Saudi cohort study finds JIA drives most paediatric uveitis cases

What drives non-infectious uveitis in children, and how well do current treatments hold up over time? In a Saudi Arabian cohort, juvenile idiopathic arthritis (JIA) emerged as the leading cause, and biologic therapies contributed to high remission rates over a 2-year follow-up period, according to a study published in PLOS One.¹

Nashawi and colleagues, of the Department of Paediatric at the Faculty of Medicine, King Abdulaziz University in Jeddah, Saudi Arabia, conducted a retrospective observational study of 36 paediatric patients diagnosed with non-infectious uveitis across two tertiary centres between January 2017 and December 2022. Data were drawn from hospital electronic medical records and ophthalmology clinic registries, with patients followed at diagnosis and at 3, 6, 12 and 24 months thereafter.¹

Who gets paediatric uveitis, and why

Two-thirds of patients were female, and the mean age at diagnosis was 8.99 years, ranging from 3 to 18 years. Roughly half of all cases were attributed to JIA, with idiopathic uveitis, Vogt-Koyanagi-Harada disease and psoriatic JIA accounting for most of the remaining diagnoses, in proportions broadly consistent with prior international cohorts.¹ Bilateral involvement occurred in 55.6% of patients, and anterior uveitis was the predominant anatomical subtype, present in 75% of cases.¹

Antinuclear antibody positivity was identified in 69.44% of patients. The authors pointed to this figure as further evidence supporting the established practice of screening antinuclear antibody status in children at elevated risk for JIA-related eye disease.¹

From steroids to biologics: What worked

At diagnosis, the most commonly prescribed treatments included topical prednisolone acetate 1% (91.67%), cyclopentolate (36.11%), adalimumab (22.22%) and oral prednisolone (19.44%), while systemic therapy for the underlying disease most often involved methotrexate (50%), prednisolone (25%) and adalimumab (22.22%).¹ Over the course of follow-up, a notable proportion of patients experienced persistent or recurrent inflammation, with most managed through escalation of local corticosteroid therapy rather than systemic treatment changes.¹

By the 2-year mark, 86.11% of patients had achieved remission, placing this cohort's outcomes in line with, and in some respects ahead of, what has been reported elsewhere internationally.¹ Complications were observed at relatively low rates, including synechiae (13.89%), cataracts (8.3%), band keratopathy (5.56%), macular oedema (2.78%) and secondary glaucoma (2.78%).¹

Closing the gaps in care

The authors noted that the higher proportion of Vogt-Koyanagi-Harada disease observed in this cohort, compared with some international series, may reflect regional genetic and ethnic factors documented in Middle Eastern populations. They concluded that despite a small sample size and retrospective design, the findings support the value of early diagnosis, systematic screening of antinuclear antibody-positive JIA patients and broader access to biologic therapy in optimising outcomes for children with non-infectious uveitis.¹ They also called for prospective studies exploring emerging treatment options such as Janus kinase and interleukin-6 inhibitors, alongside greater integration of multidisciplinary joint clinics for ongoing patient management.²

The authors declared no competing interests and reported that the study received no specific external funding.

References

1. Nashawi M, Alshareef SA, Alswealh S, et al. Clinical characteristics, management, and outcomes of pediatric non-infectious uveitis: A multicenter study in Saudi Arabia. PLoS One. 2026;21(6):e0350150. doi:10.1371/journal.pone.0350150

2. Wen J, Hu H, Chen M, Yang H, Zhao Y, Liu Y. Role of janus kinase (JAK) inhibitor in autoimmune ocular inflammation: a systematic review. J Immunol Res. 2021;2021:2324400. doi:10.1155/2021/2324400