Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Race and Other Risk Markers in Juvenile Idiopathic Arthritis-Associated Uveitis.

Angeles-Han1,  Sheila, Pelajo2,  Christina, Vogler1,  Larry B., Kennedy3,   Christine W., Ponder3,  Lori, Leong4,  Traci, Lopez-Benitez2,  Jorge M.

Emory Univ School of Medicine, Atlanta, GA
Tufts Medical Center, Boston, MA
Emory Children's Center, Atlanta, GA
Emory University School of Public Health, Atlanta, GA

Background/Purpose:

Juvenile idiopathic arthritis-associated uveitis (JIA-U) is an inflammatory eye disease that occurs in 20% of children with JIA and can cause visual impairment and blindness. Risk factors associated with JIA-U include early age at arthritis onset, JIA subtype, young age, and ANA and HLA-B27 positivity. Few studies on JIA-U focus on African American (AA) children. In this population, the role of ANA is unclear, predisposition to JIA subtype differs, and there appears to be a lower risk of JIA-U compared to White (W) children. Hence, the risk for JIA-U may differ by race and should be explored. Our objective is to characterize the epidemiology and clinical course of children with JIA-U in a cohort of children with JIA in the CARRAnet Registry.

Methods:

Children with JIA from pediatric rheumatology clinics in the US were enrolled in the CARRAnet Registry from May 2010 to June 2011. Demographic and disease-related data were collected from time of diagnosis to enrollment visit. Only children whose uveitis status was known were included. Children with JIA alone were compared to those with JIA and uveitis. Children with JIA-U were then compared based on race, specifically AA and W. N may vary in some characteristics since we excluded data that was missing or unknown.

Table 1. Characteristics of Children with JIA-associated uveitis compared to children without uveitis

 All JIA N = 2675JIA-U N = 302JIA alone N = 2373P-value
Demographic Characteristics
  Age, mean years ± SD&11.5 ± 4.810.8 ± 4.511.5 ± 4.50.003**
  Gender, female, N (%)1951 (72.9)243 (80.5)1708 (72)0.002**
  Hispanic ethnicity, N (%)&268 (10)26 (8.6)248 (10.4)NS
Race, N (%)
  White2416 (90.3)282 (93.4)2134 (89.9)NS
  Black or African American165 (6.2)9 (3)156 (6.6)0.014**
  American Indian or Alaska Native37 (1.4)3 (1)34 (1.4)NS
  Asian68 (2.5)9 (3)59 (2.5)NS
  Native Hawaiian or Pacific Islander16 (0.6)016 (0.7)NS
  Other78 (2.9)5 (1.6)73 (3.1)NS
Disease characteristics
  Age at arthritis onset, mean years ± SD&6.39 ± 4.44 ± 3.46.7 ± 4.4<0.001**
  Medications used&
    Glucocorticoids ever1798 (67.2)223 (74.8)1575 (66.8)0.005**
    Biologics ever1226 (45.8)172 (57)1054 (44.5)<0.001**
    Non-biologics, DMARDs2049 (76.6)277 (91.7)1772 (75)<0.001**
  Extent/distribution joint involvement*
    Ever, <5 joints1105 (41.3)160 (53.2)945 (40)<0.001**
  Uveitis&302 (11.3)   
  JIA subtype, %&   <0.001**
    Oligo persistent715 (26.7)133 (44)582 (24.5) 
    Oligo extended220 (8.2)46 (15.2)174 (7.3) 
    Poly RF (+)190 (7.1)2 (0.7)188 (8) 
    Poly RF (-)783 (29.3)74 (24.5)709 (30) 
    Psoriatic165 (6.2)18 (6)147 (6.2) 
    Systemic241 (9)4 (1.3)257 (10.8) 
    ERA274 (10.2)17 (5.6)262 (11) 
    Undifferentiated61 (2.3)7 (2.3)54 (2.3) 
Labs&
  ANA1163 (48.8)196 (69.2)967 (46.1)<0.001**
  RF122 (12.7)2 (2)120 (14)0.001**
  Anti-CCP110 (11.5)3 (3.5)107 (12.3)0.015**
  HLA-B27202 (14.1)19 (11.9)185 (14.5)NS
& N varies since data that was "missing"or "unknown"was excluded
** p<0.05, NS = not significant
Values are N (%) unless indicated
Chi square and Mann Whitney test as appropriate.
Cases with missing and unknown data were excluded.

