Prognostic value of antinuclear antibodies in juvenile idiopathic arthritis and anterior uveitis. Results from a systematic literature review

Aims: To analyze the prognostic role of antinuclear antibodies (ANA) for the onset of uveitis in the context of juvenile idiopathic arthritis (JIA), its correlation with uveitis course and severity and its prognostic role for the development of arthritis in children with uveitis. Methods: We conducted a systematic review analysis of the literature on the prognostic value of ANA on JIA associated uveitis and its complications. We included series published between January 1990 and December 2011 reporting the prognostic value of ANA positivity on uveitis in consecutive patients diagnosed with JIA. Results: We identified 246 studies from our search, of which 25 were selected for detailed analysis and only 9 fulfilled the inclusion criteria. Some authors have mentioned that uveitis could preceed arthritis and that ANA positivity might represent a predictive factor for subsequent joint involvement. A chronic course and insidious onset of uveitis are predictors for an association with JIA. Although recognized as a possible predictor of uveitis development, presence of positive ANA does not represent a predictor of severity. Conclusions: The presence of ANAs seems to be a risk factor for ocular involvement in patients with JIA. These autoantibodies, however, did not have any correlation with the recurrence of either idiopathic anterior uveitis or JIA-related uveitis and cannot be used as a marker to predict the clinical course of ocular inflammation. Any analysis of the literature is subjected to the limitations of each of the studies under evaluation. A large, prospective population-based study of JIA patients would be certainly ideal.