It's not Just Growing Pains: A Guide to Childhood Muscle, Bone, and Joint Pain, Rheumatic Diseases, and the Latest Treatments

By Thomas J. A. Lehman | Go to book overview

8
Uveitis

Eye Complications of Juvenile Arthritis
and Related Conditions

Virginia was a nine-year-old girl who had pauciarticular onset JA. Her
arthritis began when she was two years old but came under good
control with medication. She had a flare-up of arthritis in her knee at
six that was easily controlled. Because she was antinuclear antibody
(ANA)-positive, her family had her eyes checked every three months,
as recommended. There were never problems with her eyes. Shortly
after her eighth birthday, her parents separated and Virginia moved
out of state with her mother. Her father brought her in for a routine
check of her arthritis when she returned to visit him two years later.
Virginia said she was doing fine and had had no problems with her
arthritis. However, when I went to examine her I could not see into
her right eye. It was quickly apparent she could not see out of the eye.
When asked, she admitted she had slowly noted decreasing vision
with the right eye, but she had not said anything because she did not
want to upset her mother. Her mother had had too many other things
on her mind after the divorce and had not arranged for a new ophthal-
mologist to monitor Virginia. By the time I discovered the problem,
the vision in the right eye could not be saved.

It is important that the parents of children with JA and related conditions understand that the eyes may be involved even when there is no evidence of active joint disease. Ocular complications may take several forms. Children with pauciarticular onset, polyarticular onset, and psoriatic JA are all at risk of developing chronic anterior uveitis (silent painless eye inflammation). In this condition, inflammatory cells accumulate in the eye and the resultant irritation may cause damage to the iris (the colored part of the eye that forms the pupil), the lens, and other structures (see Fig. 16

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