Encouraging visual outcomes in children with idiopathic and JIA associated uveitis: a population-based study.

BACKGROUND: Pediatric uveitis is typically asymptomatic and may become chronic affecting ocular structures and vision. We evaluated visual outcomes, clinical features, medication, and uveitis activity in children with either idiopathic uveitis (idio-U) or juvenile idiopathic arthritis associated uveitis (JIA-U). METHODS: A longitudinal, population-based cohort study of children with uveitis in 2008-2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution, etiology, systemic association, uveitis activity, medication, and visual outcomes. RESULTS: A total of 119 patients aged < 16 years with uveitis were included. Uveitis was idio-U in 23% and associated with JIA in 77% of cases. 37% of the patients in the idio-U group and 65% in the JIA-U were girls (p = 0.014). The mean age at first uveitis was 10.0 (SD 3.4) years in idio-U and 5.5 (SD 3.3) years in JIA-U (p < 0.001). Anterior location of uveitis was noted in 74% in idio-U and 99% in JIA-U (p < 0.001). Mostly, uveitis was chronic (59% in idio-U and 75% in JIA-U) and bilateral (56% in idio-U and 64% in JIA-U). Topical corticosteroids were initially used by 89% and 100%, systemic corticosteroids by 30% and 27% in some extent during the follow-up, disease-modifying antirheumatic drugs (DMARDs) by 33% and 85% (p < 0.001) of the patients in idio-U and JIA-U, respectively. Biologic disease-modifying antirheumatic drugs (bDMARDs) were more common in JIA-U (55% vs. 15% in idio-U, respectively, p < 0.001). Most patients had normal visual acuity (Snellen > 0.8, [6/7.5]) in the affected eye and bilaterally in 85% idio-U and 70% JIA-U. Only 5 patients (4%) had visual impairment in one, but none in both eyes. Uveitis activity by SUN classification was 0 + in 81% and 72%, 0.5 + in 19% and 25%, and 1 + in 0% and 3% in the idio-U and JIA-U, respectively. CONCLUSIONS: Children with uveitis have good visual acuity and a low rate for visual impairment. In addition, modern treatment with DMARDs and bDMARDs seems to save vision.

Prevalence, incidence and epidemiology of childhood uveitis.

PURPOSE: To analyse the prevalence, incidence and aetiology of paediatric uveitis. METHODS: A retrospective, population-based cohort study of Finnish children with uveitis in Northern Ostrobothnia Hospital District in 2008-2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution of the disease, aetiology and systemic association. RESULTS: One hundred fifty patients aged <16 years (mean age 6.9 ± 3.9 years) with uveitis were included, out of whom 53% were girls. The first uveitis episode occurred at 1-6 years in 59%, and 62% of them were girls. In the age group of 7-15 years, boys were diagnosed with uveitis more frequently than girls (61% versus 39%, respectively). Seventy percent of the girls were diagnosed with their first uveitis episode at the age of 1-6 years, whereas only 48% of the boys were diagnosed at that age. The prevalence of uveitis increased from 64/100 000 children <16 years in 2008 (95% CI, 47.7-84.2) to 106/100 000 in 2017 (95% CI, 84.6-130.2). The incidence of childhood uveitis in 2008-2017 was 14/100 000 person-years in children <16 years (95% CI, 11.3-16.5). Eighty-seven percent of the cases were non-infectious, 9% were infectious, and 3% had masquerade syndromes. Sixty-one percent of patients had juvenile idiopathic arthritis (JIA). CONCLUSION: The prevalence of paediatric uveitis has increased during the last decade in both genders. Uveitis is more frequent in girls, and they were diagnosed at a younger age than boys. Idiopathic cases and JIA accounted for a majority of aetiological features.