Childhood-Onset Non-Infectious Uveitis in the "Biologic Era". Results From Spanish Multicenter Multidisciplinary Real-World Clinical Settings

• Published in: Ocular immunology and inflammation Vol. 32; no. 9; pp. 2159 - 2169
• Main Authors: Mesa-Del-Castillo, Pablo, Yago Ugarte, Inés, Bolarín, J M, Martínez, David, López Montesinos, Berta, Barranco González, Honorio, Calvo Penadés, Inmaculada, Lacruz Pérez, Lucia, Clemente, Daniel, Robledillo, Juan Carlos, Valls Ferrán, Isabel, Bravo Mancheño, Beatriz, Rubio Plats, Marina, Martín Pedraz, Laura, Alba Linero, Carmen, Sevilla-Pérez, Belén, García-Serrano, J L, Mir-Perelló, Maria Concepcion, Druetta, Noelia, Souto, Alex, Lopez-Lopez, Fernando, Zarallo-Reales, Cristina, Jerez Fidalgo, María, Solana Fajardo, Jorge, Palmou Fontana, Natalia, Demetrio Pablo, Rosalia, Pinedo, Mari Carmen, Fonollosa, Alex, Jovani Casano, Vega, Mondejar García, Jose Juan, Brandy, Anahy, García López, Alba, Esteban-Ortega, M, Reinoso, Teresa, Calzada-Hernández, Joan, Llorca Cardeñosa, Ana, Gavilán Martín, César, Mengual Verdú, Encarna, Martínez Vidal, Mari Paz, Quilis Martí, Neus, Alvarado, M C, De Inocencio, Jaime, Alonso-Martín, Beatriz, Recuero-Diaz, Sheila, Carreño, Ester, Nieto González, Juan Carlos, Ibares, Lucia, Rosas Gómez de Salazar, Jose, Sánchez Sevila, Juan Luis
• Format: Journal Article
• Language: English
• Published: England 01-11-2024
• Subjects: Adolescent; Age of Onset; Antirheumatic Agents - therapeutic use; Arthritis, Juvenile - complications; Arthritis, Juvenile - drug therapy; Biological Products - therapeutic use; Child; Child, Preschool; Female; Humans; Infant; Male; Registries; Retrospective Studies; Spain - epidemiology; Uveitis - diagnosis; Uveitis - drug therapy; Visual Acuity - physiology; Spain; Autoimmune diseases; juvenile idiopathic arthritis; uveitis; biological therapy; disease-modifying antirheumatic drugs
• ISSN: 0927-3948; 1744-5078; 1744-5078
• DOI: 10.1080/09273948.2024.2336609

To characterize and describe clinical experience with childhood-onset non-infectious uveitis.
A multicenter retrospective multidisciplinary national web-based registry of 507 patients from 21 hospitals was analyzed. Cases were grouped as immune disease-associated (IMDu), idiopathic (IDIu) or ophthalmologically distinct. Characteristics of juvenile idiopathic arthritis-associated (non-HLA-B27-related) uveitis (JIAu), IDIu, and pars planitis (PP) were compared.
IMDu (62.3%) and JIAu (51.9%) predominated in young females; and IDIu (22.7%) and PP (13.6%) in older children, without sex imbalance. Ocular complications occurred in 45.3% of cases (posterior synechiae [28%], cataracts [16%], band keratopathy [14%], ocular hypertension [11%] and cystoid macular edema [10%]) and were associated with synthetic (86%) and biologic (65%) disease-modifying antirheumatic drug (DMARD) use. Subgroups were significantly associated (
 < 0.05) with different characteristics. JIAu was typically anterior (98%), insidious (75%), in ANA-positive (69%), young females (82%) with fewer complications (31%), better visual outcomes, and later use of uveitis-effective biologics. In contrast, IDIu was characteristically anterior (87%) or panuveitic (12.1%), with acute onset (60%) and more complications at onset (59%: synechiae [31%] and cataracts [9.6%]) and less DMARD use, while PP is intermediate, and was mostly bilateral (72.5%), persistent (86.5%) and chronic (86.8%), with more complications (70%; mainly posterior segment and cataracts at last visit), impaired visual acuity at onset, and greater systemic (81.2%), subtenon (29.1%) and intravitreal (10.1%) steroid use.
Prognosis of childhood uveitis has improved in the "biologic era," particularly in JIAu. Early referral and DMARD therapy may reduce steroid use and improve outcomes, especially in PP and IDIu.