Unit 7 - Paediatric Uveitis Flashcards

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1
Q

Why is paeds uveitis different?

A

Develops rapidly
Irreversible vision loss
Few studies on treatment etc
Don’t know why they get it and if they’ll grow out of it
Don’t know if there is a risk to siblings or not

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2
Q

What percentage of uveitis is paeds?

A

2-6%

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3
Q

Who are most at risk from JIAU?

A

Girls
ANA+

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4
Q

What sort of uveitis is most prevalent in JIAU?

A

Chronic, anterior, non-granulomatous uveitis

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5
Q

When is there a worse prognosis with JIAU?

A

Boys (more severely affected but rarer)
Younger age of onst
Non-white
Duration of disease before treatment
Complications at onset

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6
Q

When do you need to investigate systemically in paed uveitis?

A

Same as adults anything other than a single, unilateral acute case of AAU

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7
Q

What investigations should be carried out in paeds uveitis - ocular tests?

A

OCT
Widefield photography
Ultrasound if no view of fundus possible
FFA or ICG if any hit of posterior involvement
Electrodiagnositcs if unexplained vision loss or as baseline

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8
Q

What blood tests need to be carried out in paeds uveitis?

A
  1. FBC
  2. U&E
  3. Ferritin
  4. ANA (antinuclea antibody - is it autoimmune)
  5. ESR/CRP
  6. Serum ACE (angiotensin converting enzyme - sarcoid)
    7.HIV
    8.Syphilis
    9IGRA (TB)
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9
Q

What two main types of Non-JIAU are there?

A

Infectious and non-infectious

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10
Q

What are some of the cause of non-infectous Non-JIAU?

A
  1. TINU
  2. Chronic anterior uveitis
  3. Intermediate uveitis/pars planitis
  4. Masquerade (ALL, retinoblastoma, xanthogranuloma,
  5. Familial juvenile systemic granulomatosis
  6. Sarcoid
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11
Q

What is the most common infectious cause of non-JIAU?

A

TB (bacterial)

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12
Q

What is the most common protozoa infection in non-JIAU and what type of uveitis do they get?

A

Toxoplasmosis - posterior lesions

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13
Q

What type of uveitis would you get in paeds TB?

A

Granuloma in choroid
Serpiginious like chorioretinopaathy

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14
Q

What is the most common parasicitc cause of non-JIAU?

A

Toxocara

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15
Q

How often is JIA screening performed?

A

Within 6 weeks of referral,
2 monthly for first 6 months
3-4 monthly until about age 12

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16
Q

What are the symptoms/signs of paeds intermediate uveitis?

A

Floaters
Slightly reduced vision
Snowbanking/snowballs
Some A/C cells
Bulk of inflammation in vitreous

17
Q

Are kids or adults more likely to get posterior uveitis?

A

Kids

18
Q

How is sarcoid in kids different to adults?

A

Skin lesions and arthritis,
Less pulmonary involvement
AAU more common
Panuveitis, retinal vasculitis and optic nerve involvment

19
Q

What is the treatment cascade in kids?

A

Topical and/or oral steroids
Antimetabolites e.g. methotrexate, mycophenolate
Biological e.g. Adalimumab (Humira), Infliximab, Tocilizumab

20
Q

Which trial looked at adalimumab and methotrexate versus methotrexate alone?

A

Sycamore, dual therapy was more effective

21
Q

What is oligoarticular JIA?

A

Less than 5 joints affected

22
Q

In a patient with oligoarticular JIA how long should screening continue?

A

<3 - 8 years
3-4; 6 years
5-8; 3 years
9-10; 1 years

23
Q

Polyarticular ANA+ JIA, what is the screening protocol?

A

<6 years - 5 years
6-9 years - 2 years

24
Q

In Polyarticular ANA- JIA what is the screening protocol

A

Less than 7 all need 5 years of screening