Adherence to screening recommendations for uveitis in juvenile idiopathic arthritis (JIA) patients: A retrospective cohort study from a tertiary referral hospital in Oman

Abstract

Background and purpose: Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in children. JIA patients are at risk of developing uveitis and undergo ophthalmic screening at specific regular intervals based on international JIA screening guidelines. This study aimed to assess the adherence of ophthalmology and rheumatology services, and patients followed at Sultan Qaboos University Hospital (SQUH), Oman, to the screening guidelines and identify factors influencing adherence. Subjects and methods: In this retrospective cohort study, we reviewed the charts of all patients diagnosed with JIA from 2015 to 2020 who were followed up by the pediatric rheumatology service at SQUH. Data collected included the patient's demographics, age at diagnosis of JIA and age at diagnosis of uveitis, disease duration, JIA subtype, disease markers, treatment, and frequency of rheumatology and ophthalmology appointments. The patients' actual appointments were compared with their planned appointments to assess adherence to the screening schedule. Results: Thirty-nine JIA patients (13 males, 26 females) were recruited in the study. The median age of the patients at diagnosis of JIA was 3 years (interquartile range 2-7 years). The distribution of JIA subtypes was 13 (33.3%) oligoarticular JIA patients, 14 (35.9%) systemic-onset JIA patients, and 12 (30.8%) polyarticular JIA patients. A total of 23 (59%) patients were on biologics. Rheumatology service adherence for referring for the first screening visit was 94.9%, while ophthalmology adherence for scheduling first-visit appointments was 76.9%, and patient adherence for the first visit was 96.7%. Over the 5 years, the average adherence to screening guidelines was 81.3% for the ophthalmology service and 88.4% for patients. One patient developed uveitis during the study period. A significant association was found between higher age at diagnosis of JIA patients and patient adherence (P = 0.037). A significant association was also found between shorter JIA disease duration and patient adherence (P = 0.000275). Conclusion: Assessment of adherence to the JIA screening recommendations for uveitis at SQUH revealed some shortcomings. While the rheumatology service's adherence is good, the ophthalmology service's adherence needs improvement. Patients' adherence to the first visit appointment is optimal but needs improvement throughout the 5 years. Although all patients had risk factors for uveitis, only one developed uveitis. In this cohort study of Omani JIA patients, the occurrence of uveitis seems to be low.

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