Predicting uveitis in juvenile idiopathic arthritis: from biomarkers to clinical practice

Abstract

Introduction: Uveitis is a sight-threatening eye inflammation and common manifestation of juvenile idiopathic arthritis (JIA). New biomarkers that can predict uveitis are needed to alleviate personalized clinical screening. In this review, we outline clinical and molecular risk factors for uveitis and discuss their putative biology and value for clinical practice. Areas covered: The recent discovery of the YST-amino acid motif in the Human Leukocyte Antigen DRB1 gene exposed a strong genetic predisposition for uveitis in females and can be used to identify low-risk cases and redefine screening policies. The established predictor ‘young age at arthritis onset’ appeared to only hold true for females, emphasizing the importance of sex-stratification in biomarker applications. Aqueous humor profiling studies have shown unique mediator changes. Finally, erythrocyte sedimentation rate and S100A12 levels can be used to stratify patients at high risk for uveitis. Expert commentary: Various markers have been identified and may significantly improve risk assessment for uveitis in JIA. However, there remains an unmet need to better predict uveitis in advance. Here, we propose a set of markers with high potential for prospective studies, which subsequently can be integrated to develop optimal prediction tools that complement improved screening guidelines for early disease detection and personalized care strategies.