649 - Characterization of Patients with Uveitis-Related Complications in Juvenile Idiopathic Arthritis

Publication Number: 649.4314

Maryam Ashoor, Boston Children's Hospital, Brookline, MA, United States; Melissa Hazen, Boston Children's Hospital, Boston, MA, United States; Olha Halyabar, Boston Children's Hospital, Boston, MA, United States; lindsay imber, Harvard Medical School, Boston, MA, United States; joseph griffith, Boston Children's Hospital, Boston, MA, United States; Maria G. Biancarelli, Boston Children's Hospital, Brookline, MA, United States; Daniel McKinley, Boston Children's Hopital, Boston, MA, United States; Benjamin Ethier, Boston Children's Hospital, San Diego, CA, United States

Background: Uveitis is a serious, vision-threatening complication affecting 10-20% of juvenile idiopathic arthritis (JIA) patients. Risk factors include oligoarticular and polyarticular subtypes, younger age at JIA diagnosis and positive antinuclear antibody (ANA) (Clarke 2016). Symptoms can be insidious, necessitating regular ophthalmologic screenings. Without early detection and appropriate treatment, uveitis may lead to cataracts, glaucoma, and blindness (Carlsson 2021). ). While uveitis is a well described complication of JIA, there is little known about what factors place patients at risk for these serious uveitis-related complications.

Objective: To analyze characteristics and risk factors in JIA patients with uveitis-related complications and identify opportunities to improve care.

Design/Methods: A retrospective review of JIA patients with uveitis-related cataracts, glaucoma, or blindness between 2000-2023 at a tertiary care center.

Results: Twenty JIA patients with uveitis complications were identified, with a higher prevalence in females (55%). Cataract (70%) was the most common complication, followed by glaucoma (30%). Mean ages at JIA diagnosis, uveitis onset, and complication development were 3.5, 5, and 6 years, respectively. A family history of autoimmune diseases was positive in 45%. Oligoarticular JIA was the most frequent subtype, with 70% of cases being ANA-positive.
Modifiable risk factors included delays in initial presentation (45%) and medication non-adherence (35%). Time from JIA diagnosis to ophthalmology screening ranged from 0-18 months (median 0.5 months). Screening exams met 2018 ACR guidelines for 62% of patients; 38% had less frequent exams.
83% of patients received systemic immunomodulatory medications within three months of JIA diagnosis, primarily methotrexate. After uveitis onset, all patients received topical corticosteroids; systemic immunomodulation was escalated in 47% with systemic steroids (26%), methotrexate (10%), leflunomide (0.5%) and TNF inhibitors (16%).

Conclusion(s): This study highlights the high burden of uveitis-related complications in JIA, especially cataracts and glaucoma. Known risk factors and modifiable elements, such as delays in presentation, non-adherence, and screening irregularities, present valuable intervention opportunities. Improved multidisciplinary collaboration between rheumatologists and ophthalmologists and early interventions may reduce uveitis complications and enhance visual outcomes for JIA patients.