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

Akbarali, Saira, Rahi, Jugnoo S, Dick, Andrew D, Parkash, Kiren, Etherton, Katie, Edelsten, Clive, Liu, Xiaoxuan and Solebo, Ameenat L (2020) Imaging based uveitis surveillance in juvenile idiopathic arthritis: feasibility, acceptability and diagnostic performance. Arthritis & rheumatology (Hoboken, N.J.). ISSN 2326-5205. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: http://onlinelibrary.wiley.com/journal/10.1002/(IS...

Abstract

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 (R =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.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WE Musculoskeletal. Orthopaedics
WN Medical imaging. Radiology
WS Paediatrics. Child health
WW Eyes. Ophthalmology
Divisions: Ambulatory Care > Rheumatology
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 05 Oct 2020 11:20
Last Modified: 05 Oct 2020 11:20
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3510

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