Laser flare photometry readings may identify uveitis associated with juvenile idiopathic arthritis

Juvenile Idiopathic Arthritis (JIA) Associated Uveitis (JIA-U) remains one of the most serious complications of Juvenile Idiopathic Arthritis in children. Historically, pediatric Juvenile Idiopathic Arthritis is diagnosed by an Optometrist or Ophthalmologist; however, barriers to scheduling increase wait times that may delay diagnosis and treatment. The purpose of this study was to evaluate laser flare photometry (LFP) use to diagnose Juvenile Idiopathic Arthritis-U in the Pediatric Rheumatology clinic for patients with Juvenile Idiopathic Arthritis. This prospective, observational study assessed pediatric patients diagnosed with Juvenile Idiopathic Arthritis without a previous history of uveitis between January 2020 and September 2022. All patients underwent at least one evaluation of both eyes using a Kowa FM-600 laser flare photometer during a routine Rheumatology appointment, as well as a standard slit lamp examination (SLE) by optometry or ophthalmology during routine clinical care. Data collected at patient visits included demographics, Juvenile Idiopathic Arthritis characteristics, treatment, laser flare photometry readings, and anterior chamber (AC) cell grade score utilizing the SUN grading system.

Data were summarized using descriptive analyses and the uveitis false positive rate was calculated. Results: The study cohort included 58 pediatric patients diagnosed with Juvenile Idiopathic Arthritis. The mean age was 8.4 years (1.2–16.3 years) at diagnosis and 11.9 (4.8–16.5 years) at enrollment. The mean duration of disease at time of enrollment was 42 months (range; 0-157 months). Participants were predominantly female (n = 43, 74.1%) and white/Caucasian race (n = 37, 63.8%). The most common Juvenile Idiopathic Arthritis subtypes included persistent oligoarticular JIA (n = 19, 32.8%), and RF negative polyarticular JIA (n = 12, 20.7%). There were 12 ANA positive patients (20.7%). At enrollment, 16 patients (27.6%) were not on medications, with 20 (34.5%) on methotrexate, 20 (34.5%) on adalimumab, 6 (10.3%) on tocilizumab, and 5 (8.6%) on etanercept. During the study period, no eye exams detected active uveitis based on SLE with a SUN grade over 0. However, of the 135 laser flare photometry readings, 131 (97.0%) were normal, yielding a false positive rate of 3%. laser flare photometry is a non-invasive tool that can be utilized in the pediatric rheumatology clinic to evaluate for Juvenile Idiopathic Arthritis-U. There is a low false positive rate of laser flare photometry when compared with standard slit lamp exam.

Reference:

Ede K, Shishov M, Wershba E, Goswami N, Gorry S, Joseph M, Mirea L, O'Neil J. Screening for juvenile idiopathic arthritis associated uveitis with laser flare photometry in the pediatric rheumatology office: a prospective observational study. Pediatr Rheumatol Online J. 2024 Jan 26;22(1):22. doi: 10.1186/s12969-024-00961-9. PMID: 38279120; PMCID: PMC10811873.

Keyword:

Laser, flare photometry, photometry readings, uveitis, juvenile idiopathic arthritis, Ede K, Shishov M, Wershba E, Goswami N, Gorry S, Joseph M, Mirea L, O'Neil J, Juvenile idiopathic arthritis asociated Uveitis, Laser flare photometry, Screening, Diagnosis