幼年特发性关节炎伴发葡萄膜炎

Uveitis associated with juvenile idiopathic arthritis

幼年特发性关节炎（JIA）是指发生在16岁以下儿童以慢性关节炎为主要临床表现的全身多系统自身免疫性疾病,临床表现为不明原因的持续6周以上的关节肿胀或炎症.大约有10％的患者伴有葡萄膜炎症,具有发病隐匿、炎症反应轻、并发症多和视力损害重等特点.好发人群为关节炎发病年龄小、抗核抗体阳性的女性少关节型关节炎患者.典型临床表现为双眼不对称的慢性轻度前葡萄膜炎,常见致盲性并发症有角膜带状变性、虹膜后粘连、并发性白内障和继发性青光眼等.局部应用糖皮质激素、非甾体抗炎剂和散瞳剂是主要治疗措施,顽固性患者需全身加用糖皮质激素、免疫抑制剂或生物制剂治疗,并发性白内障患者在围手术期需加强抗炎治疗.对幼年关节炎患儿进行密切眼部随访和及早诊治,可减轻葡萄膜炎病情和降低致盲性并发症的损害.

Juvenile idiopathic arthritis （JIA） that persists for at least 6 weeks is a group of the most common chronic arthritis conditions occurring in children under 16 years of age. Uveitis accompanies JIA in about 10% of patients. The characteristics of uveitis are usually asymptomatic with silent onset, light inflammation, more complications and severe visual damage. Traditional risk factors for uveitis development include children less than 7 years old at the time of arthritis onset, a positive antinuclear antibody （ANA） test result, female sex and oligoarthritis. The classic clinical pictures are bilateral chronic asymptomatic anterior uveitis and the major complications include band keratopathy, complicated cataract, posterior iris synechiae and secondary glaucoma. Treatment consists of topical corticosteroids, nonsteroidal anti-inflammatory drugs and mydriatics. In severe cases, treatment may include oral corticosteroids, immunosuppressive agents or biological therapies. Patients with complicated cataract need surgical management and aggressive perioperative control of intraoeular inflammation for successful cataract surgery with lens implantation. In view of the asymptomatic nature of uveitis, careful screening of eyes in JIA patients and early diagnosis and treatment of uveitis are crucial to prevent complications and blindness.