Predicting uveitis in juvenile idiopathic arthritis: from biomarkers to clinical practice

ABSTRACT

Introduction: Uveitis is a sight-threatening eye inflammation and common manifestation of juvenile idiopathic arthritis (JIA). New biomarkers that can predict uveitis are needed to alleviate personalized clinical screening. In this review, we outline clinical and molecular risk factors for uveitis and discuss their putative biology and value for clinical practice.

Areas covered: The recent discovery of the YST-amino acid motif in the Human Leukocyte Antigen DRB1 gene exposed a strong genetic predisposition for uveitis in females and can be used to identify low-risk cases and redefine screening policies. The established predictor ‘young age at arthritis onset’ appeared to only hold true for females, emphasizing the importance of sex-stratification in biomarker applications. Aqueous humor profiling studies have shown unique mediator changes. Finally, erythrocyte sedimentation rate and S100A12 levels can be used to stratify patients at high risk for uveitis.

Expert commentary: Various markers have been identified and may significantly improve risk assessment for uveitis in JIA. However, there remains an unmet need to better predict uveitis in advance. Here, we propose a set of markers with high potential for prospective studies, which subsequently can be integrated to develop optimal prediction tools that complement improved screening guidelines for early disease detection and personalized care strategies.

KEYWORDS:

• Uveitis
• biomarker
• juvenile idiopathic arthritis
• JIA
• predicting

Article highlights

• Uveitis associated with juvenile idiopathic arthritis is a serious and sight-threatening childhood disease whose aggravating impact on prognosis and vision-related quality of life stretches far into young adulthood.

• Clinical and molecular markers for uveitis in juvenile idiopathic arthritis were identified in the last decades and have provided tools for screening guidelines and direction for understanding the disease mechanism.

• These markers could direct to more personalized screening guidelines in the future.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was funded by: The Dr. F.P. Fischer Stichting, Amersfoort; The ODAS Stichting, the Landelijke Stichting Voor Blinden en Slechtzienden, Utrecht; the Stichting Nederlands Oogheelkundig Onderzoek (SNOO), Rotterdam, the Netherlands.