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MCQ – 87817

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Question

A 6-year-old female presents to an ophthalmologist for failing a routine vision screen at school. She has not noticed vision problems prior to the screening. She has complained to her parents regarding intermittent pain in several joints. Her visual acuity is 20/200 in the right eye and 20/50 in the left eye. IOPs are 20 OD and 18 OS. Anterior segment examination is significant for cortical and posterior subcapsular cataracts, in the right eye more than in the left. There is a small area of band keratopathy visible on the right temporal cornea. Anterior segment examination is significant for +1-2 cells and flare in the right eye and trace cell and flare in the left eye. Uveitis in association with this condition:
A. occurs predominantly in girls.
B.

 involves a few joints.

C.

is usually of insidious onset.
D.

first appears with pain and erythema.
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Correct Answer � D

Explanation

Answer: D.  first appears with pain and erythema. 

Explanation: D. JRA- related uveitis is typically asymptomatic, insidious, frequently detected during a routine screening of visual acuity

Juvenile idiopathic arthritis (JIA) is a form of arthritis in children. Arthritis causes joint swelling (inflammation) and joint stiffness. JIA is arthritis that affects one or more joints for at least 6 weeks in a child age 16 or younger.

Unlike adult rheumatoid arthritis, which is ongoing (chronic) and lasts a lifetime, children often outgrow JIA. But the disease can affect bone development in a growing child.

There are several types of JIA:

Systemic onset JIA. 

Oligoarticular JIA. 

Polyarticular JIA. 

Enthesitis-related JIA. 

Psoriatic arthritis.

Undifferentiated arthritis.

The trademark of JRA is the development of chronic non-granulomatous anterior uveitis in both eyes. The uvea is the colored part of the eye, including the iris, ciliary body and the choroid layer underlying the retina, nourishing and renewing it.

Uveitis of this type in JRA is typically accompanied by the development of joint pain in children between the ages of 4 and 6 years. In contrast, acute uveitis occurs in children who develop arthritis later, between the ages of 7.5 and 9 years. Arthritis typically occurs months or years before the onset of ocular signs and symptoms. However, uveitis has been recorded to develop anywhere between a year before to 16 years after the condition manifests, or even several years after remission is achieved.

 

Symptoms

JRA-associated iridocyclitis is often asymptomatic. However, almost 44% of patients present with symptoms such as:

  • Redness of the eye

  • Eye-associated pain

  • Loss of visual acuity

  • Intolerance to light, or photophobia

The following signs are present:

  • Aqueous flare

  • Keratic precipitates

  • Cellular infiltrates in the anterior chamber

  • No visual loss

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