幼年特发性关节炎合并葡萄膜炎15例病例系列报告

背景 葡萄膜炎为幼年特发性关节炎(JIA)最常见的关节外表现,治疗不及时可导致严重并发症,有致盲风险.目的 探讨JIA合并葡萄膜炎的临床特征.设计病例系列报告.方法 纳入首都儿科研究所附属儿童医院风湿免疫科2018年3月至2020年5月收治的JIA合并葡萄膜炎患儿,从病历中截取人口学资料、实验室检查、JIA分型、眼部表...

15 cases of juvenile idiopathic arthritis complicated with uveitis: A case series report

Background: Juvenile idiopathic arthritis (JIA) associated uveitis is the most common extra articular manifestation of JIA. Untimely treatment may lead to serious complications and the risk of blindness. Objective: To investigate the clinical features of JIA patients complicated with uveitis. Design: Case series report. Methods: Patients complicated with uveitis admitted to the department of rheumatology and immunology of the Children's Hospital Affiliated to the Capital Institute of Pediatrics from March 2018 to May 2020 were included. Demographic data, laboratory examination, sub type of JIA, ocular manifestations and complications, treatment, and follow up were intercepted from the medical records. Main outcome measures: Uveitis and complications, treatment and outcome. Results: Of the 278 cases with JIA, fifteen cases were complicated with uveitis, including 4 males and 11 females. The onset age was within 8 years old. Among the 15 patients, there were 13 cases of oligoarticular type, 1 case of polyarticular type and 1 case of enthesitis related arthritis type; there were 2 patients with the onset of visual impairment and the other 13 cases with the onset of arthritis; eye lesions were found in 12 cases at the initial diagnosis, and in 3 patients at the course of 1 2.5 years. All of the 15 patients were diagnosed with anterior uveitis with 8 cases of bilateral lesions and 7 cases of unilateral lesions. Visual impairment was detected in 7 cases. There were 12 patients treated with biological agents, 13 with methotrexate, 1 with sulfasalazine and mycophenolate mofetil, and 3 with glucocorticoids. For local medication, 13 cases were treated with glucocorticoids, 11 cases with mydriasis drugs, 11 cases with non steroidal anti inflammatory drugs, and 3 cases with antibiotics. During the follow up (14 41 months), the arthritis of all patients was improved after treatment. Eye lesions recovered in 7 cases, improved in 1 case, and delayed and repeated in 2 cases, remained no changes in 5 cases. Conclusion: Uveitis is the main extra articular manifestation of JIA, which is more common in oligoarticular type, occult onset, and highly disabling. Without treatment in time, serious complications may occur. Regular visual and fundus examination in children with JIA is very important for early detection and treatment of ocular lesions.