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Contempo 1998
October 7,1998

Saving the Vision of Children With Juvenile Rheumatoid Arthritis–Associated Uveitis

Author Affiliations

From the Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.

JAMA. 1998;280(13):1133-1134. doi:10.1001/jama.280.13.1133

CHRONIC UVEITIS is a serious complication of juvenile rheumatoid arthritis (JRA). Approximately 6% of all cases of uveitis occur in children,1 and up to 80% of all cases of anterior uveitis in childhood are associated with JRA.2 Although remarkable progress has been made in the care of patients with JRA-associated uveitis since the development of corticosteroids for systemic and ophthalmic use in the 1950s, up to 12% of children with uveitis associated with pauciarticular JRA still develop permanent blindness as a result of low-grade chronic intraocular inflammation.3 Ironically, these children are often under careful observation by ophthalmologists who may opt to tolerate low-grade ocular inflammation, hoping to avoid the development of corticosteroid-induced ocular adverse effects such as cataracts and glaucoma.4 The vision-robbing consequences of low-grade uveitis occur extremely slowly, typically over a period of 4 to 8 years, and the end result is clear: even low-grade uveitis may lead eventually to ocular damage, including band keratopathy, maculopathy (macular edema, macular cysts, epiretinal membrane), glaucomatous optic neuropathy, and cataract formation from chronic inflammation and corticosteroid therapy.2,5,6 Although surgical treatment of cataract and glaucoma is remarkably successful in the general population, it is consistently less so in patients with JRA-associated uveitis.2,7