Core Messages

• Uveitis is a serious extra-articular manifestation of juvenile chronic arthritis (JCA).

It is a particular challenge because of its indigenous onset, high complication rate and risk of being a potentially blinding disorder at a young age

• Screening of children with JCA for uveitis and identifying confounding factors that correlate with intraocular inflammation remains an important task for the reduction of the risk of severe ocular damage

• Whereas gender (girls) and type of arthritis (oligoarthritis) have been previously suggested as risk factors for uveitis, recent prospective studies could not confirm this and indicate the need for refinements in screening efforts

• Genetic factors that play a role in the susceptibility for uveitis in JCA include: HLA-DR5, HLA-DP 2.1 and HLA-B*27,where-as HLA-DR 1 and HLA-DR 4 are negatively associated with intraocular inflammation

• A variety of autoantigens including antinuclear antibodies, anti-histone 3, collagen type II and heat shock protein 60 (hsp60) have been suggested to play a role in JCA-associated uveitis, but still need to be confirmed in independent studies

• Conditions that are often predictive of poor outcome due to uveitis include: gender (boys), early onset of arthritis and short time interval between onset of arthritis and uveitis and the severity of intraocular inflammation at the first presentation

• The role of cytokines in JCA is an active field of interest.TNF-a, INF-g and their receptors are significantly elevated in synovial tissue of children with JCA. New treatment options directed against these cytokines have been successfully introduced for arthritis; however, their value for uveitis is not yet clear

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