CHRONIC UVEITIS is a serious complication of juvenile rheumatoid arthritis
(JRA). Approximately 6% of all cases of uveitis occur in children,1 and up to 80% of all cases of anterior uveitis in
childhood are associated with JRA.2 Although
remarkable progress has been made in the care of patients with JRA-associated
uveitis since the development of corticosteroids for systemic and ophthalmic
use in the 1950s, up to 12% of children with uveitis associated with pauciarticular
JRA still develop permanent blindness as a result of low-grade chronic intraocular
inflammation.3 Ironically, these children are
often under careful observation by ophthalmologists who may opt to tolerate
low-grade ocular inflammation, hoping to avoid the development of corticosteroid-induced
ocular adverse effects such as cataracts and glaucoma.4
The vision-robbing consequences of low-grade uveitis occur extremely slowly,
typically over a period of 4 to 8 years, and the end result is clear: even
low-grade uveitis may lead eventually to ocular damage, including band keratopathy,
maculopathy (macular edema, macular cysts, epiretinal membrane), glaucomatous
optic neuropathy, and cataract formation from chronic inflammation and corticosteroid
surgical treatment of cataract and glaucoma is remarkably successful in the
general population, it is consistently less so in patients with JRA-associated
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