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Open Access 01-12-2021 | Uveitis | Research article

Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER

Authors: Sezgin Sahin, Ceyhun Acari, Hafize Emine Sonmez, Fatma Zehra Kilic, Erdal Sag, Hatice Adiguzel Dundar, Amra Adrovic, Selcan Demir, Kenan Barut, Yelda Bilginer, Betul Sozeri, Erbil Unsal, Seza Ozen, Ozgur Kasapcopur

Published in: Pediatric Rheumatology | Issue 1/2021

Abstract

Background

Juvenile idiopathic arthritis (JIA), is the most common pediatric rheumatologic disorder with unknown etiology. Currently, no population-based data are available regarding the distribution of categories and frequency of uveitis in patients with JIA in Turkey. The purpose of this study was to evaluate the frequency of JIA-associated uveitis (JIAU) and distribution of JIA categories in a Turkish JIA cohort.

Methods

This was a retrospective study of 500 randomized patients in four pediatric rheumatology clinics in Turkey.

Results

Oligoarticular JIA (oJIA) was the most common JIA disease category in this study cohort (38.8%). The frequencies of the other categories were as follows: enthesitis-related arthritis (ERA), 23.2%; rheumatoid factor (RF)–negative polyarthritis, 15.6%; systemic arthritis, 12.2%; juvenile psoriatic arthritis, 5.2%; undifferentiated arthritis, 2.8%; and RF-positive polyarthritis, 2.2%. JIA-associated uveitis was observed in 6.8% of patients at a mean (Standard Deviation, SD) age of 9.1 (3.8) years over a mean JIA disease duration of 4 (1.9) years. Uveitis developed after joint disease, with a mean (SD) duration of 1.8 (1.9) years. Patients with oJIA had the highest rate of uveitis (12.9%) followed by patients with ERA (5.2%) and polyarticular RF-negative disease (3.8%). Compared with persistent oJIA, the extended oJIA category had a > 3-fold higher risk of uveitis (11.3% vs 27.7%; odds ratio, 3.38 [95% Confidence Interval, 1.09–10.4]). The most frequently administered drug after development of uveitis was tumor necrosis factor–alpha inhibitors (38.2%). Five patients (14.7%) had uveitis-related complications that required surgical intervention.

Conclusions

Turkish pediatric patients with JIA experience a lower frequency of oJIA and higher frequency of ERA than their white European counterparts; the occurrence of uveitis is also somewhat lower than expected. Geographic and ethnic factors may affect these differences and need further investigation.

Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390–2 Available from: http://www.ncbi.nlm.nih.gov/pubmed/14760812.PubMed

Barut K, Adrovic A, Şahin S, Kasapçopu Ö. Juvenile idiopathic arthritis. Balkan Med J. 2017;34(2):90–101 Available from: http://www.balkanmedicaljournal.org/pdf.php?&id=1665.CrossRef

Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis: A systematic review. Joint Bone Spine. 2014;81:112–7.CrossRef

Prakken B, Albani S, Martini A. Juvenile idiopathic arthritis. Lancet. 2011;377(9783):2138–49 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21684384.CrossRef

Sen ES, Dick AD, Ramanan AV. Uveitis associated with juvenile idiopathic arthritis. Nat Rev Rheumatol. 2015;11(6):338–48 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25825278.CrossRef

Kump LI, Cervantes-Castañeda RA, Androudi SN, Foster CS. Analysis of pediatric uveitis cases at a tertiary referral center. Ophthalmology. 2005;112(7):1287–92 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15921752.CrossRef

BenEzra D, Cohen E, Maftzir G. Uveitis in children and adolescents. Br J Ophthalmol. 2005;89(4):444–8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15774921.CrossRef

Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509–16 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16196117.CrossRef

Guzman J, Oen K, Tucker LB, Huber AM, Shiff N, Boire G, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-out cohort. Ann Rheum Dis 2015;74(10):1854–1860. Available from: https://doi.org/10.1136/annrheumdis-2014-205372

10.

Consolaro A, Giancane G, Alongi A, van Dijkhuizen EHP, Aggarwal A, Al-Mayouf SM, et al. Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study. Lancet Child Adolesc Health. 2019;3(4):255–63 Available from: http://www.ncbi.nlm.nih.gov/pubmed/30819662.CrossRef

11.

Glerup M, Rypdal V, Arnstad ED, Ekelund M, Peltoniemi S, Aalto K, et al. Long-term outcomes in juvenile idiopathic arthritis: 18 years of follow-up in the population-based Nordic Juvenile idiopathic arthritis (JIA) cohort. Arthritis Care Res. 2019;72:507–16.CrossRef

12.

Berthold E, Månsson B, Kahn R. Outcome in juvenile idiopathic arthritis: a population-based study from Sweden. Arthritis Res Ther 2019;21(1):218. Available from: https://doi.org/10.1186/s13075-019-1994-8

13.

