Paediatric Non-Infectious Uveitis in Cape Town, South Africa: A Retrospective Review of Disease Characteristics and Outcomes on Immunomodulating Treatment

Paediatric Non-Infectious Uveitis in Cape Town, South Africa: A Retrospective Review of Disease Characteristics and Outcomes on Immunomodulating Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Paediatric Non-Infectious Uveitis in Cape Town, South Africa: A Retrospective Review of Disease Characteristics and Outcomes on Immunomodulating Treatment Waheba Slamang, Christopher Tinley, Nicola Brice, Christiaan Scott This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-74889/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Apr, 2021 Read the published version in Pediatric Rheumatology → Version 1 posted 19 You are reading this latest preprint version Abstract Background Non-infectious uveitis is a well-reported cause of blindness in more developed countries, however data from sub-Saharan Africa is lacking. Here we aim to describe the diseases associated with non-infectious uveitis and the impact of currently available treatment in this setting. Methods A retrospective observational analysis of children with non-infectious uveitis from January 2010 to December 2017, attending the tertiary paediatric rheumatology and ophthalmology referral units in Cape Town was conducted. Statistical analysis utilising STATA13 software was performed with p < 0.05 considered significant. Results Twenty-nine children were identified: median age at first visit of 74 months (IQR 49–86 months), female to male ratio of 0.9:1, predominantly of mixed race (72.4%). Juvenile idiopathic arthritis associated uveitis (JIAU) (48.3%) was the most frequent diagnosis. All children with JIAU had chronic anterior uveitis and 3 (21.4%) presented with uveitis before arthritis. There were no differences between children with uveitis and those with arthritis only, for gender (p = 0.68) and race (p = 0.58) but significantly, children with uveitis presented at an overall younger age (p = 0.008), with antinuclear antibody positive (p < 0.001) oligo-articular JIA (p = 0.01). Older age appeared to be protective (p = 0.01 OR1.0 CI 0.6-1.7). Children with idiopathic uveitis (41.4%) were predominantly male (66.6%), of mixed race (75%), with chronic anterior uveitis (41.7%) and presented with cataracts (100%). Less commonly, sarcoidosis (6.9%) and Behcet’s disease (3.5%) were diagnosed. 55.2% had complications at presentation, predominantly cataracts (87.5%). 19 children (65.5%) had inactive disease at 12 months from diagnosis. Remission, as assessed at the last clinical visit was achieved in 58.6% on standard initial therapy and in 75% of those on tumour necrosis factor inhibitors. Surgery was needed in 41.4%, primarily in the idiopathic group. Visual acuity improved or was maintained on treatment. Conclusion The spectrum and characteristics of immune-mediated non-infectious uveitis are comparable to that reported in more developed countries. Current practice detects children with potentially sight-threatening disease and access to tumour necrosis factor inhibitors has improved outcomes in refractory cases. Pediatrics Rheumatology Non-infectious uveitis children juvenile idiopathic arthritis sub-Saharan Africa Figures Figure 1 Full Text Tables Due to technical limitations, tables 1-4 docx are only available as a download in the Supplemental Files section. Supplementary Files Table1.docx Table2.docx Table3.docx table4.docx Cite Share Download PDF Status: Published Journal Publication published 01 Apr, 2021 Read the published version in Pediatric Rheumatology → Version 1 posted Editorial decision: Major revision 13 Nov, 2020 Review # 5 received at journal 17 Oct, 2020 Review # 6 received at journal 17 Oct, 2020 Review # 3 received at journal 14 Oct, 2020 Review # 4 received at journal 14 Oct, 2020 Reviewer # 7 agreed at journal 14 Oct, 2020 Reviewer # 6 agreed at journal 13 Oct, 2020 Reviewer # 5 agreed at journal 10 Oct, 2020 Review # 2 received at journal 10 Oct, 2020 Reviewer # 4 agreed at journal 08 Oct, 2020 Reviewer # 3 agreed at journal 05 Oct, 2020 Review # 1 received at journal 01 Oct, 2020 Reviewer # 2 agreed at journal 27 Sep, 2020 Reviewer # 1 agreed at journal 25 Sep, 2020 Reviewers invited by journal 22 Sep, 2020 First submitted to journal 21 Sep, 2020 Editor assigned by journal 21 Sep, 2020 Editor invited by journal 20 Sep, 2020 Submission checks completed at journal 20 Sep, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-74889","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":2620444,"identity":"875bafbc-bd1b-4b4f-902b-f67b3da3fe2c","order_by":0,"name":"Waheba