Incidence and predictors of Uveitis in juvenile idiopathic arthritis in a Nordic long-term cohort study.
Incidence and predictors of Uveitis in juvenile idiopathic arthritis in a Nordic long-term cohort study.
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DOI：
10.1186/s12969-017-0195-8
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发表时间：
2017-08-18
期刊：
影响因子：
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通讯作者：
Nordic Study Group of Pediatric Rheumatology (NoSPeR)
中科院分区：
文献类型：
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作者：
Nordal E;Rypdal V;Christoffersen T;Aalto K;Berntson L;Fasth A;Herlin T;Nielsen S;Peltoniemi S;Straume B;Zak M;Rygg M;Nordic Study Group of Pediatric Rheumatology (NoSPeR)
与幼年特发性关节炎（JIA）相关的葡萄膜炎的发病率在世界各地各不相同。我们的目的是调查在北欧人群中葡萄膜炎的发病率和预测因素。在这项前瞻性纵向队列研究中，对来自丹麦、芬兰、瑞典和挪威特定地理区域的1997年1月至2000年6月间发病的连续性JIA病例进行了中位98个月的随访。用逻辑回归分析确定葡萄膜炎的潜在临床和免疫学预测因子。在纳入的500名定期眼科随访的435名儿童中，有89名（20.5%）发生葡萄膜炎。慢性无症状性葡萄膜炎80例，急性症状性葡萄膜炎9例。葡萄膜炎在关节炎发作后的中位间隔为0.8年（范围-4.7至9.4）。葡萄膜炎的预测因子为JIA发病时年龄< 7岁（优势比（OR）2.1，95%可信区间（CI）1.3 ~ 3.5），抗组蛋白抗体（AHA）> 15 U/ml（OR 4.8（1.8 ~ 13.4））和抗核抗体（ANA）（OR 2.4（1.5 ~ 4.0））。葡萄膜炎组（19.2 U/ml）的平均IgM/IgG AHA组合显著高于非葡萄膜炎组（10.2 U/ml）（p = 0.002）。JIA发病时年龄小可预测女孩的葡萄膜炎（p < 0.001），但不能预测男孩（p = 0.390）。早发性关节炎和女孩中存在AHA，以及两种性别中存在ANA，是慢性葡萄膜炎的重要预测因子。在这个长期的北欧JIA队列中，葡萄膜炎的高发病率可能对终身产生严重影响。
The incidence of uveitis associated with juvenile idiopathic arthritis (JIA) varies around the world. Our aim was to investigate the incidence and predictors of uveitis in a Nordic population-based cohort. Consecutive JIA cases from defined geographical areas in Denmark, Finland, Sweden and Norway with disease onset between January 1997 to June 2000 were followed for median 98 months in this prospective longitudinal cohort study. Potential clinical and immunological predictors of uveitis were identified with logistic regression analysis. Uveitis occurred in 89 (20.5%) of the 435 children with regular ophtalmologic follow-up among the 500 included. Chronic asymptomatic uveitis developed in 80 and acute symptomatic uveitis in 9 children. Uveitis developed at a median interval of 0.8 (range − 4.7 to 9.4) years after onset of arthritis. Predictors of uveitis were age < 7 years at JIA onset (Odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3 to 3.5), presence of antihistone antibodies (AHA) > 15 U/ml (OR 4.8 (1.8 to 13.4)) and antinuclear antibodies (ANA) (OR 2.4 (1.5 to 4.0)). Mean combined IgM/IgG AHA was significantly higher in the uveitis group (19.2 U/ml) than in the non-uveitis group (10.2 U/ml) (p = 0.002). Young age at JIA onset predicted uveitis in girls (p < 0.001), but not in boys (p = 0.390). Early-onset arthritis and presence of AHA in girls, as well as presence of ANA in both genders, were significant predictors of chronic uveitis. The high incidence of uveitis in this long-term Nordic JIA cohort may have severe implications in a lifelong perspective.