Juvenile idiopathic arthritis: uveitis/ridocyclitis

By Cristiano Antonino On Nov 15, 2022

Uveitis/iridocyclitis is an inflammation that can cause significant eye damage, up to and including total loss of vision. In most cases it is treated with local therapy

The eye is made up of three layers: the innermost is the retina, the outermost consists of the sclera and cornea, the middle one is called the uvea and is particularly rich in blood vessels.

Uveitis or iridocyclitis is an inflammation of the uvea that can cause major damage to the eye, with loss of vision and in some rare cases, even blindness

Uveitis can be anterior, middle or posterior.

The form that occurs in children with juvenile idiopathic arthritis is typically an anterior uveitis.

The causes can be many, but the most frequent are autoimmune diseases such as:

Juvenile idiopathic arthritis;
Behcet’s disease;
Chronic inflammatory bowel disease.

Uveitis can manifest itself with reddening of the eye, red eye, a burning sensation in the eye or intense tearing, so-called acute iridocyclitis

There is photophobia, i.e. an abnormal intolerance to light that causes discomfort and pain in the eyes, and decreased visual acuity.

In many cases uveitis may present without any symptoms and therefore may go unnoticed.

In these cases, only the ophthalmologist, during a thorough examination of the eye, can realise that there is uveitis.

The diagnosis is made with a simple examination of the eye.

The ophthalmologist, with a special lamp called a slit lamp, looks at the anterior chamber of the eye and can thus assess the presence of inflammatory cells and thus uveitis.

Since children with juvenile idiopathic arthritis, especially females with the oligoarticular form and positive antinuclear antibodies (ANA), have a higher risk of developing this complication, they must undergo regular ophthalmic check-ups.

These check-ups should be performed every three months even if the children have no eye discomfort.

Uveitis is treated in most cases with local therapy, i.e. by placing drops of cortisone and pupil dilating drugs in the eyes.

But in some more severe cases, systemic therapy, i.e. by mouth or intravenously, may be necessary.

In cases that do not respond to local therapy, the most commonly used drugs are Methotrexate and TNF inhibitors such as Adalimumab.

When uveitis causes complications, surgery may be necessary

To prevent uveitis, it is very important to first treat juvenile idiopathic arthritis and make sure that this disease is well controlled.

It is also essential to have regular eye check-ups, every three months, so that the ophthalmologist can detect the onset of uveitis very early, especially when uveitis does not cause any symptoms.

Early diagnosis allows uveitis to be treated with local therapy alone and ensures a higher probability of recovery.

The prognosis of uveitis is closely related to early diagnosis and treatment

If treated early and well, it heals without leaving any scarring of the eye.

If, however, the diagnosis is made too late and the uveitis is not treated properly, it can lead to eye problems such as reduced vision due to the complications of chronic inflammation (cataracts, synechiae and glaucoma), and in some rare cases to loss of vision and thus blindness.

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