What is the link between optic neuritis and Juvenile Idiopathic Arthritis (JIA)?

From the Guidelines

Optic neuritis is not typically associated with Juvenile Idiopathic Arthritis (JIA), and the primary ocular complication linked to JIA is uveitis, particularly anterior uveitis. The relationship between optic neuritis and JIA is not well-established, and optic neuritis is more commonly associated with other conditions such as multiple sclerosis, neuromyelitis optica, or other demyelinating disorders 1.

Key Points

• Uveitis, especially anterior uveitis, is a common extra-articular manifestation of JIA, affecting approximately 10-20% of children with JIA 1.
• Children with JIA, particularly those with oligoarticular JIA, positive antinuclear antibodies (ANA), and younger age at onset, require regular ophthalmologic screening for uveitis 1.
• If a child with JIA develops visual symptoms such as eye pain, redness, light sensitivity, or vision changes, immediate ophthalmologic evaluation is necessary 1.
• Optic neuritis, when present in children, is more commonly associated with separate concurrent autoimmune conditions or other underlying pathology rather than JIA 1.

Treatment and Screening

• Regular ophthalmology screening of children with JIA is recommended because of the risk of uveitis and frequency of screening should be based on individual risk factors 1.
• Initial treatment of children with JIA-associated uveitis typically includes topical glucocorticoids, followed by methotrexate and tumor necrosis factor inhibitor (TNFi) biologics if necessary 1.
• The American College of Rheumatology (ACR) and the Arthritis Foundation (AF) recommend regular ophthalmologic screening and timely treatment to improve visual outcomes and prevent complications in children with JIA-associated uveitis 1.

From the Research

Optic Neuritis and JIA Link

• Optic neuritis (ON) is a rare condition in patients with juvenile idiopathic arthritis (JIA) 2.
• A study found a low prevalence of ON in JIA patients, with only one patient (0.15%) out of 630 JIA patients developing ON 2.
• The patient who developed ON was a 6-year-old male with extended oligoarticular JIA, who was treated with naproxen, methotrexate, and leflunomide before developing ON 2.
• The development of ON in JIA patients may be associated with demyelinating disease, even in the absence of anti-aquaporin 4 (anti-AQP4) antibody and normal brain MRI 2.
• Treatment of JIA with disease-modifying antirheumatic drugs (DMARDs) may improve outcomes and reduce the risk of complications such as ON 3.
• However, the exact link between JIA and ON is not well understood and requires further study 2, 3, 4, 5, 6.

JIA Treatment and Complications

• JIA is a heterogeneous group of disorders characterized by childhood-onset chronic joint inflammation 4.
• Early recognition and treatment of JIA are vital to prevent sequelae of uncontrolled inflammation on the developing skeleton 4.
• JIA can have significant complications, including uveitis, macrophage activation syndrome, and infectious diseases 4, 6.
• Treatment strategies for JIA have changed significantly in recent years, with the availability of multiple newer targeted therapies 5.
• The use of biologic agents and targeted synthetic disease-modifying agents has improved symptom control and reduced complications in patients with JIA 5.