Juvenile Idiopathic Arthritis Uveitis Workup

Updated: Jan 06, 2016
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Workup

Approach Considerations

The different subtypes of JIA have individual serologic characteristics. Specific laboratory studies may be helpful to gauge the risk for developing uveitis and to rule out other possible diagnoses. [8, 3, 7, 19]

Antinuclear antibody

The term ANA encompasses all the antibodies that can be demonstrated to react with nuclei in tissue sections by the classic indirect immunofluorescence test (IFA).

ANA-positivity is present in most children with oligoarticular onset JIA and uveitis; however, it is present in up to 80% of those without uveitis. For that reason, ANA negativity may be some help in predicting that a child will not develop uveitis, but their positivity does not assist in the prediction of the development of uveitis.

ANA-positivity in young girls with pauciarticular JIA presents the highest risk of developing uveitis.

Rheumatoid factor

RF classically is defined as an IgM antibody to the Fc portion of human immunoglobulin G (IgG) antibody; it often is present in serum in a complex with IgG antibody.

Many patients with JIA who develop uveitis are RF negative. A few adolescent girls who are RF positive have juvenile variant idiopathic arthritis, and they are not at significant risk for developing ocular disease.

Human leukocyte antigen B27

The only HLA antigen with a disease association strong enough to be useful in differential diagnosis is human leukocyte antigen B27 (HLA-B27).

A subgroup of older boys having pauciarticular arthritis with high risk for developing uveitis often is positive for HLA-B27 and negative for both RF and ANA.

A significant percentage of patients with JIA with spinal involvement are HLA-B27 positive.

HLA-B27 determination also is useful in ruling out seronegative spondyloarthropathies.

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Imaging Studies

Radiography of joints: Radiographic studies of affected joints typically reveal nondestructive but chronic articular changes.

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Other Tests

Additional serologic tests

After undergoing a complete history, a detailed review of systems, and a comprehensive examination, additional serologic tests may be requested based on the findings (differentials). These tests may include the following:

  • Syphilis serologies (treponemal and nontreponemal)

  • Lyme titers

  • Angiotensin-converting enzyme (ACE)

  • Serum lysozyme

Serologic prognosticators presently under study

Recent investigations are concentrated on determining which specific subsets of ANA and human leukocyte antigen D (human leukocyte antigen DR, human leukocyte antigen DP, and human leukocyte antigen DQ) have significant associations with early onset pauciarticular (EOPA) JIA uveitis. [20]

Human leukocyte antigen DR5 is associated with uveitis in children with oligoarticular JIA. On the other hand, human leukocyte antigen DR1 and human leukocyte antigen DR4 are associated negatively with uveitis.

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Histologic Findings

Pathologic results demonstrate that the synovium becomes hyperplastic, with subsynovial lymphocytic infiltration, vascular endothelial hyperplasia, and edema. A comparable histologic picture is observed in the eyes of patients with JIA-associated uveitis where lymphocytes, plasma cells, and scattered giant cells infiltrate the iris and ciliary body.

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