Selvaag AM, Aulie HA, Lilleby V, Flatø B. Disease progression into adulthood and predictors of long-term active disease in juvenile idiopathic arthritis. Ann Rheum Dis. 2016;75(1):190–5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25362042.CrossRef

14.

Sengler C, Klotsche J, Niewerth M, Liedmann I, Föll D, Heiligenhaus A, et al. The majority of newly diagnosed patients with juvenile idiopathic arthritis reach an inactive disease state within the first year of specialised care: data from a German inception cohort. RMD Open 2015;1(1):e000074. Available from: https://doi.org/10.1136/rmdopen-2015-000074

15.

Adib N, Hyrich K, Thornton J, Lunt M, Davidson J, Gardner-Medwin J, et al. Association between duration of symptoms and severity of disease at first presentation to paediatric rheumatology: results from the childhood arthritis prospective study. Rheumatology 2008;47(7):991–995. Available from: https://doi.org/10.1093/rheumatology/ken085

16.

Heiligenhaus A, Niewerth M, Ganser G, Heinz C, Minden K, Ganser G, et al. Prevalence and complications of uveitis in juvenile idiopathic arthritis in a population-based nation-wide study in Germany: suggested modification of the current screening guidelines. Rheumatology. 2007;46(6):1015–9.CrossRef

17.

Saurenmann RK, Rose JB, Tyrrell P, Feldman BM, Laxer RM, Schneider R, et al. Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: ethnicity as a risk factor. Arthritis Rheum 2007;56(6):1974–1984. Available from: https://doi.org/10.1002/art.22709

18.

Angeles-Han ST, Pelajo CF, Vogler LB, Rouster-Stevens K, Kennedy C, Ponder L, et al. Risk Markers of Juvenile Idiopathic Arthritis-associated Uveitis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol. 2013;40(12):2088–96 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24187099.CrossRef

19.

Tiller G, Buckle J, Allen R, Munro J, Gowdie P, Cox A, et al. Juvenile idiopathic arthritis managed in the new millennium: one year outcomes of an inception cohort of Australian children. J Pediatr Rheumatol. 2018;16(1):69.CrossRef

20.

Shih Y-J, Yang Y-H, Lin C-Y, Chang C-L, Chiang B-L. Enthesitis-related arthritis is the most common category of juvenile idiopathic arthritis in Taiwan and presents persistent active disease. Pediatr Rheumatol. 2019;17(1):58 Available from: http://www.ncbi.nlm.nih.gov/pubmed/31443722%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC6708211.CrossRef

21.

Shen C-C, Yeh K-W, Ou L-S, Yao T-C, Chen L-C, Huang J-L. Clinical features of children with juvenile idiopathic arthritis using the ILAR classification criteria: A community-based cohort study in Taiwan. J Microbiol Immunol Infect. 2013;46(4):288–94 Available from: https://linkinghub.elsevier.com/retrieve/pii/S1684118212000448.CrossRef

22.

Kunjir V, Venugopalan A, Chopra A. Profile of Indian patients with Juvenile onset chronic inflammatory joint disease using the ILAR classification criteria for JIA: A community-based cohort study. J Rheumatol 2010;37(8):1756–1762. Available from: https://doi.org/10.3899/jrheum.090937

23.

Shin JI, Kim KH, Chun JK, Lee TJ, Kim KJ, Kim HS, et al. Prevalence and patterns of anti-nuclear antibodies in Korean children with juvenile idiopathic arthritis according to ILAR criteria. Scand J Rheumatol 2008;37(5):348–351. Available from: https://doi.org/10.1080/03009740801998762

24.

Yasumura J, Yashiro M, Okamoto N, Shabana K, Umebayashi H, Iwata N, et al. Clinical features and characteristics of uveitis associated with juvenile idiopathic arthritis in Japan: first report of the pediatric rheumatology association of Japan (PRAJ). Pediatr Rheumatol 2019;17(1):15. Available from: https://doi.org/10.1186/s12969-019-0318-5

25.

Weakley K, Esser M, Scott C. Juvenile idiopathic arthritis in two tertiary centres in the Western Cape, South Africa. Pediatr Rheumatol 2012;10(1):35. Available from: https://doi.org/10.1186/1546-0096-10-35

26.

Chipeta J, Njobvu P, Wa-Somwe S, Chintu C, McGill PE, Bucala R. Clinical patterns of juvenile idiopathic arthritis in Zambia. Pediatr Rheumatol. 2013;11(1):1 Available from: Pediatric Rheumatology.CrossRef

27.

Demirkaya E, Özen S, Bilginer Y, Ayaz NA, Makay BB, Ünsal E, et al. The distribution of juvenile idiopathic arthritis in the eastern Mediterranean: results from the registry of the Turkish paediatric rheumatology association. Clin Exp Rheumatol. 2011;29(1):111–6.PubMed

28.

Alkan C, Kavak P, Somel M, Gokcumen O, Ugurlu S, Saygi C, et al. Whole genome sequencing of Turkish genomes reveals functional private alleles and impact of genetic interactions with Europe, Asia and Africa. BMC Genomics 2014;15(1):963. Available from: https://doi.org/10.1186/1471-2164-15-963

29.

