1 - Serviço de Oftalmologia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;
2 - Serviço de Pediatria Reumatológica, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa.
- Apresentação sob a forma de Poster - 44th Annual Meeting – European Paedriatic Ophthalmological Society, Budapeste, Setembro 2018
Introduction: Juvenile idiopathic arthritis (JIA) is the most frequent rheumatic disease in paediatric population. Uveitis is the commonest extra-articular manifestation, typically with an insidious and asymptomatic presentation, the reason why ophthalmologic screening is fundamental.
The aim of this study was to describe clinical findings and analyse treatment evolution of a paediatric population with JIA-associated uveitis, followed in a tertiary hospital.
Methods: Retrospective cohort study of a population with JIA-associated uveitis. Patients where characterized according to their gender, age at diagnosis, JIA subtype, interval in years from rheumatic diagnosis to uveitis diagnosis, clinical features of uveitis, serologic laboratory findings, best corrected visual acuity (BCVA), treatment, complications and surgical procedures.
Results: A total of 24 patients were included, 13 (54,1%) females, with median age at uveitis diagnosis of 6 years (3,0-9,25) and median interval between arthritis and uveitis of 1 month (0-42). In 57,1% of patients, uveitis diagnosis occurred before or at the same time of JIA diagnosis and 80,9% until 4 years of disease. Oligoarticular arthritis was the most frequent subtype (58,3%). Anti-nuclear antibodies were positive in 70,8% of patients. Ophthalmologic complications were found in 12 patients (50%), with posterior synechiae being the most common (50%; 12/14), followed by cataracts (25%; 6/24). Five patients (20,8%) were summited to surgery. At last follow-up, 6,25% of the eyes presented with a BCVA of less than 0,3logMAR. A shorter time interval between rheumatic and ophthalmologic diagnosis was significantly related with development of complications (median=0; IQR 13 vs Median=36; IQR 64; p=0,034). Currently, 29,2% are on methotrexate as monotherapy and 20,8% on methotrexate plus adalimumab.
Conclusion: Most of JIA-associated uveitis occurred within first 4 four years of rheumatic disease. Approximately 50% of patients developed ophthalmologic complications, whose risk was higher when uveitis diagnosis was prior or concomitant of JIA diagnosis. These data corroborate the relevance of ophthalmologic screening in these population.
Palavras-chave: juvenile idiopathic arthritis, uveitis