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Could bilateral uveitis be an early manifestation of idiophatic juvenile arthritis?

Poster Details

First Author: T.Mitulescu ROMANIA

Co Author(s):    I. Careba   V. Popescu   S. Gradinaru   R. Ciuluvica   R. Tudosescu   D. Predeteanu

Abstract Details

Purpose:

To present the evolution of a teenage patient from their first diagnosis of acute anterior uveitis of the right eye and panuveitis of the left eye to a later diagnosis of idiophatic juvenile arthritis although the patient belonged to the HLA-B51 genotype which may have been an indicator of Behcet disease

Setting:

Department of Ophthalmology, University Emergency Hospital, Department of Rheumatology and Internal Medicine, ”Sf. Maria” Clinical Hospital, University of Medicine and Pharmacy ”Carol Davila”, Bucharest, Romania

Methods:

Clinical ocular examination: decreased visual acuity in her left eye, posterior synechia in right eye, panuveitis in left eye and normal intraocular pressure. Fundus examination revealed papillary and macular edema and hazy vitreous in the left eye. Clinical examination by the rheumatologist revealed: painful swelling of the right wrist. Paraclinical examinations ( immunological examinations, tests for infections) were negative,except HLA-B51 which was positive. In the absence of other signs and symptoms of Behcet disease, HLA-B51 was considered only the patient genotype. The rheumatologist made the diagnosis of juvenile idiopathic arthritis known to associate with uveitis in 30% of cases.

Results:

The patient has received iv corticosteroids followed by oral costicosteroids, local NSAIDs and mydriatic treatment. The visual acuity has improved and the macular and papillary oedema and anterior uveitis have decreased. The corticosteroid continued for several months with tapered doses and Methotrexate was added to the treatment. The patient is monitored monthly by the rheumatologist and by the ophthalmologist for recurrence of macular edema or involvement of the second eye posterior pole.

Conclusions:

1 -The severity of uveitis represent a risk of loss of vision in our young patient 2 -The early rheumatological diagnosis of juvenile idiopathic arthritis followed by introduction of remisive threatment with methotrexate aimed at preventing it. 3 -The strict monitoring of our patient by a team of ophthalmologist and rheumatologist contributed to the good management of the patient. ACKNOWLEDGEMENT: This paper is partly supported by the Sectorial Operational Programme Human Resources Development (SOPHRD), financed by the European Social Fund and the Romanian Government under the contract number POSDRU 141531”

Financial Disclosure:

NONE

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