Imaging based uveitis surveillance in juvenile idiopathic arthritis: feasibility, acceptability and diagnostic performance

OBJECTIVE: Children with juvenile idiopathic arthritis need regular examinations for uveitis to avoid visual morbidity from the most common extra-articular manifestation of disease. We investigated the feasibility, acceptability and performance of optical coherence tomography (OCT) imaging based diagnosis of uveitis.

METHODS: Observational cross-sectional study involving children with and without uveitis. Children underwent routine clinical examination and acquisition of anterior segment (AS) OCT scans images of intraocular inflammatory cells. Acceptability of image acquisition was assessed using a visual analogue scale, and duration of image acquisition. Inter and intra-observer variability of manual counting of acquired images (Bland-Altman limits of agreement), correlation between imaging and routine assessment, and sensitivity and specificity of AS-OCT detection of active inflammation were assessed.

RESULTS: Of 26 children aged 3yrs to 15yrs (median 8yrs) who underwent imaging, 12 had active inflammation. All patients rated acceptability of image acquisition as at least 8·5/10. Time taken to acquire images ranged from 1·5mins to 22mins (median 8mins). There was good positive correlation between clinical assessment and image based cell quantification (R2 =0·63, p=0·002). Sensitivity of AS-OCT manual image cell count for diagnosis of active inflammation was 92% (95% Confidence interval 62%-99%), specificity 86% (58%-98%), and negative predictive value ('ruling-out' uveitis) 92% (65%-99%).

CONCLUSION: Non-contact, high-resolution imaging for JIA uveitis surveillance is feasible, acceptable to patients, and holds the promise of transforming paediatric practice. Further work is needed to determine the analytic and clinical validity of AS-OCT quantification of active inflammation, and the clinical and cost-effectiveness of imaging based disease monitoring.