8%, p<0.001). We determined that a positive ANA titer occurred statistically significantly more frequent in females (OR inf., CI 3.18-inf., p=0.001). No significant statistical difference in ANA titer was found between groups of patients who were diagnosed with rheumatologic or ocular disease before and after the age of 6 (OR 1.85, CI 0.12-29.57, p=0.6111) nor between different subtypes of JIA. There was no difference in time passed between the occurrence of rheumatologic and ocular manifestations (median difference =1.75 years, W=131, p=0.2597), nor between ANA titer (OR 0.57, CI 0.09-3.12, p=0.4775) between groups with and without ocular complications. Patients who first presented with ocular manifestations did not have a greater likelihood to develop ocular complications (OR 5.59, CI 0.51-299.98, p=0.175). Conclusion: A group of female patients suffering from RF negative subtypes of JIA and uveitis, with onset occurring before the age of 6 and positive ANA was prominent. These patients were traditionally classified as different subtypes of JIA, but together, they are best described as “early onset ANA positive JIA”, concurring the need for reclassification of JIA. Limited by a small number of patients, this was partly confirmed with significant statistical findings, a recurrent positive ANA titer in females with JIA and uveitis and a more frequent occurrence of uveitis in oligoarthritis. The occurrence of ocular complications was not dependent upon ANA titer, nor upon the time difference between rheumatic and ocular symptoms or their order of appearance.

juvenile idiopathic arthritis ; uveitis ; antinuclear antibodies ; biological therapy

Sažetak je objavljen kao suplement časopisu (indeksiran u CC-u): Annals of the rheumatic diseases (Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1963)