Severe childhood uveitis without overt arthritis.
OBJECTIVE
To look for forme fruste (incomplete) forms of juvenile idiopathic arthritis (JIA)-associated uveitis.


METHODS
The study involved 6 patients (3 girls and 3 boys) without overt arthritis who had been sent for ophthalmologic and rheumatologic evaluation because of uveitis resembling that seen in JIA.


RESULTS
Two patients evinced no evidence of arthritis, 3 had non-specific signs and symptoms such as pains or valgus ankle and one may have had an episode of arthritis. Five patients carried the HLA allele B27 and 4 were positive for antinuclear antibodies. The mean age at diagnosis of uveitis was 8.4 years (range 3.5-14.2 years) and the mean follow-up period was 6.2 years (range 3.8-7.3 years). All patients had obviously had their uveitis for a long period prior to the first contact with an ophthalmologist. In 3 patients uveitis was asymptomatic when diagnosed, 2 had mild conjunctival injection and one had exacerbation of the disease process. Subsequently the uveitis was asymptomatic and bilateral in all patients. Complications of uveitis were common: cataract was found in 4 patients, glaucoma in 1 patient, cystoid macular edema in 4, posterior synechiae in 5 and band keratopathy in 3. The final visual acuity was poor in one eye of 1 patient despite effective treatment of uveitis. Uveitis was still active in all patients at the close of follow-up.


CONCLUSIONS
Asymptomatic uveitis, which is frequently positive for antinuclear antibodies, can occur in children who show no clear evidence of arthritis. Complications occur in consequence of a delay in the diagnosis of insidious uveitis.
Kotaniemi
K
K
Department of Ophthalmology, Rheumatism Foundation Hospital, 18120 Heinola, Finland. kaisu.kotaniemi@sci.fi
Savolainen
A
A
Aho
K
K
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D016059:Range of Motion, Articular; D012216:Rheumatic Diseases / Q000175:diagnosis; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D014605:Uveitis / Q000175:diagnosis*