CLINICAL PRACTICE

OPHTHALMOLOGICAL SCREENING IN SERONEGATIVE JUVENILE CHRONIC ARTHRITIS: A PERSONAL VIEW BY ALISON M. LEAK Royal Sea Bathing Hospital, Canterbury Road, Margate, Kent CT9 5BQ

uveitis has been recognized as a complication of juvenile chronic arthritis (JCA) for many years [1]. However both diseases are uncommon and therefore experience of their management in a District Hospital is limited. While the Canadian Red Cross Memorial Hospital at Taplow served as a National Referral Centre for paediatric rheumatic diseases under the care of Professor Eric Bywaters and Dr Barbara Ansell, their consultant colleagues in ophthalmology, initially Mr W. K. Smiley and latterly Mr J. J. Kanski, treated a large number of children with chronic uveitis in association with JCA [2]. Details from 315 such patients were recently published [3]. Other series from North America have far fewer patients, for example 35 from Saskatchewan [4], 41 from San Francisco [5], 51 from Michigan [6]. I was privileged to study 100 of the children at Taplow for my MD thesis with respect to their chronic anterior uveitis and the associated anti-nuclear antibodies [7]. There is considerable information on the clinical features of this chronic iridocyclitis [8, 9] and the high complication rate regarding visual morbidity [6,8]. Early features such as posterior synechiae and subsequent development of cataracts in 40% of cases, and glaucoma in 20% can cause significant loss of vision. More recently it has become very apparent that the earlier the diagnosis is made the better the visual outcome. Herein lies the problem. The typical patient is a girl aged 3 years with one or two swollen joints. She does not complain of a painful or red eye. The time to diagnosis of arthritis may have been several months since young children rarely complain of pain, and mild morning stiffness or swelling of a knee or ankle in a toddler are easily overlooked. When juvenile arthritis is confirmed by an experienced paediatrician or rheumatologist the child should be referred for immediate slit lamp biomicroscopy by an ophthalmologist. Anterior uveitis, with cells present in the anterior chamber of the eye, may already be present at this first eye examination. When posterior synechiae are also found at this time the likelihood of developing severe visual loss (e.g. acuity of

Ophthalmological screening in seronegative juvenile chronic arthritis: a personal view.

CLINICAL PRACTICE OPHTHALMOLOGICAL SCREENING IN SERONEGATIVE JUVENILE CHRONIC ARTHRITIS: A PERSONAL VIEW BY ALISON M. LEAK Royal Sea Bathing Hospital...
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