Risk of chronic uveitis onset is increased in juvenile idiopathic arthritis in the absence of methotrexate therapy

Abstract

Purpose

To analyze factors associated with anterior chronic uveitis development in juvenile idiopathic arthritis (JIA), focusing on methotrexate (MTX) exposure and discontinuation.

Methods

We conducted a multicenter retrospective study. Patients with JIA-associated uveitis (JIA-U) were compared with JIA patients without uveitis, matched 1:1 according to JIA subtype, age at JIA diagnosis, and serum markers. Data included demographics, clinical features and treatments. The effect of MTX on JIA-U onset was analyzed and adjusted for matching factors.

Results

A total of 404 patients with JIA were included, 77 (19%) developed uveitis, mostly chronic anterior uveitis. Uveitis onset occurred within three years of JIA diagnosis, with a median time of 1.7 years (IQR 0.42–3.65). In the matched analysis (62 JIA-U and 62 JIA-no-U), no statistically significant differences were observed in previous MTX exposure within the first two years after JIA diagnosis between patients with and without uveitis (82% vs. 91%; p = 0.14). Among patients who discontinued MTX before developing uveitis, the median time from MTX withdrawal to uveitis onset was 1.7 years (IQR 0.89–3.7). At uveitis onset, 57.1% of patients were not receiving systemic treatment, 31.2% were receiving MTX, 7.8% were receiving etanercept and 3.9% were receiving both.

Conclusions

Our study suggests that uveitis in JIA occurs more frequently in patients who are not receiving systemic treatment, including those with long-standing disease, although this association was not statistically significant in our cohort. Close ophthalmologic screening during the 18 months following MTX discontinuation may allow earlier diagnosis of uveitis and prevent complications.