Juvenile chronic arthritis (Juvenile rheumatoid arthritis in the USA)

This is an inflammatory arthritis affecting children under 16 years.  There are three types, of which the pauciarticular type is particularly associated with iritis.  The iritis is unusual in that there are frequently no symptoms (red eye, pain) to alert the patient or his parents that there is something wrong with the eye. Diagnosis of iritis is therefore frequently delayed.

Types of JCA

Pauciarticular - associated with iritis in 20%. Fewer than 5 joints affected (usually knees)
Polyarticular - associated with iritis in 5%. More than 5 joints affected. May lead to deformity
Systemic (Still's disease) - rarely associated with iritis. Fever, rash, enlargement of liver and spleen, joint pain, arthritis


HLA-B27 is positive in those who are prone to relapsing (acute) iritis
ANA (anti-nuclear antibody) is present in 80% of those with both JCA and iritis (present in only 30% of those with JCA only).
RhF (rheumatoid factor) is usually not associated with iritis but may be associated with early onset rheumatoid arthritis

Eye complications

Early complications

Iritis with a white, non-painful eye
Posterior synechiae (very common) - avoided by treatment with dilating drops

Late complications (these complications are due to long-standing iritis)

Deposition of calcium on the cornea (band keratopathy) (occurs eventually in 40%)
Cataract (30%)
Glaucoma (15%)

Treatment of the eye

Steroid drops
Dilating drops esp. atropine
Non-steroidal anti-inflammatory drugs (NSAIDS)
Oral steroids
Surgical treatment of cataract, glaucoma, and band keratopathy


Depends on the severity of the initial inflammation and the duration of the delay in the diagnosis

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