Uveitis Leads to Poorer Vision in JIA Children, Affecting Life Quality

Uveitis, a form of eye inflammation, worsens vision and vision-related quality of life among children with juvenile idiopathic arthritis (JIA), according to a large questionnaire study.

Results also showed worse physical functioning in these children compared with those with uveitis but not JIA.

The study, “Comprehensive assessment of quality of life, functioning and mental health in children with juvenile idiopathic arthritis and non-infectious uveitis,” was published in the journal Arthritis Care & Research.

JIA is the systemic disease most commonly associated with uveitis, which — if untreated — can lead to severe eyesight complications and blindness. This form of inflammation generally affects the anterior (front) part of the eye in children with JIA.

To study the impact of uveitis on the visual acuity, physical/mental health, and quality of life in children with JIA, researchers at the Cincinnati Children’s Hospital Medical Center and colleagues conducted a large study based on questionnaires given to both parents and children.

Their study took place at four sites: Cincinnati Children’s Hospital Medical Center in Ohio, Emory University in Georgia, Children’s Mercy Hospital in Missouri, and the University of California Los Angeles.

Overall, 549 children (70.5% girls, mean age of 10.5) enrolled in the study, including 332 (60.5%) with JIA only, 124 (22.6%) with JIA and uveitis, and 93 (16.9%) with uveitis not associated with JIA.

The median age of JIA diagnosis was 5.4, with a median disease duration of 2.6 years. The most frequent JIA subtype was the oligoarticular persistent, affecting 39.7% of patients.

Compared with JIA alone, children who also had uveitis were diagnosed at a younger age (3.0 years vs. 6.4 years) and had a significantly longer disease duration (5.5 years vs. 1.9 years).

Uveitis lasted for a median of 2.8 years. Most patients (68.2%) had inflammation in both eyes, or bilateral. Among the 141 children with an eye exam within the last two months, 40% had active uveitis.

The impact on vision was assessed using the Effects of Youngsters’ Eyesight on Quality of Life (EYE-Q) questionnaire, which assessed various vision-related functions (VRF) — near and far vision, color vision, night vision, photosensitivity — and vision-related quality of life (VRQOL), with questions on use of medication, participation in activities related to vision, and regarding a uveitis diagnosis.

Children with JIA and uveitis scored significantly worse compared to children with JIA only, both in VRF (86.0 vs. 91.4) and VRQOL (70.4 vs. 82.0) scores reported by parents. Total EYE-Q scores here were 82.1 for those with JIA and uveitis, and 89.7 for JIA only. Results were similar in the child reports, with the exception of VRF.

“Children with uveitis did not report significant VRF differences compared to those without uveitis, although their parent

reports did,” the researchers wrote, noting this “discrepancy” may be due to “a child’s perception of their own visual

function.”

In children with both JIA and uveitis and in those with uveitis not associated with JIA, inflammation affecting the front part of the eye was associated with higher (better) total EYE-Q scores compared to uveitis also affecting other eye locations, like the middle or back of the eye.

As assessed by parents, EYE-Q scores were worse in children with bilateral uveitis and more severe visual loss, than in those with unilateral disease and lesser impairment.

No significant differences were found among the three groups regarding anxiety and depression, with results showing no evidence of these complications in the children.

Using the Pediatric Quality of Life Inventory (PedsQL), the researchers observed that patients with JIA and uveitis had worse physical scores compared to those with anterior uveitis only.

Among those with arthritis, no differences were evident between children with JIA and JIA with uveitis regarding physical functioning — assessed with the Childhood Health Assessment Questionnaire — indicating both groups face similar difficulties in daily life activities, the team said.

Those with uveitis but not with JIA were more likely to receive local glucocorticoids drops (61.3%) than were those with JIA and uveitis (41.9%). Methotrexate was the most common whole-body (systemic) treatment, used by 220 children (40.1%).

In the group with uveitis, those treated with both topical and systemic treatment (65 patients) had worse EYE-Q total scores, reported by parents and children, compared with patients receiving no treatment.

Overall, “our results suggest that uveitis has a significant impact on VRQOL and VRF, and that vision-specific instruments are important in the assessment of patient outcomes,” the researchers wrote.

“Larger and more diverse cohorts [groups] are needed to study the impact of visual impairment and ocular complications on QOL and functioning,” they concluded.

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