Improved clinical outcomes in patients with juvenile idiopathic arthritis associated uveitis in the last decade

Purpose The purpose of the study was to analyse the development of ocular complications and visual prognosis in juvenile idiopathic arthritis associated uveitis (JIA-uveitis) compared to the previous decade in the light of new treatment guidelines. Methods In this retrospective cohort, 143 patients with JIA-uveitis were stratified into two cohorts based on the year of diagnosis of uveitis, <2010 (n = 61) and >= 2010 (n = 82). Development of ocular complications and visual outcomes were analysed by univariate and multivariate methods. Treatment with systemic corticosteroids and immunomodifying medication (IMT) were documented. Results In total, 109 and 133 affected eyes, respectively, for cohort 1 (<2010) and cohort 2 (>= 2010) were included for analysis. In the multivariate analysis with correction for paired eyes, patients in cohort 1 were at higher risk for cataract surgery (p = 0.03) and secondary glaucoma (p = 5.15 x 10(-3)). Also, the number of eyes that were legally blind and visually impaired at 5 years of follow-up was significantly higher in cohort 1 (7% versus 2% and 8% versus 0%, p = 0.01 respectively). The number of patients that started IMT was significantly higher in cohort 2 (57% versus 98%, p = 2.17 x 10(-6)). In cohort 2, both methotrexate and anti-TNF-alpha therapy were prescribed earlier in the disease course (1.41 versus 0.05 years, p = 8.31 x 10(-6) and 6.07 versus 1.84 years, p = 5.14 x 10(-5) respectively). Conclusions The prognosis of JIA-uveitis has improved during the last decade. There is a reduction in the number of cataract surgeries and secondary glaucoma and fewer patients lose their vision parallel with earlier access to tertiary care and earlier introduction of IMT.