Inflammatory eye disease with juvenile rheumatoid arthritis

Inflammatory eye disease (uveitis) can develop as a complication in children with juvenile rheumatoid arthritis (JRA). Children and adults with JRA can develop cataracts, glaucoma, corneal degeneration (band keratopathy), or vision loss.

The incidence of eye disease in children with JRA is from 2% to 34%.1 Eye disease associated with JRA often has no symptoms, although blurred vision may be an early sign. To prevent eye problems from progressing to the point that vision loss occurs, regular eye examinations by an ophthalmologist are very important for children who have JRA.

Eye disease develops in about 20% of children with pauciarticular JRA (oligoarthritis), particularly children who have a positive antinuclear antibody (ANA) test result.2

Early detection and treatment of inflammatory eye disease gives a child the best chance of a good outcome. Discuss the appropriate examination schedule with your doctor. Your doctor will consider the type of arthritis, the age of the child when the disease began, how long the child has had JRA, and whether or not eye disease is present in deciding how often an eye examination is recommended. Over time, the child may need fewer examinations each year, but he or she should continue to have regular eye examinations for life.

Long-term outlook (prognosis)

Although most children with inflammatory eye disease maintain good vision, some do not.

If eye disease occurs, most children are treated with corticosteroids and prescription eyedrops. More severe or continuing eye disease may require other medicines such as methotrexate. If eye disease does not respond to these treatments, either cyclosporine or TNF inhibitors such as etanercept may help.3

The outlook for inflammatory eye disease has improved. Early and aggressive treatment of uveitis has reduced the complications of eye disease in JRA. Before treatment with methotrexate and TNF inhibitors became common, only about 1 out of 4 children (25%) had a good long-term vision outcome. Today, because of early treatment and better medicines, children with eye inflammation have a better chance of having a good vision outcome with less treatment.1

Citations

  1. Cassidy J, et al. (2006). Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics, 117(5): 1843–1845.
  2. Wallace CA, Sherry DD (2003). Juvenile rheumatoid arthritis. In CD Rudolph et al., eds., Rudolph's Pediatrics, 21st ed., chap 12.4, pp. 836–840. New York: McGraw-Hill.
  3. Giannini EH, Brunner HI (2005). Treatment of juvenile rheumatoid arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 1301–1318. Philadelphia: Lippincott Williams and Wilkins.

Last Updated: June 25, 2008

Author: Shannon Erstad, MBA/MPH

Medical Review: Michael J. Sexton, MD - Pediatrics & Stanford M. Shoor, MD - Rheumatology

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