Paediatric Non-Infectious Uveitis in Cape Town, South Africa: A Retrospective Review of Disease Characteristics and Outcomes on Immunomodulating Treatment
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
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Posted 24 Sep, 2020
On 13 Nov, 2020
Received 17 Oct, 2020
Received 17 Oct, 2020
On 14 Oct, 2020
Received 14 Oct, 2020
Received 14 Oct, 2020
On 13 Oct, 2020
On 10 Oct, 2020
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On 08 Oct, 2020
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On 27 Sep, 2020
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Invitations sent on 22 Sep, 2020
On 21 Sep, 2020
On 21 Sep, 2020
On 20 Sep, 2020
On 20 Sep, 2020
Paediatric Non-Infectious Uveitis in Cape Town, South Africa: A Retrospective Review of Disease Characteristics and Outcomes on Immunomodulating Treatment
Posted 24 Sep, 2020
On 13 Nov, 2020
Received 17 Oct, 2020
Received 17 Oct, 2020
On 14 Oct, 2020
Received 14 Oct, 2020
Received 14 Oct, 2020
On 13 Oct, 2020
On 10 Oct, 2020
Received 10 Oct, 2020
On 08 Oct, 2020
On 05 Oct, 2020
Received 01 Oct, 2020
On 27 Sep, 2020
On 25 Sep, 2020
Invitations sent on 22 Sep, 2020
On 21 Sep, 2020
On 21 Sep, 2020
On 20 Sep, 2020
On 20 Sep, 2020
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.