PO:30:153 | Long-term outcomes of JIA-associated uveitis: a systematic review and meta-analysis

Laura Scagnellato¹, Giacomo Cozzi¹, Matteo Molfese¹, Mariagrazia Lorenzin¹, Jamie Alexander King¹, Gianluca Poncina¹, Stefano Rizzetto¹, Roberta Ramonda¹ | ¹UOC Reumatologia, Dipartimento di Medicina dei Sistemi DIMED, Ospedale Università di Padova, Italy

Objective. Our systematic review aims to gather the latest evidence on ocular damage accrual in adults with Juvenile Idiopathic Arthritis associated Uveitis (JIAU) with publications from the last 20 years.

Methods. JIAU is a potentially blinding condition affecting children from a young age. Disease flare-ups may occur throughout the life of an affected subject, resulting in severe ocular damage. The review protocol was published in PROSPERO with ID number 1033522 and included screening of eligible human studies on JIAU with over 10-year follow-up and/or on JIAU patients older than 18-year-old, published after 2000. Quality was assessed using the Newcastle-Ottawa scale. We extracted the cumulative incidence of uveitis complications for all studies, where available. The meta-analysis was completed with pooled estimates (PE), heterogeneity, sensitivity, robustness and risk of reporting bias assessment by relevant R packages. Pooled estimates for each long-term outcome were obtained by fitting a random effects model based on median cumulative incidence and patient numerosity from each study with comparable proportions (percentage of patients affected by a specific outcome at a given timepoint > 10 years after uveitis onset). Studies that did not report comparable estimates were not included in the meta-analysis.

Results. Sixteen single retrospective or cohort studies met eligibility criteria, reporting 1208 cases of long-term JIAU. Among reported cases, at least one course was prescribed of either csDMARD (methotrexate) in 308/455 cases (68%) or bDMARDs in 282/458 cases (62%). Quality was deemed good in 4 studies, fair in 7 and poor in 5. Despite high heterogeneity for every outcome (p-values <0.01), results were acceptable when tested for sensitivity. Reporting bias assessment revealed asymmetry for cataract and glaucoma. The cumulative incidence PE of severe visual impairment was 16.6% (95% CI, 11.4%-22.6%) at about 18 years. Cataract was the most frequently reported complication (PE 52 %, 95% CI, 28.9-74.7) followed by glaucoma, posterior synechiae, band keratopathy, cystoid macular oedema and ocular hypotony.

Conclusions. The long-term prevalence and cumulative incidence of JIAU flare-ups (1) and complications remain high in young adults, with over 10% of cases consistently reporting severe visual impairment. Further pathological and clinical studies are needed to improve these outcomes.

References
1. Scagnellato L, Cozzi G, Prosepe I, Lorenzin M, Doria A, Martini G, Zulian F, Ramonda R. Relapses of juvenile idiopathic arthritis in adulthood: A monocentric experience. PLoS One. 2024 May 2;19(5):e0298679. doi: 10.1371/journal.pone.0298679. PMID: 38696444; PMCID: PMC11065285.