Slamang","email":"","orcid":"","institution":"University of Cape Town","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Waheba","middleName":"","lastName":"Slamang","suffix":""},{"id":2620445,"identity":"4a484ebd-3894-4016-ab29-d10de1fb5b82","order_by":1,"name":"Christopher Tinley","email":"","orcid":"","institution":"University of Cape Town","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"","lastName":"Tinley","suffix":""},{"id":2620446,"identity":"519359d4-93f0-4104-864b-5d87d62ee174","order_by":2,"name":"Nicola Brice","email":"","orcid":"","institution":"University of Cape Town","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nicola","middleName":"","lastName":"Brice","suffix":""},{"id":2620447,"identity":"e37f696f-e27f-4e76-9d9c-5af655fbaac7","order_by":3,"name":"Christiaan Scott","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIie3QMQrCMBiG4a/80CnSNYK0V0jxQhWhF3ARLCIIuiiuih6mJRAXD1DQQXeHduvQwVQKbqluDnmnLA/5EsBm+8c4kLZH5/4jcYkEIL4jaInLvyLecfvIKswDL9ipGUtqeOuUisp0ye0sJIMMDytyr0wJ8EuEcGMggseQ+jmRUJr0FnpYDkSsgzTD3mTSkECTrO4gKQO9CTVE5HCWplt4rocx0bxlPOyf1JCFl9GSBgbi7WMqq6n+McoexTPxff8sZfk0kHbe56gnOYtOYLPZbDZzL6C3QS2w+TOZAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-3874-1704","institution":"University of Cape Town","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Christiaan","middleName":"","lastName":"Scott","suffix":""}],"badges":[],"createdAt":"2020-09-09 11:15:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-74889/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-74889/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12969-021-00537-x","type":"published","date":"2021-04-01T19:06:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":2579943,"identity":"5f1fd42a-d5fd-48d6-8d04-a6f732130fcf","added_by":"auto","created_at":"2020-09-24 15:53:18","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":60795,"visible":true,"origin":"","legend":"1.a: Time to inactive Disease: n=28, Median time to inactive disease: 7months (IQR 6- 15mths)\n1.b: Time to inactive disease by diagnosis: n=28; Bechet’s disease 3 months, Sarcoidosis\nmedian 7 months (IQR 6-8mths), JIA median 6 months (IQR 4-15months)\nIdiopathic median 10.5 months (IQR 6-16.5months)\n1.c: Inactive disease at 12 months: n=19; Standard initial treatment n=16: JIA(9)\nidiopathic(4) Bechet’s(1) Sarcoidosis (2) TNF-inhibitors: n=3: idiopathic(2)\nJIA(1)\n1.d: Time to Uveitis from JIA diagnosis: n=11 Two children were diagnosed at first\nscreen, Eight children developed uveitis within 1 year of JIA diagnosis detected\nat routine screening, one child developed uveitis 4 years after initial JIA\ndiagnosis, detected at routine screening. 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href='/article/rs-74889/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp\u003eDue to technical limitations, tables 1-4 docx are only available as a download in the Supplemental Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-rheumatology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"proj","sideBox":"Learn more about [Pediatric Rheumatology](http://ped-rheum.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/proj/default.aspx","title":"Pediatric Rheumatology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Non-infectious uveitis, children juvenile, idiopathic arthritis, sub-Saharan Africa","lastPublishedDoi":"10.21203/rs.3.rs-74889/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-74889/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u0026nbsp;\u003c/strong\u003eNon-infectious uveitis is a well-reported cause of blindness in more developed countries, however data from sub-Saharan Africa is lacking. Here we aim\u0026nbsp;to\u0026nbsp;describe\u0026nbsp;the\u0026nbsp;diseases\u0026nbsp;associated\u0026nbsp;with\u0026nbsp;non-infectious\u0026nbsp;uveitis\u0026nbsp;and\u0026nbsp;the\u0026nbsp;impact of\u0026nbsp;currently\u0026nbsp;available treatment in this\u0026nbsp;setting.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u0026nbsp;A retrospective observational analysis of children with non-infectious uveitis from January 2010 to December 2017, attending the tertiary paediatric rheumatology and ophthalmology\u0026nbsp;\u0026nbsp;referral\u0026nbsp;units in Cape Town was conducted. Statistical analysis utilising STATA13 software\u0026nbsp;\u0026nbsp;was performed with p \u0026lt; 0.05 considered\u0026nbsp;significant.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u0026nbsp;Twenty-nine children were identified: median age at first visit of 74 months (IQR 49–86\u0026nbsp;months), female to male ratio of 0.9:1, predominantly of mixed race (72.4%).