Medication Use May Predict Uveitis Risk in Juvenile Idiopathic Arthritis

Uveitis may be more likely to develop alongside juvenile idiopathic arthritis (JIA) when patients are treated with etanercept (ETA) or methotrexate (MTX), or in those not treated with disease-modifying anti-rheumatic drugs (DMARDs), according to a study published in the American Journal of Ophthalmology. 

Researchers examined charts of 184 patients diagnosed with JIA and followed them for at least 18 months at a pediatric hospital in Chicago between April 2014 and April 2022. Participants were grouped by 5 treatment types: 76 with no DMARDs, 36 prescribed adalimumab (ADA), 23 taking ETA, 25 MTX, and 24 receiving “other biologics” which included abatacept, anakinra, canakinumab, infliximab, tocilizumab, and tofacitinib. The study’s risk-stratification was developed from metrics on patient characteristics and medication usage. 

Of the total, 21 new cases of uveitis occurred; 11 in the no DMARD cohort, 5 taking MTX, and 5 prescribed ETA — with no significant difference between the 3 groups. Notably, there were no uveitis diagnoses in the ADA or “other biologics” sets. In the empiric risk-stratification, use of the later 2 drug groups comprised lower risk to develop uveitis (Fisher’s P =.0003). Two patient characteristics revealed higher risk; younger age at JIA diagnosis (t-test P =.0045), and shorter disease duration (t-test P =.0005). 

Researchers compared their empiric risk-stratification to the American College of Rheumatology’s (ACR) high and low risk criteria — benchmarks that use International League of Associations for Rheumatology (ILAR)-defined subtype of arthritis, antinuclear antibody status, age at JIA diagnosis, and disease duration, although not medications. With ACR guidelines, the resulting uveitis incidence ratio between high- and low-risk groups was 1.90 (0.72 to 4.93, P =.15), but for the novel empiric system it was 8.21 (2.68 to 33.55, P <.0001). 

“In our study, patients on no DMARD treatment or MTX were significantly more likely to have oligoarthritis than the other cohorts. As noted previously, MTX and several biologics have been associated with decreased uveitis incidence,” according to the researchers. “This suggests that the apparent increased risk of uveitis in oligoarthritis in some studies may reflect decreased use of uveitis-preventing medications rather than inherent differences in risk profile.”

Limiting this investigation was a small number of individuals representing specific regimens in the “other biologics” group, as well as a study design drawing on the same database for both developing and testing the empirical criteria.