Dr Ben Wild
Overview |
Juvenile idiopathic arthritis (JIA) is the most common systemic disease associated with anterior uveitis in childhood. Normally, the anterior chamber of the eye, which extends from the inner layer of the cornea to behind the iris, is void of any signs of inflammation. In anterior uveitis, fibrous debris and white blood cells are seen either stuck to the inner cornea or floating around in the anterior chamber of the eye.
Frontal view (left) and sagittal view (right) of a healthy eye.
JIA occurs in 1 in every 1000 people and represents an arthritis of unknown cause. It typically becomes symptomatic before the age of 16. Oligoarticular JIA includes inflammation of 4 joints or less, typically involves the knees, ankles and wrists, and usually presents at the age of 2. Polyarticular JIA involves over 5 joints and can present with rashes. Both types can present with uveitis but oligoarticular is more common. Still’s disease includes fever, rash, swollen lymph nodes, swollen liver and spleen and inflamed joints.
Frontal view (left) showing synechiae (areas where iris is stuck to the lens) and sagittal view (right) showing white blood cells, fibers and the iris stuck to the lens.
Signs and Symptoms |
Signs
There are not usually any signs that can be seen without specialized equipment. With this equipment, signs include white blood cells floating in the eye, white blood cells stuck to the inside of the cornea or to the iris, fibers floating around the anterior chamber, elevated eye pressures, iris stuck to the lens of the eye.
With increased age; clouding of the cornea, cataracts, swelling of the retina, glaucoma.
Symptoms
Usually, no symptoms but there is a small chance of episodes of mild light sensitivity and/or pain.
Causes and Risk Factors |
Causes
Genetic immune system response against various joint and eye structures.
Risk Factors
The presence of auto-immune markers in the blood like anti-nuclear antigen, HLA-B27 proteins, and rheumatoid factor.
Prevention and Treatment |
Prevention
There are no known preventative measures.
Treatments
· Follow up eye exams every 3, 6 or 12 months depending on age and which auto-immune markers are found in the blood.
· Steroid drops or ointments.
· Cyclogyl dilating drops.
· Steroid injections.
· Steroid pills.
· Non-steroidal anti-inflammatory pills.
· Disease modifying anti-rheumatic drugs.
Prognosis |
Progression of uveitis associated with JIA towards a state of blindness has historically been very likely but has been quickly down trending with better access to eyecare in developed countries. Early detection of uveitis is necessary but difficult as most cases do not present with any symptoms. Frequent follow ups are therefore required and can drastically reduce the chances of blindness.
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