ab21319

Severe childhood uveitis without overt arthritis

K. Kotaniemi¹, A. Savolainen², K. Aho³

¹Department of Ophthalmology and ²Department of Pediatric Rheumatology, Rheumatism Foundation Hospital, Heinola; ³National Public Health Institute, Helsinki, Finland

ABSTRACT
Objective
To look for forme fruste (incomplete) forms of juvenile idiopathic arthritis (JIA)-associated uveitis.

Methods
The study involved 6 patients (3 girls and 3 boys) without overt arthritis who had been sent for ophthalmologic and rheumatologic evaluation because of uveitis resembling that seen in JIA.

Results
Two patients evinced no evidence of arthritis, 3 had non-specific signs and symptoms such as pains or valgus ankle and one may have had an episode of arthritis. Five patients carried the HLA allele B27 and 4 were positive for antinuclear antibodies. The mean age at diagnosis of uveitis was 8.4 years (range 3.5 - 14.2 years) and the mean follow-up period was 6.2 years (range 3.8 - 7.3 years). All pa-tients had obviously had their uveitis for a long period prior to the first contact with an ophthalmologist. In 3 patients uveitis was asymptomatic when diagnosed, 2 had mild conjunctival injection and one had exacerbation of the disease process. Subsequently the uveitis was asymptomatic and bilateral in all patients.
Complications of uveitis were common: cataract was found in 4 patients, glaucoma in 1 patient, cystoid macular edema in 4, posterior synechiae in 5 and band keratopathy in 3. The final visual acuity was poor in one eye of 1 patient despite effective treatment of uveitis. Uveitis was still active in all patients at the close of follow-up.

Conclusion
Asymptomatic uveitis, which is frequently positive for antinuclear antibodies, can occur in children who show no clear evidence of arthritis. Complications occur in consequence of a delay in the diagnosis of insidious uveitis.

Key words
Uveitis, children, juvenile idiopathic arthritis.

Please address correspondence and reprint requests to: Kaisu Kotaniemi, MD, Rheumatism Foundation Hospital, 18120 Heinola, Finland.
E-mail kaisu.kotaniemi@sci.fi