Children with polyarticular juvenile idiopathic arthritis (pJIA) — the second most common form of JIA — have worse functional disability and poorer quality of life, a Swedish study finds.
While the researchers found no major impact of JIA-associated uveitis on quality of life, they called for larger studies on the effect of this type of eye inflammation on children.
The study, “Visual Function And Quality Of Life In A Cohort Of Swedish Children With Juvenile Idiopathic Arthritis,” was published in the journal Clinical Ophthalmology.
Uveitis is an inflammatory condition that causes swelling and destruction of a part of the eye called uvea, and, if untreated, can lead to blindness. It is the most frequent and severe extra-articular complication associated with JIA, and affects nearly 20% of children with this rheumatic disease, according to a recent study.
JIA-associated uveitis may develop before, at the same time as, or after the development of arthritis, but it typically appears within the first three years after JIA diagnosis.
As JIA may cause long-term disability and significantly affect quality of life, there is an increasing need to assess physical and visual function, as well as vision-related quality of life in children with this disorder.
In the study, researchers conducted detailed ophthalmological examinations and recorded the age of uveitis onset, any eye complications secondary to uveitis, and any previous eye surgery in 40 Swedish children with JIA (31 girls, 9 boys).
Visual function and vision-related quality of life were assessed with the Effects of Youngsters’ Eyesight on Quality of Life instrument (EYE-Q). Functional disability was measured by the Childhood Health Assessment Questionnaire (CHAQ), which consists of eight functional categories, including one that addresses pain and another that measures overall well-being.
In both questionnaires (to parents and children), higher scores indicate worse condition — poorer vision and quality of life, or higher disability.
Children were treated at the pediatric ophthalmology department at Queen Silvia Children’s Hospital, in Gothenburg. Their mean age was 7.9 years (range from 3.1 to 11.8 years) and their age of disease onset was 3.7 years, corresponding to a mean of 4.2 years living with JIA.
A total of 25 children had persistent oligoarticular JIA (62.5%), eight had pJIA (20%), five had extended oligoarticular JIA (12.5%), one had systemic JIA (2.5%), and another had psoriatic arthritis (2.5%).
Seven children (17.5%) — two boys and five girls — had uveitis at assessment or in the past, which had developed after JIA diagnosis in all cases. Three of these children experienced additional eye complications. Current treatments included methotrexate and adalimumab (marketed as Humira by Abbvie, and biosimilars), among others.
The results showed that children with pJIA had significantly worse disability and poorer well-being than those with other JIA subtypes. Also, longer disease duration was significantly associated with greater disability and poorer overall quality of life.
Persistent oligoarticular JIA was the most common JIA subtype (57%) among children with uveitis. However, no specific subtype was significantly associated with the presence or absence of uveitis.
The team also found that vision parameters, visual function, and functional disability were similar between children with or without uveitis.
While children with uveitis had higher (worse) maximum scores in quality of life than those without uveitis, no significant difference was found.
“This could be due to the fact that the patients were relatively stable in their JIA, but also due to the few cases with uveitis,” the researchers wrote.
They also noted that “both the CHAQ and EYE-Q instruments scored low in general, which we believe is due to effective management of the arthritis disease as well as good screening programs, strong collaboration between the ophthalmic and the pediatric clinics.”
Overall, “this study indicates the importance of measuring not only physical function but also [vision-related quality of life] in children with JIA and JIA-associated uveitis,” the researchers added.
Larger studies are needed to clarify whether uveitis is associated with poorer quality of life in children with JIA, they said.