Ophthalmological screening in juvenile arthritis: should the frequency of screening be based on the risk of developing chronic iridocyclitis?

Chronic iridocyclitis (CI) may complicate juvenile chronic arthritis (JCA) and if left untreated may cause significant ocular impairment. It is usually not symptomatic and diagnosis relies on slit lamp biomicroscopy. It is unclear how often children with JCA should be screened for this complication. From a review of the literature, the following recommendations could be made, although these require scientific validation. All children with JCA should have at least one adequate slit lamp examination as soon as possible after diagnosis of the arthritis. If CI is detected then appropriate treatment and follow up should be determined by the ophthalmologist. If CI is not detected initially, all children with JCA should be screened by slit lamp examinations every 3-4 months for the first 5 years after arthritis onset. After 5 years, CI screening could be stopped. The only exceptions would be arthritic children at low risk for CI, including systemic onset JCA, juvenile spondyloarthropathy and juvenile onset rheumatoid arthritis, who do not need to be screened if the initial slit lamp examination is normal.