Abs0303 Juvenile Idiopathic Arthritis (jia) With Chronic Anterior Uveitis – Long-term Progression and Classification Insights
Year: 2025
Type: conference-abstract
Abstract: Background: Chronic anterior uveitis is the most common extra-articular manifestation of Juvenile Idiopathic Arthritis (JIA). Recent criteria proposed by the Pediatric Rheumatology International Trials Organization (PRINTO) suggest a unique JIA subtype in the pediatric population with a high risk of iridocyclitis. This study investigates whether chronic anterior uveitis defines a distinct JIA subset with consistent characteristics into adulthood, regardless of antinuclear antibodies (ANA) status, gender, or age of onset. Objectives: To identify clinical and laboratory factors associated with prevalent chronic or recurrent anterior uveitis in JIA patients at long-term follow-up and evaluate if these characteristics persist into adulthood. Methods: We conducted a national, multicenter, retrospective study using data from all Portuguese centers registered in the National Registry of Rheumatic Patients (Reuma.pt). We included JIA patients who were ≥18 years of age at the time of their last visit. Chronic or recurrent uveitis was defined as a single episode lasting >3 months with relapse within 3 months of therapy discontinuation, or as repeated episodes with ≥3 months of inactivity between them. Patients with acute or no uveitis were grouped together for analysis. Associations between variables were analyzed using the appropriate statistical tests, and multiple comparisons were adjusted for using the Holm-Bonferroni correction. Results: A total of 778 patients were included, of whom 496 (63.8%) were female, with a median age at disease onset of 9.8 years [interquartile range (IQR) 8.3], and a mean disease duration of 23.6 years [standard deviation (SD) ± 3.1]. The most common JIA subtypes [according to International League of Associations for Rheumatology (ILAR) classification] were enthesitis related arthritis (ERA) [150/739 (20.3%)] and persistent oligoarthritis [150/739 (20.3%)], followed by rheumatoid factor (RF)-negative polyarthritis [133/739 (18.0%)]. At the time of the last visit, 51.6% of patients (181/351) were in remission, including 61.5% (16/26) of those with chronic or recurrent uveitis, with a median JADAS10 of 1.7 (IQR 4.8). Chronic or recurrent anterior uveitis was observed in 51 patients (6.6%). There was no significant difference in gender distribution between patients with chronic uveitis and those without ( p = 0.766). Patients with chronic uveitis had an earlier disease onset [4.7 (IQR 6.4) vs. 10.1 (IQR 7.8) years of age] compared to those without ( p < 0.001). Positivity for ANA was two times more frequent in patients with chronic uveitis (66.0% vs. 33.0%, p < 0.001), whereas RF and anti-cyclic citrullinated peptide (anti-CCP) antibodies were significantly less common in this group (2.4% vs . 17.0% and 0.0% vs. 17.3%; p = 0.025 and p = 0.013, respectively). Table 1 shows the distribution of the main clinical and serological features between the two groups. Persistent oligoarthritis was the most common JIA subtype among patients with chronic uveitis [26/50 (52.0%)], significantly more prevalent compared to those without ( p < 0.001) (Table 2). Patients with chronic uveitis were more frequently treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs) during the follow-up period (62.7% vs. 44.7%, p = 0.019) (Table 1). The number of bDMARD switches was also significantly higher in the chronic uveitis group [0.0 (IQR 2.0) vs . 0.0 (IQR 0.0), p < 0.001]. JIA patients without chronic uveitis met the criteria for adult disorders in 73.8% of cases, compared to 46.5% in those with chronic uveitis ( p < 0.001). Among patients with chronic uveitis, the most common adult disease criteria fulfilled were undifferentiated spondyloarthritis (14.0%) (Table 2). In a subgroup analysis, we categorized patients into three groups based on ANA status, fulfillment of adult disease criteria (yes/no), and age of disease onset (≤6 vs . >6 years of age) to assess whether the prevalence of chronic uveitis and other variables differed significantly among them. We found that ANA-positive patients were more frequently female (80% vs . 58.1%, p < 0.001), had an earlier disease onset (7.7 ± 5.0 vs . 10.2 ± 4.5 years of age, p < 0.001), and a higher chronic uveitis prevalence (14.7% vs . 4.2%, p < 0.001). They also fulfilled adult disease criteria less frequently (58.6% vs . 74.2%, p = 0.001). Patients not meeting adult disease criteria had a higher prevalence of chronic uveitis (14.8% vs . 5.1%, p < 0.001), an earlier disease onset [7.4 (IQR 8.4) vs . 11.5 (IQR 7.1) years, p < 0.001], and the most common JIA subtypes were persistent oligoarthritis (46.7% vs. 4.9%, p < 0.001) and extended oligoarthritis (26.3% vs. 8.6%, p < 0.001). Patients with disease onset before 6 years of age were more frequently female (73.0% vs . 60.0%, p = 0.002), ANA-positive (50.6% vs . 28.9%, p < 0.001), and had a higher prevalence of chronic uveitis (14.5% vs . 4.1%, p < 0.001). Persistent oligoarthritis (31.8% vs . 15.8%, p < 0.001) and extended oligoarthritis (25.8% vs . 8.0%, p < 0.001) were also the most common JIA subtypes in this group. Conclusion: This study highlights that chronic anterior uveitis in JIA patients is associated with distinct clinical and laboratory features, including earlier disease onset, ANA positivity, and oligoarticular JIA subtypes. These patients are less likely to meet criteria for adult inflammatory arthritis, supporting the idea that JIA with chronic uveitis is a unique disease subset persisting into adulthood. In contrast to previous beliefs, in our cohort, female gender was not associated with chronic uveitis. REFERENCES: NIL . Acknowledgements: I would like to acknowledge the participating centers and thank Reuma.pt for their support in providing the data used in this study. Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.
Source: Annals of the Rheumatic Diseases
Authors: B. Paulo Correia, D. Vinha, S. Rosário, I. Leal, J. Madruga Dias, G. Sequeira, A.R. Cunha, I. Santos, J. Silva-Dinis, H.M. Assuncao, L. Cunha-Miranda, M. Cruz, M. Santos Faria, F. Araújo, P. Nero, F. Albuquerque, M. Diz Lopes, F. Campos Costa, F. Farinha, A. Furtado, A.F. Mourão, M. Cabral, V. Fraga, S.F. Azevedo, J. Tavares-Costa, R. Vieira, M. Conde, M. Pontes-Ferreira, A.M. Rodrigues, R. Campanilho-Marques, F. Oliveira-Ramos
Institutions: University of Lisbon, Centro Académico de Medicina de Lisboa, Unidade Local de Saúde Santa Maria, Universidade Nova de Lisboa, Unidade Local de Saúde do Médio Tejo, Unidade Local de Saúde do Algarve, Unidade Local de Saúde do Tâmega e Sousa, Unidade Local de Saúde de Viseu Dão-Lafões, Unidade Local de Saúde de São José, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Hospital Dr. Nélio Mendonça, Hospital de Sant'Ana, Hospital CUF Descobertas, Unidade Local de Saúde de Coimbra, Hospital de São João, Unidade Local de Saúde Gaia/Espinho, Hospital do Divino Espírito Santo, Hospital de Egas Moniz, Comprehensive Health Research Centre, Hospital Prof. Dr. Fernando Fonseca, Unidade Local de Saúde de Almada-Seixal, Unidade Local de Saúde da Região de Aveiro, Instituto Português de Reumatologia, Hospital de Dona Estefânia, Unidade Local de Saúde do Alto Minho
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,870
OpenAlex ID: W4411427775