Juvenile Rheumatoid Arthritis (JRA) and Your Child's Eyes

Juvenile rheumatoid arthritis (JRA) is the most common type of arthritis that can affect children. JRA is an autoimmune disorder that causes inflammation and stiffness in the joints. Children suffering from JRA usually experience episodes of pain and swelling, even after periods of rest or limitation of movement. Some children may also have frequent fevers and rashes.

Signs and symptoms of JRA sometimes become apparent in the eyes. In extreme cases, it may cause loss of vision or even blindness.

How JRA Can Affects Your Child's Eyes

Even though JRA mainly affects the joints of children, it can also cause eye inflammation. Low level eye inflammation is usually not painful, so most children with JRA-related eye problems may not have any noticeable symptoms. However, some children may be sensitive to light or have blurry vision. You may notice a redness or cloudiness in your child's eyes. Because eye symptoms usually develop slowly over time and without much notice, serious eye damage can occur before the inflammation is detected. Therefore, it is very important to have a pediatric ophthalmologist periodically examine your child's eyes and vision.

JRA and Uveitis

JRA can cause eye inflammation Inflammation. Eye inflammation associated with JRA is referred to as uveitis. The form of uveitis most often affecting kids with JRA is known as iritis or iridocyclitis. Iritis is an inflammation or swelling of the eye's uvea. The uvea is located in the center of the eye, between the sclera and the retina. When the uveal tissue becomes inflamed, the tissues in the eye become sticky and internal adhesions may occur. Also, visible inflammatory cells, such as white blood cells, begin to appear in the fluid inside the eye.

Children who develop uveitis related to JRA may have severe enough eye inflammation to cause the patient to complain of the following symptoms:

• Light sensitivity: Your child may be extremely sensitive to bright light, both indoors and outdoors.
• Eye pain: Your child may complain of aching or pain in the eyes.
• Blurred vision: Blurry vision is sometimes a complaint of children. More often, a parent detects symptoms of blurred vision such as squinting.
• Excessive tearing: Your child's eyes may produce more tears than normal, which can lead to red or swollen eyes.

Uveitis related to JRA can also create an environment in the eye that puts your child at risk for developing significant eye disease, such as the following:

• Glaucoma
• Cataract
• Band Keratopathy

Treating JRA-Related Uveitis

Treatment for JRA-related uveitis will be started as soon as the disease is detected, to prevent possible vision loss. Uveitis in children with JRA is initially treated with corticosteroid and cycloplegic eye drops. In most cases, children respond very well. In other cases, steroids must be used for an extended duration. Long-term steroid use puts children at even greater risk for developing steroid-induced glaucoma and cataracts. In complex cases, children may take other medications such as methotrexate or cyclosporine.

Pauciarticular JRA

Pauciarticular JRA is a type of JRA that some children develop, usually among young girls. Pauciarticular JRA can cause a very dangerous level of inflammation in the eyes, referred to as iridocyclitis. The inflammation can sometimes cause scarring of the lens and often results in permanent vision loss if not detected early. Fortunately, iridocyclitis can be detected by an optometrist or ophthalmologist with the use of a slit lamp.

What You Should Know

Uveitis in children with JRA is a leading cause of vision loss and blindness. However, if it is detected early and treated promptly, most children will have a good prognosis. It is therefore vital to schedule regular eye examinations with a pediatric ophthalmologist. When determining an appropriate examination schedule, your doctor will consider the type of arthritis, the age of the child at the onset of JRA, the duration of symptoms of JRA, the results of blood tests looking for anti-nuclear antibodies and the presence or absence of eye inflammation. Your child may require fewer eye examinations over time.

_Source:

_{Cassidy, James and Jane Kivlin, Carol Lindsley and James Nocton. Ophthalmologic Examinations in Children With Juvenile Rheumatoid Arthritis, Pediatrics 2006.}