Table 2. Characteristics of African American Children with JIA-U

Black N = 9White N = 282p-value 
Demographic Characteristics
  Age, mean years ± SD14.5 ± 410.65 ± 4.40.027**
  Gender, female, %4 (44.4)230 (81.6)0.019**
  Hispanic ethnicity, %2 (22.2)19 (6.7)NS
Disease characteristics
  Uveitis, N (% of all JIA-U)9 (3)282 (97)0.014**
    Current, N (%)1 (11.1)107 (37.9) 
    Past, N (%)8 (88.9)175 (62.1) 
  Age at arthritis onset, mean years ± SD&7.8 ± 5.63.89 ± 3.3NS
  Medications used
    Glucocorticoids ever&7 (77.8)210 (75.2)NS
    Biologics ever7 (77.8)159 (56.4)NS
    Non-biologics, DMARDs8 (88.9)260 (92.2)NS
  Extent/distribution joint involvement
    Ever, <5&5 (62.5)149 (52.8)NS
  JIA subtype, %0.009**
    Oligo persistent3 (33.3)125 (44.3) 
    Oligo extended2 (22.2)41 (14.5) 
    Poly RF (+)02 (0.7) 
    Poly RF (-)073 (26) 
    Psoriatic017 (6) 
    Systemic03 (1.1) 
    Enthesitis related arthritis (ERA)4 (44.4)13 (4.6) 
    Undifferentiated07 (2.5) 
Lab&
  ANA3 (37.5)186 (70)NS
  RF02 (2.2)NS
  Anti-CCP1 (25)2 (2.5)NS
  HLA-B272 (28.6)14 (9.5)NS
& N varies since data that was "missing"or "unknown"was excluded
** p<0.05, NS = not significant
Values are N (%) unless indicated
Chi square and Mann Whitney test as appropriate.
Cases with missing and unknown data were excluded.

Results:

The mean age of children with JIA-U was 10.8 years (±4.5), 80% were female and 3% were AA (Table 1). Compared to children without uveitis, they were more likely to be younger, female, require more medications, have less joint involvement, have oligoarticular disease, be ANA (+), and RF, anti-CCP and HLA-B27 (-). AA children with JIA-U were significantly different from W children and had decreased frequency of uveitis, were more likely to be male, and have oligoarticular or enthesitis related JIA (Table 2).

Conclusion:

With current therapy, the prevalence estimate of JIA-U in the CARRAnet registry is 11% which consists of the largest database of children with JIA to date. Consistent with the AAP guidelines for uveitis screening, known risk markers such as the ANA, age at arthritis onset, and oligo persistent subtype were more frequent in our JIA-U cohort. However, gender and race may also be important. In concurrence with the literature, this cohort of JIA-U consisted of 3% AA who had a lower frequency of JIA-U compared to W children. There were significant differences in gender, and JIA subtype, although the status of ANA, RF and HLA-B27 were similar. This suggests that risk factors associated with uveitis may differ depending on race and implies that a change in the screening schedule may be appropriate, but needs further investigation.

To cite this abstract, please use the following information:
Angeles-Han, Sheila, Pelajo, Christina, Vogler, Larry B., Kennedy,  Christine W., Ponder, Lori, Leong, Traci, et al; Race and Other Risk Markers in Juvenile Idiopathic Arthritis-Associated Uveitis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :271
DOI:

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