Risk Factors for the Development of Uveitis in JRA

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Several clinical and laboratory factors have been associated with the development of uveitis in JRA. It has to be kept in mind, however, that retrospective studies investigating the prevalence of uveitis in children with JRA are limited because of differences in the classification systems in the past. Although these limitations need to be borne in mind, several factors including gender, type and onset of arthritis and laboratory findings such as autoantibodies have been proposed as risk factors of uveitis.

A number of studies indicate that girls are predominantly affected by uveitis with a prevalence of 77-82% of all arthritis patients [6, 8, 49]. However, since girls are far more frequently affected by JCA than boys, this observation has to be carefully reevaluated. Indeed, more recent prospective studies were not able to identify gender as an independent risk factor [35].

Similarly, the type of arthritis needs also to be critically reevaluated. It has been suggested that children with oligoarthritis are more likely to develop uveitis as compared to children with polyarthritis or systemic onset of JCA. This again has to be carefully reconsidered, since oligoarthritis is the predominant type of arthritis [49]. It also has to be kept in mind that a number of children initially diagnosed with oligoarthritis may subsequently develop polyarthritis during their follow-up. Indeed, when Kotaniemi et al. reclassified children with JCA and uveitis beyond the first 6 months after onset of uveitis, a comparable number of patients with oligoarthritis and polyarthritis was found [35].

Not only the type of arthritis but also the onset ofarthritis has been proposed as a risk factor for uveitis. In general, uveitis appears significantly more frequent in children with early manifestation of JCA [35]. Young children, aged 2-4years, are of the highest risk of developing uveitis. With few exceptions, most children develop uveitis within 18-24 months after the onset/diagnosis of arthritis [5,6,49]. Subsequently, the risk for intraocular inflammation diminishes on long-term follow-up. Within 4-7 years after onset of arthritis, 90 % of all uveitis manifestations are diagnosed.

Antinuclear antibodies have been repeatedly associated with an increased risk of developing uveitis. ANA positivity was significantly more frequent in patients with uveitis as compared with those that did not have uveitis in a prospective study [35].

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