6298 Uveitis screening in Juvenile Idiopathic Arthritis: Are we following the guidelines?

Objectives Juvenile Idiopathic Arthritis (JIA) is the most common inflammatory arthritis in children. Uveitis is a common (8–30%) and potentially sight-threatening complication of JIA.¹ Early detection and treatment of uveitis can prevent permanent visual impairment, making uveitis screening an essential part of the management. The purpose of this audit was to evaluate the referral and management of uveitis screening in JIA patients in our healthcare setting compared with Guidelines for Screening for Uveitis in JIA produced jointly by BSPAR and the RCOphth 2006. Methods The patients with a diagnosis of JIA at our District General Hospital (DGH) were reviewed retrospectively. The data was collected based on demographics, JIA diagnosis, subtypes, referral for uveitis screening, timing of uveitis screening, and screening outcome. Data was then analysed to assess if we met BSPAR and the RCOphth 2006 standards. Results A total of 42 patients were identified with a diagnosis of JIA between January 2021 and January 2023. Based on our criteria, 4 patients were excluded and the final analysis was done with 38 patients. 34 patients (89%) with JIA were referred for uveitis screening. 31 of those patients (91%) were referred within 6 weeks, while 3 patients (9%) were referred after 6 weeks of diagnosis. Only 9 patients (24%) were seen for uveitis screening within the 6 weeks after initial referral as per BSPAR standards. Uveitis was diagnosed in 5 patients(13%). 1 out of 38(2.6%) patients was diagnosed with Uveitis prior to diagnosis of JIA. Regarding the distribution of JIA subtypes, there were 15 cases of Polyarticular JIA, 14 instances of Oligoarticular JIA, 6 occurrences of Psoriatic JIA, 2 instances of Enthesitis-related JIA, and 1 case of Systemic JIA. Out of the 5 patients diagnosed with Uveitis, 2 had Polyarticular JIA, 2 had Oligoarticular JIA, and 1 presented with Psoriatic JIA. Furthermore, 2 of these patients tested positive for ANA, 1 tested negative, while the ANA status remained unknown for the remaining 2 individuals. Conclusion The results showed the need for improvement to be fully compliant with the guidelines for screening uveitis in JIA patients. We aim to ensure that all patients are referred and reviewed within 6 weeks for uveitis screening, as early detection and treatment of uveitis can prevent permanent visual impairment. We recommend collaborating with the ophthalmology unit to streamline the referral pathway and explore the idea of doing MDT clinics. Education should be arranged to raise awareness among all relevant healthcare staff. Reference Guidelines for screening for uveitis in Juvenile Idiopathic Arthritis (JIA) produced jointly by BSPAR and the RCPOphth2006 https://www.bspar.org.uk/DocStore/FileLibrary/PDFs/BSPAR%20Guidelines%20for%20Eye%20Screening%202006.pdf