One particular issue unique to adult JIA is the management of uveitis. If the patient had uveitis as a child, it is prone to recur and regular ophthalmological care is indicated. If the patient never had uveitis, new onset in adulthood is extraordinarily unusual, to the extent that other diagnoses should be considered if it occurs. Further, should uveitis appear, an adult would typically notice symptoms, such as blurry vision, mild photosensitivity, and floaters. For this reason, while we discuss uveitis with our adult JIA patients, we no longer routinely screen patients without prior eye disease for uveitis.7
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Explore This IssueMay 2013
JIA is different from adult RA, but the differences are minor compared to the similarities. Making the diagnosis requires a particular sensitivity to the physical exam, whereas the history and laboratory studies may be less useful or even misleading. Surveillance of the eyes is essential to detect vision-threatening occult uveitis. Early and effective treatment is mandatory to ensure normal growth and function of the skeleton, and may require treatment strategies that are often more aggressive than those employed in adults. Since JIA persists into adulthood, in many patients, perhaps even the majority, adult centers need to be able to transition these patients and care for them long term. With appropriate education, this is a task for which adult rheumatologists are well prepared.
Dr. Nigrovic is a board-certified pediatric and adult rheumatologist and directs the Center for Adults with Pediatric Rheumatic Illness (CAPRI) at the Brigham and Women’s Hospital. He is assistant professor of medicine at Harvard Medical School in Boston.
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