Early initiation of methotrexate can postpone the development of cataracts requiring surgery in juvenile idiopathic arthritis patients who are at high risk due to posterior adhesions at diagnosis with uveitis, said Dr. Karen M. Sijssens.
Cataract surgery in eyes with inflamed uveas is difficult. The presence of posterior adhesions (synechia) at diagnosis and the treatment of uveitis with corticosteroids have been tied to an increased risk of cataracts in children with JIA who develop uveitis.
To evaluate cataract risk factors and determine effective treatments, Dr. Sijssens of the University Medical Center Utrecht (the Netherlands) and colleagues analyzed 53 children diagnosed with JIA before age 16. Fifty-one had JIA-associated uveitis; 2 had antinuclear antibody-positive uveitis (Am. J. Ophthalmol. 2007;144:574–9).
Uveitis was the first manifestation of JIA in 12 children, and arthritis was the first manifestation of JIA in 41 children.
Overall, 11 of the 12 children (92%) for whom uveitis was the first presenting symptom of JIA required cataract surgery significantly sooner after diagnosis, versus the 16 of the 41 children (39%) for whom arthritis was the first sign of JIA (3.5 years vs. 6.6 years).
Posterior synechia were present at uveitis diagnosis in 15 children. Even after controlling for the use of periocular corticosteroids, children with posterior synechia required cataract surgery significantly sooner than the 33 children without adhesions (3.0 years vs. 8.5 years).
But the need for cataract surgery was significantly delayed in the 17 children treated with methotrexate during the first year after uveitis diagnosis, versus the 25 children not treated with methotrexate (7.0 years vs. 3.5 years). The presence of adhesions was approximately the same in both the methotrexate-treated and untreated children.
The delayed development of cataracts requiring surgery in the methotrexate-treated children may be due to better inflammation control, the researchers noted. “Another explanation may be that treatment with methotrexate diminishes the need for treatment with topical or systemic corticosteroids,” they wrote.
Study limitations include its small size and the fact that no patients were studied who had methotrexate and uveitis as the first JIA symptom, the authors noted.