Long-term outcomes of JIA-associated uveitis: a systematic review and meta-analysis

Background and aim Juvenile idiopathic arthritis-associated uveitis (JIAU) is a potentially blinding condition beginning in childhood. Flare-ups may occur throughout life, leading to cumulative ocular damage. This systematic review aimed to summarise the latest evidence on long-term ocular damage in adults with JIAU, focusing on studies published in the past 20 years. Methods The review protocol was registered in PROSPERO (ID 1033522). We included human studies on JIAU with at least 5 years of follow-up and/or young people ≥18 years old, published after 2000. Study quality was assessed using the Newcastle-Ottawa Scale. We extracted the cumulative incidence of complications and performed a meta-analysis to obtain pooled estimates (PE), assess heterogeneity, sensitivity, robustness and reporting bias using R packages. Results 22 retrospective or cohort studies were eligible, encompassing 2208 long-term JIAU cases. Study quality was rated as good in 10, fair in 7 and poor in 5. Despite high heterogeneity (p<0.01), sensitivity analyses supported robustness. Evidence of reporting bias was found for severe visual impairment and cataract. The pooled incidence of severe visual impairment was 16.6% (95% CI 9.9% to 22.6%) at approximately 18 years. Cataract was the most frequent complication (PE 44.3% (95%CI 27.5% to 61.7%)), followed by glaucoma, synechiae, band keratopathy and hypotony. In cohorts with >50% biologic exposure, PE were numerically lower. Conclusion Long-term prevalence and cumulative incidence of JIAU complications may persist in adulthood, with >10% developing severe visual impairment despite biologic therapy.