Granulomatous inflammation in juvenile idiopathic arthritis-associated uveitis.
OBJECTIVE
The uveitis that is associated with juvenile idiopathic arthritis (JIA) has typically been described as nongranulomatous. This study reports the prevalence of granulomatous disease in a population with JIA-associated uveitis.


METHODS
We conducted a retrospective analysis of all patients with JIA-associated uveitis seen between 1973 and 2006 at a hospital-based uveitis service. Patients with uveitis were included if they were diagnosed with JIA by a specialist and experienced at least 6 weeks of arthritis starting before the age of 16 years. Granulomatous disease was defined as Busacca or angle nodules, mutton-fat keratic precipitates (KP), or hyalinized "ghost" KPs. Statistical tests were performed to seek associations between granulomatous disease and various clinical factors.


RESULTS
Seventy-one patients with JIA-associated uveitis were included. Granulomatous uveitis was observed in 28% of the population, with 7% exhibiting mutton-fat KP, and 21% "ghost" KP. There was no association between the presence of granulomatous disease and age of arthritis onset, age of uveitis onset, sex, antinuclear antibody status, or whether the arthritis was pauciarticular or polyarticular. In this population, 67% of black patients had granulomatous disease compared with 25% of nonblack patients (p < 0.05), and 24% of white patients showed granulomatous disease compared with 56% of nonwhite patients (p = 0.11).


CONCLUSIONS
Granulomatous disease is more common in JIA-associated uveitis than previously thought and may be more common in black patients. Although it is necessary to exclude other forms of granulomatous uveitis, such as sarcoidosis, the presence of granulomatous uveitis is not inconsistent with a diagnosis of JIA-associated uveitis.
Keenan
Jeremy D
JD
University of Illinois Eye and Ear Infirmary, Chicago, Illnois, USA. Jeremy.keenan@ucsf.edu
Tessler
Howard H
HH
Goldstein
Debra A
DA
D000974:Antibodies, Antinuclear / Q000097:blood; D001171:Arthritis, Juvenile / Q000150:complications*; D044383:Black People / Q000706:statistics & numerical data; D002648:Child; D003316:Corneal Diseases / Q000209:etiology / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D014605:Uveitis / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D044465:White People / Q000706:statistics & numerical data
D000974:Antibodies, Antinuclear