Juvenile Idiopathic Arthritis: Inflammatory Eye Disease

Topic Overview

Inflammatory eye disease (uveitis) can develop as a complication in children who have juvenile idiopathic arthritis (JIA). Children and adults who have JIA can develop cataracts, glaucoma, corneal degeneration (band keratopathy), or vision loss.

The incidence of eye disease is 2 to 34 out of 100 children who have JIA.^{footnote 1} It is most common in oligoarticular and RF-negative polyarticular forms of the disease. Eye disease associated with JIA often has no symptoms, although blurred vision may be an early sign. To prevent eye problems from progressing to the point that vision loss occurs, regular eye examinations by an ophthalmologist are very important for children who have JIA.

Eye disease develops in about 30 out of 100 children who have oligoarticular JIA, particularly children who have a positive antinuclear antibody (ANA) test result.^{footnote 2}

Early detection and treatment of inflammatory eye disease gives a child the best chance of a good outcome. Discuss the appropriate examination schedule with your doctor. Your doctor will consider many things when deciding how often to recommend an eye examination. He or she will think about the type of arthritis, the age of the child when the disease began, how long the child has had JIA, and whether or not eye disease is present. Over time, the child may need fewer examinations each year. But he or she should continue to have regular eye examinations.

Long-term outlook (prognosis)

Most children with inflammatory eye disease maintain good vision. Some do not.

If eye disease occurs, most children are treated with corticosteroids and prescription eyedrops. More severe eye disease, or eye disease that does not respond to these treatments, may be treated with other medicines such as azathioprine or methotrexate.^{footnote 2}

The outlook for inflammatory eye disease has improved. Early and aggressive treatment of uveitis has reduced the complications of eye disease in JIA. Before treatment with methotrexate and TNF inhibitors became common, only about 1 out of 4 children had a good long-term vision outcome. Today, because of early treatment and better medicines, children with eye inflammation have a better chance of having a good vision outcome with less treatment.^{footnote 1}