Occurrence of uveitis in recently diagnosed juvenile chronic arthritis - A prospective study
Occurrence of uveitis in recently diagnosed juvenile chronic arthritis - A prospective study
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DOI：
10.1016/s0161-6420(01)00773-4
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发表时间：
2001-11-01
期刊：
影响因子：
13.7
通讯作者：
Aho, K
中科院分区：
文献类型：
--
作者：
Kotaniemi, K;Kautiainen, H;Aho, K
目的：探讨新近确诊的幼年型慢性关节炎(JCA)患者葡萄膜炎的发生和特点。设计：前瞻性观察病例系列。参与者/方法：研究对象为1989~1996年在芬兰海诺拉风湿病基金会医院儿科就诊的426例JCA患儿。主要观察指标：JCA患儿每年进行2~4次眼科和儿科检查。结果：426例患儿中104例(24%)发生葡萄膜炎。所有患者中有三分之二是女孩，患葡萄膜炎的患者中也有相同比例。从比例上看，葡萄膜炎在少关节炎儿童(27%)和血清阴性多发性关节炎儿童(25%)中同样常见。葡萄膜炎患者的抗核抗体检测频率(66%)明显高于非葡萄膜炎患者(37%)(P<；0.001)。99例葡萄膜炎无症状，仅5例出现急性前部症状性葡萄膜炎。104名儿童中有51名(49%)在近期关节炎发病前或发病后3个月内发现葡萄膜炎(49%)，104名儿童中有53名(51%)在发病后发现葡萄膜炎。诊断为葡萄膜炎的平均年龄为5.9岁(范围1.1-17.7；中位数4.9岁)。从诊断JCA到诊断葡萄膜炎的平均时间为1.1年(范围-2.4-6.5年；中位数为0.3年)。葡萄膜炎患者确诊时的平均年龄为4.8岁(范围为0.6-15岁；中位数为3.2岁)，而非葡萄膜炎患者的平均诊断年龄为7.3岁(范围为0.9-16岁；中位数为6.7岁)(P<；0.001)。在随访期结束时，63名儿童的葡萄膜炎仍在进行。所有患儿的平均随访时间为4.5年(0~9.7)，葡萄膜炎患儿为5.6年(1.3~9.6)。在大多数情况下，视力预后良好。在104例患者中，有25例(24%)出现一种或多种葡萄膜炎并发症，但只有3例儿童视力降至20/60以下，无一例失明。其余患者视力均大于或等于20/40。结论：本组患者JCA葡萄膜炎发病较早。葡萄膜炎在早期发病的关节炎合并ANA阳性的患者中明显更常见。患有葡萄膜炎的儿童在患有多发性关节炎的儿童中的比例与患有少关节炎的儿童一样多，并不偏爱女孩。眼科2001；美国眼科学会108：2071-2075(C)2001。
Objective: To examine the occurrence and characteristics of uveitis in patients with recently diagnosed juvenile chronic arthritis (JCA).Design; A prospective observational case series.Participants/Methods: The study covered the new cases detected with JCA (426 children), all of whom were referred to an ophthalmologic consultation during 1989 to 1996 at the Pediatric Department of the Rheumatism Foundation Hospital, Heinola, Finland.Main Outcome Measures: The children with JCA were followed by ophthalmologic and pediatric examinations two to four times a year. The type and course of arthritis and presentation and characteristics of uveitis were examined prospectively.Results: Uveitis was detected in 104 of 426 children (24%). Two thirds of all patients and the same proportion of those with uveitis were girls. Proportionally, uveitis was found to be as common among children with oligoarthritis (27%) as among those with seronegative polyarthritis (25%). Antinuclear antibodies (ANA) were detected significantly more frequently in patients with uveitis (66%) than among those without uveitis (37%) (P < 0.001). The uveitis was asymptomatic in 99 cases; only 5 children had episodes of acute anterior symptomatic uveitis. Uveitis was found before or within 3 months from the onset of recent arthritis in 51 of 104 children (49%) and later on in 53 of 104 children (51%). The mean age at diagnosis of uveitis was 5.9 years (range, 1.1-17.7; median, 4.9 years). The mean period from the diagnosis of JCA to the diagnosis of uveitis was 1.1 years (range, -2.4-6.5; median, 0.3 years). The mean age at diagnosis of JCA was 4.8 years (range, 0.6-15; median, 3.2 years) among those with uveitis and 7.3 years (range, 0.9-16; median, 6.7 years) among those who did not have it (P < 0.001). Uveitis was ongoing in 63 children at the end of the follow-up period. The mean follow-up time was 4.5 years (range, 0-9.7) for all children and 5.6 years (range, 1.3-9.6) for those with uveitis. In most instances, the visual prognosis was good. In 25 of 104 patients (24%) one or more complications of uveitis were found, but in only three children did the visual acuity decrease to 20/60 or less, and none became blind. All the other patients had visual acuity greater than or equal to 20/40.Conclusions: In this patient group, uveitis in JCA frequently appeared very early after the onset of arthritis. The uveitis was significantly more common in patients with an early onset of arthritis combined with ANA positivity. The proportion of children with uveitis was as large in those with polyarthritis as in those with oligoarthritis, with no predilection to girls. Ophthalmology 2001;108:2071-2075 (C) 2001 by the American Academy of Ophthalmology.