Juvenile Rheumatoid Arthritis (JRA)

Created on: Friday, July 07, 2017

Juvenile rheumatoid arthritis is an arthritis that affects children age 17 and under.  Symptoms include joint pain, swelling, stiffness and fevers.  Symptoms can vary in that children may only experience the symptoms for a few months while others can experience it for the rest of their lives.  Sometimes the early symptoms that are being reported by a child may be dismissed as "growing pains".  Signs may include skin rashes, weight loss and complications of the eye.

What Effect Does JRA Have on the Eyes?

Juvenile rheumatoid arthritis and its effect on the eyes can start as persistent redness and progress to pain and blurred vision.  The pain and blurred vision occur when the inflammation occurs internally in the eye.  The term uveitis is used to describe inflammation in one or more structures inside the eye.  The structures that may be affected include:

  • Iris - colored part of eye controlling the amount of light entering the eye
  • Ciliary body - controls the lens shape and helps the eye focus
  • Choroid - a layer of blood vessels in the back of the eye
  • Retina- the thin light sensitive tissue lining the inside back of the eye where images are focused
  • Vitreous - the clear gel that fills the back of the eye

Sometimes however the symptoms of uveitis may be very mild which is why eye exams for patients with juvenile rheumatoid arthritis are so important.  Treatment for uveitis includes topical steroid drops and often times a topical dilating drop to widen the pupil.

Certain medications used to treat juvenile rheumatoid arthritis can also lead to eye complications.  The medications of concern are hydroxychloroquine (Plaquenil) and corticosteroids (such as prednisone).  Hydroxychloroquine can cause pigment changes in the macula, the central part of the retina, which can cause blurred or fuzzy vision and possibly a decrease in color vision.  Corticosteroids used long term can lead to glaucoma, an increased pressure in the eye leading to a decrease in peripheral vision, as well as cataracts, a clouding of the lens in the eye causing hazy vision and difficulty with night vision and glare.

 By: Dr. Mitch Albers