Yakovlev AA, Gaidar EV, Sorokina LS, Nikitina TN, Chikova IA, Kalashnikova OV, Kostik MM. Features of patients with uveitis associated with juvenile idiopathic arthritis required eye surgery. World J Clin Pediatr 2025; 14(4): 107290 [DOI: 10.5409/wjcp.v14.i4.107290]
Corresponding Author of This Article
Mikhail Mikhailovich Kostik, MD, PhD, Professor, Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint Petersburg 194100, Russia. kost-mikhail@yandex.ru
Research Domain of This Article
Rheumatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Alexandr Alexandrovich Yakovlev, Ekaterina Vladimirovna Gaidar, Lyubov Sergeevna Sorokina, Irina Alexandrovna Chikova, Olga Valerievna Kalashnikova, Mikhail Mikhailovich Kostik, Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Tatiana Nikolaevna Nikitina, Department of Ophthalmology, Saint-Petersburg State Pediatric Medical University, Saint Petersburg 194100, Russia
Author contributions: Yakovlev AA and Kostik MM contributed to conceptualization, writing, reviewing, and editing; Yakovlev AA contributed to formal analysis; Gaidar EV and Kostik MM contributed to methodology; Gaidar EV, Sorokina LS, Nikitina TN, and Chikova IA contributed to investigation and visualization; Nikitina TN contributed to validation; Kalashnikova OV contributed to software, resources, and data curation; Kostik MM contributed to supervision and project administration; All authors read and agreed to the published version of the manuscript.
Institutional review board statement: The protocol of the study was approved by the Ethical Committee of Saint-Petersburg State Pediatric Medical University, No. 3114.
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mikhail Mikhailovich Kostik, MD, PhD, Professor, Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint Petersburg 194100, Russia. kost-mikhail@yandex.ru
Received: March 25, 2025 Revised: April 27, 2025 Accepted: July 7, 2025 Published online: December 9, 2025 Processing time: 220 Days and 17.6 Hours
Abstract
BACKGROUND
Uveitis associated with juvenile idiopathic arthritis (U-JIA) is a vision-threatening condition. Estimates of prevalence of uveitis in patients with known juvenile idiopathic arthritis range from 11.6% to 30.0%. First-line treatment includes topical glucocorticoids; methotrexate (MTX) is used if topical corticosteroids are ineffective. In severe cases biological therapy like adalimumab may be prescribed. Complications, including vision loss, may be related to the disease and the ongoing treatment (topical corticosteroids). In severe cases surgical intervention is often necessary and is typically associated with poor vision outcomes.
AIM
To highlight the characteristics of operated U-JIA and to identify predictors of treatment failure.
METHODS
A retrospective cohort study analyzed data from 68 pediatric patients (under 18 years old) with U-JIA between 2007 and 2023. The study focused on demographic, clinical, treatment, and outcome variables. Survival analysis using Kaplan-Meier curves and the Cox proportional hazards model was performed to estimate the impact of surgical intervention on the course of uveitis and to identify predictors of treatment failure.
RESULTS
Eye surgery was performed on 17 (25%) patients with U-JIA. It was associated with an earlier onset of uveitis (P = 0.017), lower uveitis remission rate [odds ratio = 5.29, 95% confidence interval (CI): 1.23-24.90, P = 0.015], longer time to remission (P = 0.036), reduced probability of achieving remission on MTX (P = 0.033), and the necessity of the following treatment with biological disease-modifying antirheumatic drugs (odds ratio = 5.60; 95%CI: 1.11-55.19, P = 0.021) with similar efficacy with biological treatments in operated and non-operated cases. Kaplan-Meier curves showed a borderline difference in time to surgical intervention based on the MTX initiation cutoff (P = 0.065) although earlier MTX initiation might be associated with a higher likelihood of deferred surgery.
CONCLUSION
Operated patients exhibited an aggressive early-onset uveitis profile that needed early and more intensive treatment. Delayed and failed MTX treatment as well as delayed switching to biologics often required subsequent eye surgery.
Core Tip: Uveitis, a vision-threatening condition associated with juvenile idiopathic arthritis, requires rapid control of intraocular inflammation. There is limited information in the literature regarding patients with juvenile idiopathic arthritis-associated uveitis who have undergone surgical treatment, making our study a unique contribution. According to the obtained data, patients who have undergone surgical treatment for uveitis or its complications require more aggressive therapy, including the use of biological disease-modifying antirheumatic drugs. Additionally, it is important to consider that early methotrexate administration in this patient group may be associated with a decreased probability of surgical intervention.
