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Research article
Paediatric Non-Infectious Uveitis in Cape Town, South Africa: A Retrospective Review of Disease Characteristics and Outcomes on Immunomodulating Treatment
Christiaan Scott
University of Cape Town
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3874-1704
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Background Non-infectious uveitis is a well-reported cause of blindness in more developed countries, however data from sub-Saharan Africa is lacking. Here we aim to describe the diseases associated with non-infectious uveitis and the impact of currently available treatment in this setting.
Methods A retrospective observational analysis of children with non-infectious uveitis from January 2010 to December 2017, attending the tertiary paediatric rheumatology and ophthalmology referral units in Cape Town was conducted. Statistical analysis utilising STATA13 software was performed with p < 0.05 considered significant.
Results Twenty-nine children were identified: median age at first visit of 74 months (IQR 49–86 months), female to male ratio of 0.9:1, predominantly of mixed race (72.4%).
Juvenile idiopathic arthritis associated uveitis (JIAU) (48.3%) was the most frequent diagnosis. All children with JIAU had chronic anterior uveitis and 3 (21.4%) presented with uveitis before arthritis. There were no differences between children with uveitis and those with arthritis only, for gender (p = 0.68) and race (p = 0.58) but significantly, children with uveitis presented at an overall younger age (p = 0.008), with antinuclear antibody positive (p < 0.001) oligo-articular JIA (p = 0.01). Older age appeared to be protective (p = 0.01 OR1.0 CI 0.6-1.7).
Children with idiopathic uveitis (41.4%) were predominantly male (66.6%), of mixed race (75%), with chronic anterior uveitis (41.7%) and presented with cataracts (100%). Less commonly, sarcoidosis (6.9%) and Behcet’s disease (3.5%) were diagnosed.
55.2% had complications at presentation, predominantly cataracts (87.5%). 19 children (65.5%) had inactive disease at 12 months from diagnosis. Remission, as assessed at the last clinical visit was achieved in 58.6% on standard initial therapy and in 75% of those on tumour necrosis factor inhibitors. Surgery was needed in 41.4%, primarily in the idiopathic group. Visual acuity improved or was maintained on treatment.
Conclusion The spectrum and characteristics of immune-mediated non-infectious uveitis are comparable to that reported in more developed countries. Current practice detects children with potentially sight-threatening disease and access to tumour necrosis factor inhibitors has improved outcomes in refractory cases.
Keywords
Non-infectious uveitis, children juvenile, idiopathic arthritis, sub-Saharan Africa
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CURRENT STATUS: Under Review
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On 13 Nov, 2020
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Received 14 Oct, 2020
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Reviewer #6 agreed
On 13 Oct, 2020
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On 10 Oct, 2020
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Reviewer #4 agreed
On 08 Oct, 2020
Reviewer #3 agreed
On 05 Oct, 2020
Review #1 received
Received 01 Oct, 2020
Reviewer #2 agreed
On 27 Sep, 2020
Reviewer #1 agreed
On 25 Sep, 2020
Reviewers invited
Invitations sent on 22 Sep, 2020
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This preprint is under consideration at Pediatric Rheumatology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Paediatric Non-Infectious Uveitis in Cape Town, South Africa: A Retrospective Review of Disease Characteristics and Outcomes on Immunomodulating Treatment
Christiaan Scott
University of Cape Town
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3874-1704
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 24 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 13 Nov, 2020
Review #6 received
Received 17 Oct, 2020
Review #5 received
Received 17 Oct, 2020
Reviewer #7 agreed
On 14 Oct, 2020
Review #4 received
Received 14 Oct, 2020
Review #3 received
Received 14 Oct, 2020
Reviewer #6 agreed
On 13 Oct, 2020
Reviewer #5 agreed
On 10 Oct, 2020
Review #2 received
Received 10 Oct, 2020
Reviewer #4 agreed
On 08 Oct, 2020
Reviewer #3 agreed
On 05 Oct, 2020
Review #1 received
Received 01 Oct, 2020
Reviewer #2 agreed
On 27 Sep, 2020
Reviewer #1 agreed
On 25 Sep, 2020
Reviewers invited
Invitations sent on 22 Sep, 2020
First submitted
On 21 Sep, 2020
Editor assigned
On 21 Sep, 2020
Submission checks complete
On 20 Sep, 2020
Editor invited
On 20 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Non-infectious uveitis is a well-reported cause of blindness in more developed countries, however data from sub-Saharan Africa is lacking. Here we aim to describe the diseases associated with non-infectious uveitis and the impact of currently available treatment in this setting.
Methods A retrospective observational analysis of children with non-infectious uveitis from January 2010 to December 2017, attending the tertiary paediatric rheumatology and ophthalmology referral units in Cape Town was conducted. Statistical analysis utilising STATA13 software was performed with p < 0.05 considered significant.
Results Twenty-nine children were identified: median age at first visit of 74 months (IQR 49–86 months), female to male ratio of 0.9:1, predominantly of mixed race (72.4%).
Juvenile idiopathic arthritis associated uveitis (JIAU) (48.3%) was the most frequent diagnosis. All children with JIAU had chronic anterior uveitis and 3 (21.4%) presented with uveitis before arthritis. There were no differences between children with uveitis and those with arthritis only, for gender (p = 0.68) and race (p = 0.58) but significantly, children with uveitis presented at an overall younger age (p = 0.008), with antinuclear antibody positive (p < 0.001) oligo-articular JIA (p = 0.01). Older age appeared to be protective (p = 0.01 OR1.0 CI 0.6-1.7).
Children with idiopathic uveitis (41.4%) were predominantly male (66.6%), of mixed race (75%), with chronic anterior uveitis (41.7%) and presented with cataracts (100%). Less commonly, sarcoidosis (6.9%) and Behcet’s disease (3.5%) were diagnosed.
55.2% had complications at presentation, predominantly cataracts (87.5%). 19 children (65.5%) had inactive disease at 12 months from diagnosis. Remission, as assessed at the last clinical visit was achieved in 58.6% on standard initial therapy and in 75% of those on tumour necrosis factor inhibitors. Surgery was needed in 41.4%, primarily in the idiopathic group. Visual acuity improved or was maintained on treatment.
Conclusion The spectrum and characteristics of immune-mediated non-infectious uveitis are comparable to that reported in more developed countries. Current practice detects children with potentially sight-threatening disease and access to tumour necrosis factor inhibitors has improved outcomes in refractory cases.
Figure 1
Due to technical limitations, full-text HTML conversion of this manuscript could not be completed. However, the manuscript can be downloaded and accessed as a PDF.
Due to technical limitations, tables 1-4 docx are only available as a download in the Supplemental Files section.