Tunca M, Ozdogan H, Kasapcopur O, Yalcinkaya F, Ozen S, Topaloglu R, et al. Familial Mediterranean fever (FMF) in Turkey. Medicine. 2005;84(1):1–11 Available from: http://journals.lww.com/00005792-200501000-00001.CrossRef

30.

Ozen S, Karaaslan Y, Ozdemir O, Saatci U, Bakkaloglu A, Koroglu E, et al. Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study. J Rheumatol. 1998;25(12):2445–9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/9858443.PubMed

31.

Comak E, Dogan CS, Akman S, Koyun M, Gokceoglu AU, Keser I. MEFV gene mutations in Turkish children with juvenile idiopathic arthritis. Eur J Pediatr 2013;172(8):1061–1067. Available from: https://doi.org/10.1007/s00431-013-2003-x

32.

Ayaz NA, Ozen S, Bilginer Y, Erguven M, Taskiran E, Yilmaz E, et al. MEFV mutations in systemic onset juvenile idiopathic arthritis. Rheumatology 2008;48(1):23–25. Available from: https://doi.org/10.1093/rheumatology/ken409

33.

Saurenmann RK, Levin A V., Feldman BM, Rose JB, Laxer RM, Schneider R, et al. Prevalence, risk factors, and outcome of uveitis in juvenile idiopathic arthritis: A long-term followup study. Arthritis Rheum 2007;56(2):647–657. Available from: https://doi.org/10.1002/art.22381

34.

Ravelli A, Felici E, Magni-Manzoni S, Pistorio A, Novarini C, Bozzola E, et al. Patients with antinuclear antibody-positive juvenile idiopathic arthritis constitute a homogeneous subgroup irrespective of the course of joint disease. Arthritis Rheum. 2005;52(3):826–32.CrossRef

35.

Heiligenhaus A, Heinz C, Edelsten C, Kotaniemi K, Minden K. Review for disease of the year: epidemiology of Juvenile idiopathic arthritis and its associated Uveitis: the probable risk factors. Ocul Immunol Inflamm 2013;21(3):180–191. Available from: https://doi.org/10.3109/09273948.2013.791701

36.

Kanski JJ. Uveitis in juvenile chronic arthritis: incidence, clinical features and prognosis. Eye. 1988;2(6):641–5 Available from: http://www.nature.com/articles/eye1988118.CrossRef

37.

Kasapçopur O, Yologlu N, Ozyazgan Y, Ercan G, Caliskan S, Sever L, et al. Uveitis and anti nuclear antibody positivity in children with juvenile idiopathic arthritis. Indian Pediatr. 2004;41(10):1035–9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15523130.PubMed

38.

Çakan M, Ayaz NA, Karadağ ŞG, Ekinci DY. Why is the frequency of uveitis low in Turkish children with juvenile idiopathic arthritis? Rheumatology. 2020;59(3):679–80 Available from: http://www.ncbi.nlm.nih.gov/pubmed/31497847.PubMed

39.

Nordal E, Rypdal V, Christoffersen T, Aalto K, Berntson L, Fasth A, et al. Incidence and predictors of Uveitis in juvenile idiopathic arthritis in a Nordic long-term cohort study. Pediatr Rheumatol 2017;15(1):66. Available from: https://doi.org/10.1186/s12969-017-0195-8

40.

Chalom EC, Goldsmith DP, Koehler MA, Bittar B, Rose CD, Ostrov BE, et al. Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. J Rheumatol. 1997;24(10):2031–4 Available from: https://linkinghub.elsevier.com/retrieve/pii/S1091853198901148.PubMed

41.

Constantin T, Foeldvari I, Anton J, de Boer J, Czitrom-Guillaume S, Edelsten C, et al. Consensus-based recommendations for the management of uveitis associated with juvenile idiopathic arthritis: the SHARE initiative. Ann Rheum Dis 2018;77(8). Available from: https://doi.org/10.1136/annrheumdis-2018-213131

42.

Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the screening, monitoring, and treatment of Juvenile idiopathic arthritis-associated Uveitis. Arthritis Care Res. 2019;71(6):703–16 Available from: http://www.ncbi.nlm.nih.gov/pubmed/31021540.CrossRef

Title: Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER
Authors: Sezgin Sahin
Ceyhun Acari
Hafize Emine Sonmez
Fatma Zehra Kilic
Erdal Sag
Hatice Adiguzel Dundar
Amra Adrovic
Selcan Demir
Kenan Barut
Yelda Bilginer
Betul Sozeri
Erbil Unsal
Seza Ozen
Ozgur Kasapcopur
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Uveitis
Juvenile Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis
Pediatric Rheumatology
Familial Mediterranean Fever
Published in: Pediatric Rheumatology / Issue 1/2021
Electronic ISSN: 1546-0096
DOI: https://doi.org/10.1186/s12969-021-00613-2

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Springer Medicine

Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

Methods

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