Unit 7 - Paediatric Uveitis

Question 1

Why is paeds uveitis different?

Answer 1

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

Question 2

What percentage of uveitis is paeds?

Answer 2

2-6%

Question 3

Who are most at risk from JIAU?

Answer 3

Girls
ANA+

Question 4

What sort of uveitis is most prevalent in JIAU?

Answer 4

Chronic, anterior, non-granulomatous uveitis

Question 5

When is there a worse prognosis with JIAU?

Answer 5

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

Question 6

When do you need to investigate systemically in paed uveitis?

Answer 6

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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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)

Question 9

What two main types of Non-JIAU are there?

Answer 9

Infectious and non-infectious

Question 10

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

Answer 10

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

Question 11

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

Answer 11

TB (bacterial)

Question 12

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

Answer 12

Toxoplasmosis - posterior lesions

Question 13

What type of uveitis would you get in paeds TB?

Answer 13

Granuloma in choroid
Serpiginious like chorioretinopaathy

Question 14

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

Answer 14

Toxocara

Question 15

How often is JIA screening performed?

Answer 15

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

Question 16

What are the symptoms/signs of paeds intermediate uveitis?

Answer 16

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

Question 17

Are kids or adults more likely to get posterior uveitis?

Answer 17

Kids

Question 18

How is sarcoid in kids different to adults?

Answer 18

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

Question 19

What is the treatment cascade in kids?

Answer 19

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

Question 20

Which trial looked at adalimumab and methotrexate versus methotrexate alone?

Answer 20

Sycamore, dual therapy was more effective

Question 21

What is oligoarticular JIA?

Answer 21

Less than 5 joints affected

Question 22

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

Answer 22

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

Question 23

Polyarticular ANA+ JIA, what is the screening protocol?

Answer 23

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

Question 24

In Polyarticular ANA- JIA what is the screening protocol

Answer 24

Less than 7 all need 5 years of screening