Guidelines for Ophthalmologic Examinations in Children With Juvenile Rheumatoid Arthritis

Abstract

Chronic, nongranulomatous iridocyclitis is an important complication of juvenile rheumatoid arthritis (JRA).^1-3 First reported by Ohm in 1910, the association between iridocycitis and JRA has become well established. The intraocular inflammation referred to as iridocyclitis primarily affects the iris and ciliary body. Overall, the reported incidence of iridocyditis varies from 2% to 21% in children with JRA.⁴ The morbidity of iridocydlitis includes cataracts, glaucoma, band keratopathy, and loss of vision.^5,6 Diagnosis of early iridocycitis is usually not possible by routine direct ophthalmoscopy. Sitlamp examination detects the signs of active anterior chamber inflammation. Guidelines for the schedule of routine serial sitlamp examination are suggested for early detection of iridocycitis.

The presentation of eye involvement in JRA may be asymptomatic or of an insidious onset. The outcome has improved in the past 20 years. The majority of children have a relatively good visual prognosis if the iridocycitis is detected and treated early.⁶

RISK FACTORS FOR IRIDOCYCLITIS

Articular Features

The diagnosis of JRA describes a heterogeneous group of arthritic conditions with onset of disease before age 16 years. There are three major subtypes of JRA: systemic onset, polyarticular onset, and pauciarticular onset, defined by the clinical manifestations in the first 6 weeks of the disease.⁷ Fewer than 2% of children with systemic-onset JRA have iridocycitis.^4,5 Children with polyarticular disease are at moderate risk, with 7% to 37% incidence of iridocyditis. The majority of children with iridocycitis have pauciarticular disease.^1-3,5 The onset of the iridocyclitis may precede the onset of the arthritis in approximately 6% of cases.