Juvenile Idiopathic Arthritis: Inflammatory Eye Disease
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Inflammatory eye disease ( uveitis ) can develop as a complication in children who have juvenile idiopathic arthritis (JIA). Children and adults who have JIA can develop cataracts , glaucoma , corneal degeneration (band keratopathy), or vision loss.
The incidence of eye disease is 2 to 34 out of 100 children who have JIA. footnote 1 It is most common in oligoarticular and RF-negative polyarticular forms of the disease. Eye disease associated with JIA 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 JIA.
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 many things when deciding how often to recommend an eye examination. He or she will think about the type of arthritis, the age of the child when the disease began, how long the child has had JIA, and whether or not eye disease is present. Over time, the child may need fewer examinations each year. But he or she should continue to have regular eye examinations.
Long-term outlook (prognosis)
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. footnote 3
The outlook for inflammatory eye disease has improved. Early and aggressive treatment of uveitis has reduced the complications of eye disease in JIA. Before treatment with methotrexate and TNF inhibitors became common, only about 1 out of 4 children 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. footnote 1
- Cassidy J, et al. (2006). Ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics, 117(5): 1843–1845.
- Nistala K, et al. (2009). Juvenile idiopathic arthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1657–1675. Philadelphia: Saunders Elsevier.
- 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.
Other Works Consulted
- Hsu JJ, et al. (2013). Treatment of juvenile idiopathic arthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., vol. 2, pp. 1752–1770. Philadelphia: Saunders.
Primary Medical Reviewer Susan C. Kim, MD - Pediatrics
E. Gregory Thompson, MD - Internal Medicine
Martin J. Gabica, MD - Family Medicine
Specialist Medical Reviewer John Pope, MD - Pediatrics
Current as ofFebruary 24, 2016
Current as of: February 24, 2016
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