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Uveitis and joint disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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About 20% of children with the pauciarticular form of juvenile rheumatoid arthritis develop a chronic bilateral nongranulomatous uveitis. Females are affected about four times more frequently than males.

The onset is insiduous. The average age of detection is about 5 years when the child is noted to have a difference in size or shape of the pupil, a difference in colour between the two eyes, or strabismus. There is no correlation between the onset of the arthritis and that of the uveitis. The knee is most commonly affected. Evidence of the uveitis is shown as aqueous flare, white keratitic precipitates and posterior synechiae.

Corticosteroids and mydriatics are of value only in treating the acute exacerbations. The long-term prognosis is poor.

There is no association between adult rheumatoid arthritis and anterior uveitis.

About 10-60% of patients with ankylosing spondylitis develop nongranulomatous anterior uveitis. Males are most often affected. Presentation is with ciliary injection, pain, photophobia and blurred vision. About 90% of patients with ankylosing spondylitis are HLA-B27 positive. Anterior and posterior synechiae, cataracts and glaucoma are common complications.

The diagnosis is confirmed by X-ray of the lumbosacral spine.

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