Importance of pediatric rheumatologists and transitional car
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Juvenile idiopathic arthritis-associated uveitis (JIA-U) is a serious condition associated with the risk of blindness. However, pediatric rheumatologists rarely encounter cases of blindness, because most patients reach adulthood during the course of follow-up before blindness occurs. The aim of this article is to highlight the importance of the role of pediatric rheumatologists and transitional care in preventing blindness associated with JIA-U.

A retrospective analysis of the case records of 9 JIA-U patients was conducted. All patients presented with oligo-juvenile idiopathic arthritis the median age of uveitis onset was 5.0 years, and the onset of uveitis preceded the onset of arthritis in 2 patients. The median disease duration was 12.5 years; 4 patients had anti-nuclear antibody (ANA) positivity (all with a homogeneous and speckled-pattern subtype). All patients were negative for the rheumatoid factor. Eight patients received methotrexate, 7 patients received one or more biologic drugs (etanercept, infliximab, adalimumab, and golimumab), and 6 patients required ophthalmic surgery at an early age.

Two patients developed blindness after the transition period. Medical examination by pediatric rheumatologists and the use of biologics had been delayed in both patients. One patient developed depression after transition and interrupted her own treatment.

In summary, the reason for blindness in the 2 patients was thought to be the delay in the commencement of treatment and failure to provide transitional care. Inflammation is difficult to control in JIA-U even with appropriate treatment. Pediatric rheumatologists must be informed about the risk of JIA-U blindness, especially after the transition. To ensure a good prognosis, the specialized treatment with the involvement of pediatric rheumatologists is necessary early on, and consideration for transitional medicine is essential. Therefore, this report reaffirms the importance of planned transitional care that has been advocated for globally.