Arthritis Rheumatoid Arthritis What Is Juvenile Idiopathic Arthritis-Associated Uveitis? How JIA Can Affect Your Child's Eyes By Troy Bedinghaus, OD Troy Bedinghaus, OD LinkedIn Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association. Learn about our editorial process Updated on February 28, 2022 Medically reviewed by Riteesha G. Reddy, MD Medically reviewed by Riteesha G. Reddy, MD Riteesha G. Reddy, MD, is a board-certified rheumatologist and internist at a private practice in Dallas, Texas. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Prognosis Uveitis is the most common extra-articular (occurring outside of the joints) complication of juvenile idiopathic arthritis (JIA). Characterized by inflammation of the inner eye, uveitis can cause serious optical complications. If untreated, a child's vision could be affected. In extreme cases, uveitis may cause loss of vision or even blindness. Natalie Faye/Image Source/Getty Images A focus on joint health in children with JIA is critical, but it's also important that you are aware of all of the ways arthritis can affect your child's body—especially their eyes. While an immediate referral for an eye exam is a typical next step after a juvenile idiopathic arthritis diagnosis is made, and symptoms are not always noticeable at first, you should be aware of the possibilities and how JIA-associated uveitis (a.k.a. JIA-U, iridocyclitis) can progress over time. Juvenile idiopathic arthritis is an autoimmune disorder in children up to age 16 that causes inflammation and stiffness in the joints, but can also affect other parts of the body. Types of Uveitis JIA-U can be a chronic or acute disease: Chronic anterior uveitis (CAU) is the most common form of JIA-associated uveitis. Roughly 10% to 20% of children with JIA develop this condition. Acute anterior uveitis (AAU) occurs in children with spondyloarthritis, including psoriatic arthritis. AAU comes and goes and will present suddenly with symptoms. It generally does not require systemic treatment. The Symptoms and Treatment of Juvenile Idiopathic Arthritis Uveitis Symptoms The condition can affect one or both eyes, but three out of four uveitis patients develop inflammation in both eyes. While JIA patients can experience obvious joint pain and swelling, chronic uveitis eye symptoms may not appear early on or may be mild enough that no eye problems seem evident. But as the condition progresses, children may have severe enough eye inflammation to develop the following symptoms: Sensitivity to bright light, both indoors and outdoorsAching or pain in the eyesBlurred visionMore tear production than normal, which can lead to red or swollen eyes Chronic uveitis related to JIA can also create an inflammatory environment in the eye that can scar tissues and cause significant eye diseases, such as: Glaucoma Cataracts Band keratopathy (calcification of the cornea) Macular edema (fluid in the retina) Blindness Uveitis symptoms develop slowly, sometimes over several years, and permanent eye damage can occur before vision complications are evident. Causes JIA-associated uveitis is caused by JIA itself, with the autoimmune disorder producing systemic inflammation that progresses and damages the eyes. In some cases, medications to treat uveitis can also cause vision complications. In particular, corticosteroids—while an effective front-line treatment—may contribute to the formation of cataracts. Uveitis is more common in girls (up to 80% of cases), probably because JIA itself affects girls and boys at a roughly 3:2 ratio. While the pathogenesis of JIA-U is not fully understood, some research has shown JIA patients having increased numbers of antibodies against the iris and retina, possibly explaining the autoimmune response attacking the eyes. The Link Between Arthritis and Eye Problems Diagnosis Once a JIA diagnosis is initially confirmed, the child should immediately see a pediatric ophthalmologist for a thorough eye exam to check for inflammation. Early detection of JIA-U is critical. Generally, an ophthalmologist will use a special microscope called a slit lamp to shine a thin beam of light into an eye to examine the interior. The presence of inflammation generally indicates JIA-U. Onset No signs of eye inflammation soon after receiving a JIA diagnosis does not mean that uveitis is not a possibility. While uveitis can occur concurrently with JIA, that is not always the case. JIA-U can occur up to a year before JIA is diagnosed or even many years after diagnosis. In about half of uveitis patients, the condition manifests within five months of JIA symptoms setting in. About three-quarters of uveitis diagnoses happen within one year of JIA symptoms setting in. Most cases come from early-onset JIA, usually between ages 4 and 6. What to Expect From an Eye Exam Treatment Initial treatment of children with JIA-associated uveitis typically includes topical corticosteroids (eye drops) to help reduce inflammation. Medications commonly used for JIA can also be used for uveitis: Methotrexate is the usual first-line systemic immunosuppressive drug. Tumor necrosis factor inhibitor (TNFi) biologics may also be used, particularly the monoclonal antibodies infliximab and adalimumab. JIA Treatment Options Prognosis If JIA-U is detected early and treated promptly, most children will have a good prognosis. In one study of JIA-U patients treated with a variety of methotrexate, adalimumab, and topical corticosteroids, 82% of patients achieved inactive uveitis after one year, and 80% after two years. Almost 60% of patients achieved an inactivity period greater than six months. Along with treatment, it is vital to schedule regular, ongoing eye examinations with a pediatric ophthalmologist. When determining an appropriate examination schedule, your healthcare provider will consider the type of arthritis, the age of the child at the onset of JIA, the duration of symptoms of JIA, any potential uveitis symptoms, and the amount of eye inflammation. A Word From Verywell While there's no guarantee that any child with juvenile idiopathic arthritis will develop uveitis, it's important for the healthcare provider diagnosing JIA to refer the child to a pediatric ophthalmologist for ongoing monitoring. Early detection and treatment of uveitis is worth stressing again, as it offers the child the best chance for normal vision throughout life. A Caregiver's Guide to Coping With Vision Loss 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Angeles-han ST, Ringold S, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken). 2019; doi:10.1002/acr.23871 Clarke, S.L.N., Sen, E.S. & Ramanan, A.V. Juvenile idiopathic arthritis-associated uveitis. Pediatr Rheumatol 14, 27 (2016). doi:10.1186/s12969-016-0088-2 Heiligenhaus A, Minden K, Föll D, Pleyer U. Uveitis in juvenile idiopathic arthritis. Dtsch Arztebl Int. 2015;112(6):92–i. doi:10.3238/arztebl.2015.0092 Cleveland Clinic. Juvenile idiopathic arthritis and the eyes. The Ocular Immunology Ureitis Foundation. Juvenile Idiopathic Arthritis and Uveitis: What is it and what is its effect on the eye? Arnd Heiligenhaus, Jens Klotsche, Christoph Tappeiner, Claudia Sengler, Martina Niewerth, Ina Liedmann, Sabine Hoeft, Karoline Walscheid, Miha Lavric, Dirk Foell, Kirsten Minden, Predictive factors and biomarkers for the 2-year outcome of uveitis in juvenile idiopathic arthritis: data from the Inception Cohort of Newly diagnosed patients with Juvenile Idiopathic Arthritis (ICON-JIA) study, Rheumatology, Volume 58, Issue 6, June 2019, Pages 975–986, doi:10.1093/rheumatology/key406 By Troy Bedinghaus, OD Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit