Time of onset of uveitis in children with juvenile rheumatoid arthritis

Background: Recently, it has been advocated to decrease the frequency of eye examinations to screen for uveitis in children with juvenile rheumatoid arthritis (JRA) because of the low yield of positive findings after an initial normal eye examination. This study was undertaken to determine the time interval for the development of uveitis after the diagnosis of JRA and to further describe patients who develop uveitis related to JRA. Methods: This was a retrospective chart review of all patients with JRA examined by either of 2 pediatric ophthalmologists from August 1984 to June 2001. All patients were also under the care of the Pediatric Rheumatology Division at Schneider Children's Hospital. Age of diagnosis of JRA, disease onset subtype of JRA, antinuclear antibody titers, age of diagnosis of uveitis, and complications from uveitis were recorded. Results: One hundred fifty eight patients with JRA had eye examinations; 39 (25%) developed uveitis. Sixteen patients had uveitis on the initial eye examination, and 23 subsequently developed uveitis. When uveitis was absent at the initial eye examination, the mean time to develop it was 20 months (range, 4-81 months). Conclusions: A normal initial eye examination does not preclude the development of uveitis in patients with JRA. We recommend continuing the current standards of ophthalmologic examinations to screen for uveitis in children with JRA as prescribed by the Section on Rheumatology and Ophthalmology of the American Academy of Pediatrics.