Last modified: 2014-04-03
Abstract
Optic neuritis (ON) was rarely reported in juvenile idiopathic arthritis (JIA) patients, particularly in those under anti-tumor necrosis factor alpha blockage. However, to our knowledge, the prevalence of ON in JIA population has not been studied. Therefore, 5,793 patients were followed up at our University Hospital and 630 (11%) had JIA. One patient (0.15%) had ON and was reported herein. A 6 year old male was diagnosed with extended oligoarticular JIA, and received naproxen and methotrexate subsequently replaced by leflunomide. At 11 years old, he was diagnosed with aseptic meningitis followed by a partial motor seizure with secondary generalization. Brain magnetic resonance imaging (MRI) and electroencephalogram showed diffuse disorganization of the brain electric activity and leflunomide was suspended. Seven days later, the patient presented acute ocular pain, loss of acuity for color, blurred vision, photophobia, redness and short progressive visual loss in the right eye. Fundoscopic exam detected unilateral papilledema without retinal exsudates. Orbital MRI suggested right ON. The anti-aquaporin 4 (anti-AQP4) antibody was negative. Pulse therapy with methylprednisolone was administered for five days and subsequently with prednisone, he had clinical and laboratory improvement. In conclusion, a low prevalence of ON was observed in our JIA population. The absence of anti-AQP4 antibody and the normal brain MRI not exclude the possibility of demyelinating disease associated with chronic arthritis. Therefore, rigorous follow up is required.
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References
- Steffen H. Optic nerve neuritis. Ophthalmologe 2013;110:783-9.
- Cardoso LMCD, Zacharias LC, Monteiro MLR. Neuropatia óptica auto imune: relato de caso. Arq Bras Oftalmol 2006;69:593-5.
- Simsek I, Erdem H, Pay S, Sobaci G, Dinc A. Optic neuritis occurring with anti-tumor necrosis fator α therapy. Ann Rheum Dis 2007;66: 1255-8.
- Tristano AG. Neurological adverse events associated with anti-tumor necrosis factor α treatment. J Neurol 2010;257:1421-31.
- Tran TH, Milea D, Cassoux N, Bodaghi B, Bourgeois P, LeHoang P. Optic neuritis associated with infliximab. J Fr Ophtalmol 2005;28:201-4.
- Tauber T, Turetz J, Barash J, Avni I, Morad Y. Optic neuritis associated with etanercept therapy for juvenile arthritis. J AAPOS 2006;10:26-9.
- Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol 1998;25:1991-4.
- Pedro-Egbe CN, Fiebai B, Ejimadu CS. Visual outcome following optic neuritis: a 5-year review. Niger J Clin Pract 2012;15:311-4.
- Morales DS, Siatkowski RM, Howard CW, Warman R. Optic neuritis in children. J Pediatr Ophthalmol Strabismus 2000;37:254-9.
- Shatriah I, Adlina AR, Alshaarawi S, Wan-Hitam WH. Clinical profile of Malay children with optic neuritis. Pediatr Neurol 2012;46:293-7.
- Stübgen JP A literature review on optic neuritis following vaccination against virus infections. Autoimmun Rev 2013;12:990-7.
- McKinney AM, Lohman BD, Sarikaya B, Benson M, Benson MT, Lee MS. Accuracy of routine fat-suppressed FLAIR and diffusion-weighted images in detecting clinically evident acute optic neuritis. Acta Radiologica 2013 (in press).
- Hickman SJ, Dalton CM, Miller DH, Plant GT. Management of acute optic neuritis. Lancet 2002;360:1953-62.
- de Seze J. Atypical forms of optic neuritis. Rev Neurol 2012;168:697-701.
- McKeon A, Lennon VA, Lotze T, Tenenbaum S, Ness JM, Rensel M, et al. CNS aquaporin-4 autoimmunity in children. Neurology 2008;71: 93-100.
- Tillema JM, McKeon A. The spectrum of Neuromyelitis Optica (NMO) in childhood. Journal of Child Neurology 2012;27:1437-47.
- Mohan N, Edwards ET, Cupps TR, Oliverio PJ, Sandberg G, Crayton H, et al. Demyelination occurring during anti-tumor necrosis factor alpha therapy for inflammatory arthritides. Arthritis Rheum 2001;44:2862-9.
- Gal RL, Vedula SS, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database Syst Rev 2012;18:4.
- Beck RW. The Optic Neuritis Treatment Trial. Arch Ophthalmol 1988;106:1051-3.