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 21%.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. Permanent functional blindness has been reported in 15% to 40% of affected eyes. Of children with inflammatory eye disease:¹

• 25% have a good long-term visual outcome.
• 50% develop moderate to severe inflammation that requires years of treatment; these children generally have a good visual outcome.
• 25% do not respond well to treatment and are most likely to develop cataracts, glaucoma, or blindness; some require surgery.

If eye disease occurs, most children are treated with corticosteroids and prescription eyedrops. More severe or continuing eye disease may require nonsteroidal anti-inflammatory drugs (NSAIDs) or methotrexate. If eye disease does not respond to these treatments, either cyclosporine or TNF inhibitors such as etanercept may help.³

Citations

1. American Academy of Pediatrics (1993, reaffirmed 1999). Guidelines for ophthalmologic examinations in children with juvenile rheumatoid arthritis. Pediatrics, 92(2): 295–296.

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.