\u003c/p\u003e\u003cp\u003eJuvenile idiopathic arthritis associated uveitis (JIAU) (48.3%) was the most frequent diagnosis. All children with JIAU had chronic anterior uveitis and 3 (21.4%) presented with uveitis before arthritis. There were no differences between children with uveitis and those with arthritis only, for gender (p = 0.68) and race (p = 0.58) but significantly, children with uveitis presented at an overall younger age (p = 0.008), with antinuclear antibody positive (p \u0026lt; 0.001) oligo-articular JIA (p = 0.01). Older age appeared to be protective (p = 0.01 OR1.0 CI\u0026nbsp;0.6-1.7).\u003c/p\u003e\u003cp\u003eChildren with idiopathic uveitis (41.4%) were predominantly male (66.6%), of mixed race (75%), with chronic anterior uveitis (41.7%) and presented with cataracts (100%).\u0026nbsp;Less commonly, sarcoidosis (6.9%) and Behcet’s disease (3.5%) were diagnosed.\u003c/p\u003e\u003cp\u003e55.2% had complications at presentation, predominantly cataracts (87.5%). 19 children (65.5%) had inactive disease at 12 months from diagnosis. Remission, as assessed at the last clinical visit was achieved in 58.6% on standard initial therapy and in 75% of those on tumour necrosis factor inhibitors. Surgery was needed in 41.4%, primarily in the idiopathic group. Visual acuity improved or was maintained on treatment.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u0026nbsp;The spectrum and characteristics of immune-mediated non-infectious uveitis are comparable to that reported in more developed countries. Current practice detects children with potentially sight-threatening disease and access to tumour necrosis factor inhibitors has improved outcomes in refractory cases.\u003c/p\u003e","manuscriptTitle":"Paediatric Non-Infectious Uveitis in Cape Town, South Africa: A Retrospective Review of Disease Characteristics and Outcomes on Immunomodulating Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-09-24 15:53:16","doi":"10.21203/rs.3.rs-74889/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-11-14T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-17T12:00:00+00:00","index":5,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"editorInvitedReview","content":"","date":"2020-10-17T12:00:00+00:00","index":6,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"editorInvitedReview","content":"","date":"2020-10-14T12:00:00+00:00","index":3,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"editorInvitedReview","content":"","date":"2020-10-14T12:00:00+00:00","index":4,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-14T12:00:00+00:00","index":7,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-10-13T12:00:00+00:00","index":6,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-10-10T12:00:00+00:00","index":5,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-10T12:00:00+00:00","index":2,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2020-10-08T12:00:00+00:00","index":4,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-10-05T12:00:00+00:00","index":3,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-01T12:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2020-09-27T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-09-25T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-09-22T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-09-21T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-09-21T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-09-20T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-09-20T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-rheumatology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"proj","sideBox":"Learn more about [Pediatric Rheumatology](http://ped-rheum.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/proj/default.aspx","title":"Pediatric Rheumatology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"64467d89-ed89-41c0-a18d-6f27c72e616d","owner":[],"postedDate":"September 24th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":600756,"name":"Pediatrics"},{"id":600757,"name":"Rheumatology"}],"tags":[],"updatedAt":"2021-08-18T19:22:47+00:00","versionOfRecord":{"articleIdentity":"rs-74889","link":"https://doi.org/10.1186/s12969-021-00537-x","journal":{"identity":"pediatric-rheumatology","isVorOnly":false,"title":"Pediatric Rheumatology"},"publishedOn":"2021-04-01 19:06:09","publishedOnDateReadable":"April 1st, 2021"},"versionCreatedAt":"2020-09-24 15:53:16","video":"","vorDoi":"10.1186/s12969-021-00537-x","vorDoiUrl":"https://doi.org/10.1186/s12969-021-00537-x","workflowStages":[]},"version":"v1","identity":"rs-74889","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-74889","identity":"rs-74889","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}