VISUAL OUTCOMES PROGNOSTICATORS IN JUVENILE RHEUMATOID ARTHRITIS-ASSOCIATED UVEITIS

Purpose: The purpose of the study is to delineate the visual prognosti cators in juvenile rheumatoid arthritis-associated uveitis, Methods: T he records of 43 patients with juvenile rheumatoid arthritis-associate d uveitis who were observed for at least 6 months were studied retrosp ectively. Bivariate and multivariate statistical models were applied t o more than 40 parameters to determine the relative odds of visual reh abilitation among patients with each characteristic. Results: Thirty-s even (86%) patients were females and 6 (14%) males. The mean known age of uveitis onset was 13 years, with females having, on average, 4 yea rs earlier onset of disease compared to males (P = 0.04). Ninety-three percent had chronic, 5% had recurrent, and 2% had an acute monophasic disease course. Of the 76 affected eyes, 93% were nongranulomatous an d 97% had iridocyclitis, The mean overall duration of uveitis was 146 months, with females suffering from a significantly longer duration of active disease than did males (P < 0.001). Nineteen (44%) patients un derwent cataract extraction, and 16 (37%) underwent vitrectomy. Thirty (70%) of the patients experienced visual improvement with their thera py, When controlling for potential confounders, male sex (P = 0.006), shorter duration of uveitis (P = 0.007), older age at disease onset (P = 0.02), and a shorter delay in presentation to a subspecialist (P = 0.02) were associated significantly with visual acuity improvement. Vi sual acuity at presentation (P = 0.001), use of systemic nonsteroidal anti-inflammatory drugs (P = 0.01), older age at disease onset (P = 0. 02), absence of glaucomatous neuropathy (P = 0.02), and male sex (P = 0.03) were correlated strongly with a final visual acuity outcome of 2 0/40 or better, Conclusion: Juvenile rheumatoid arthritis-associated u veitis is a serious disease with a guarded visual prognosis. It is hop ed that increased awareness of its prognosticators will lead to treatm ent and referral patterns that have the best chance of minimizing the likelihood of visual impairment in patients with juvenile rheumatoid a rthritis.