Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines
Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines
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DOI：
10.1093/rheumatology/kem053
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发表时间：
2007-06-01
期刊：
影响因子：
5.5
通讯作者：
Minden, K.
中科院分区：
文献类型：
--
作者：
Heiligenhaus, A.;Niewerth, M.;Minden, K.
目标。分析一大群幼年特发性关节炎 (JIA) 患者中葡萄膜炎的患病率和并发症及其预测因素。方法。对 1 年内纳入国家数据库的 3271 名 JIA 患者的数据进行了分析，这些患者按照国际风湿病协会联盟 (ILAR) 标准分类。所有 JIA 患者中葡萄膜炎的患病率为 12%。最常见的是少关节炎扩展（25%）和持续性（16%）。患有葡萄膜炎的 JIA 患者出现关节炎（3.8 岁 vs 7.0 岁）或 ANA 阳性（86% vs 42%）的时间明显比没有葡萄膜炎的患者年轻。葡萄膜炎的预测因素包括发病年龄 (P = 0.03) 和 ANA 阳性 (P < 0.01)，此外还包括某些 JIA 亚组 (P = 0.04)。 75% 的少关节炎患者的葡萄膜炎在临床上是无症状的，但与附着点炎相关的关节炎患者则没有。葡萄膜炎的中位发病时间为关节炎出现后 5.5 个月。分别有 73%、77% 和 90% 的人在关节炎发生后 1、2 和 4 年内出现葡萄膜炎。前葡萄膜炎是最常见的葡萄膜炎解剖类型（83%）。平均随访 5.6 年时葡萄膜炎并发症很常见 (56%)，并发症的预测因素包括首次就诊时出现并发症 (P < 0.001) 和关节炎前葡萄膜炎表现 (P=0.001)，但不包括 ANA 阳性。结论。 JIA 亚组在相关葡萄膜炎的患病率和病程方面存在显着差异。关节炎发病后应尽早开始眼科筛查，筛查间隔时间与 JIA 亚组相关。建议修改当前的筛查指南。
Objectives. To analyse the prevalence and complications of uveitis and their predictors in a large cohort of patients with juvenile idiopathic arthritis (JIA).Methods. Data of 3271 JIA patients as classified by International League of Associations for Rheumatology (ILAR) criteria included in a national database during 1 yr were analysed.Results. Uveitis prevalence was 12% of all JIA patients. The most frequent were oligoarthritis extended (25%) and persistent (16%). JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs 7.0 yrs) or ANA-positive (86% vs 42%) than the patients without uveitis. Predictors of uveitis included age at onset (P = 0.03) and ANA-positivity (P < 0.01) besides the presence of a certain JIA subgroup (P=0.04). Uveitis was clinically silent in 75% of the oligoarthritis but in none of the enthesitis-related arthritis patients. The median onset of uveitis was 5.5 months after arthritis manifestation. In 73%, 77% and 90%, uveitis developed within 1, 2 and 4 yrs after arthritis, respectively. Anterior uveitis was the most common anatomic type of uveitis (83%). Uveitis complications at mean follow-up of 5.6 yrs were common (56%), and predictors for complications included presence of complications at first visit (P < 0.001) and uveitis manifestation before arthritis (P=0.001), but not ANA positivity.Conclusions. The JIA subgroups markedly differ with respect to the prevalence and course of associated uveitis. Ophthalmological screening should be initiated early after arthritis onset and the intervals be related to the JIA subgroup. A modification of the current screening guidelines is suggested.