한국에서의 소아 류마티스관절염에서 발생한포도막염의 임상양상

목적: 소아 류마티스관절염(Juvenile idiopathic arthritis, JIA)에서 발생된 포도막염의 빈도 및 임상양상을 알아보고자 하였다. 대상과 방법: JIA로 진단된 환자를 ILAR (International League of Associations for Rheumatology)분류에 따라 세분하여 포도막염의임상양상을 조사하였으며 시력저하를 일으키는 위험인자를 알아보았다. 결과: 전체 149명(남:여=79:70)으로 평균나이는 7.42 ± 3.82년이었다. 포도막염 발생은 13명(8.6%)으로 소수관절형(5명), 다수관절 류마티스인자 음성형(4명), 전신형(4명), 착부염관련형(2명)에서 골고루 나타났다. 포도막염은 항핵항체 양성(46.15%)시 발생빈도가 높았고 임상양상은 대부분 급성(11명), 양안(11명), 전방염증(12안)으로 나타났다. 만성포도막염 2명의 경우 어린 나이(평균 5세)에 발병, 초기 심한 염증반응(≥3+ cells)을 특징으로 하였으며 띠각막병증 및 홍채후유착이 발생하여 시력감퇴가 동반되었다. 결론: 포도막염은 JIA 모든 아형에서 골고루 나타났으며 핵항체 양성인 환자에서 발생빈도가 높았다. 만성 포도막염은 어린 나이에발병하여 초기 심한 염증반응을 보였으며 비교적 빠른 시기에 합병증이 발생되므로 적극적인 치료 및 관리가 요구된다. Purpose: To investigate the incidence and clinical characteristics of juvenile idiopathic arthritis (JIA)-associated uveitis in Korea and to identify the risk factors for developing uveitis and poor visual outcome. Methods: We performed a retrospective chart review of 149 patients who were diagnosed as JIA between January 2001and December 2012. Patients were classified based on the International League of Associations for Rheumatology (ILAR)criteria and the incidence and clinical course of uveitis according to each subtype was investigated. We also evaluated the risk factors for poor prognostic outcomes. Results: The present study included 79 males and 70 females and the mean age was 7.42 ± 3.82 years. In 13 patients (8.6%), uveitis manifested evenly among JIA subtypes, including 5 patients with oligoarthritis type, 4 patients with polyarthritis rheumatoid negative type, and 4 patients with systemic type. Anti-nuclear antibody (ANA) was detected more in the uveitic group (46.13%). The characteristics of uveitis were acute (85%), bilateral (85%), and anterior uveitis (92%). Chronic uveitis occurred in only 2 patients who had uveitis at an early age (mean age of 5 years) and had severe anterior chamber reaction at presentation. Poor visual outcome was associated with band keratopathy and posterior synechiae preceded by the chronic uveitis. Conclusions: JIA-associated uveitis occurred evenly in each subtype. Uveitis was increased in the presence of ANA. Most uveitis showed good visual outcomes but in cases of early uveitis onset and with severe anterior chamber reaction at presentation the risk of chronic uveitis increased resulting in poor visual outcomes. KCI Citation Count: 0