Audit Presentation - Uveitis.pptx

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This document outlines a screening program for uveitis in patients with juvenile idiopathic arthritis (JIA). The screening aims to allow for early detection and intervention of uveitis, a major cause of vision loss. The screening schedule details examination frequencies based on JIA subtype and age of onset. Results found that 76% of patients experienced delays or fallouts in ophthalmology appointments. Recommendations include dedicating a uveitis screening clinic for JIA patients and hiring an additional ophthalmology consultant to address challenges.

Healthcare

UVEITIS SCREENING IN JUVENILE IDIOPATHIC
ARTHRITIS
Dr Ogbudu Henrypat, ST3 Paediatrics

Outlines
• Background
• Aim of the Screening Programme
• Screening Schedule
• Methods
• Results
• Recommendations/ Action Plan
• References

Background
• Uveitis is the inflammation of Uveal tract:
- Anterior (iris & ciliary body)
- Posterior (Choroid)
- It is a major cause of vision loss
• Complications:
- Cataract, glaucoma, optic atrophy, cystoid macular
oedema, Band keratopathy, etc

- Prevalence of uveitis in Juvenile Idiopathic Arthritis
(JIA) is 8-30%
- Most cause of avoidable morbidity is missed
examinations in the first year of the disease.

Aim of the Screening Programme
• Early detection of uveitis allowing for early
intervention.

Screening Schedule
Screening
Examination
Symptomatic patients:
- Within a week of referral
Non-symptomatic patients:
- First screening within 6 weeks of referral
- 2 monthly intervals from the onset of arthritis
for 6 months
Missed Appointments:
- Rebook as a priority

• 3-4 monthly screening for:
a) Oligoarticular JIA, Psoriatic arthritis onset and
Enthesitis related arthritis (ERA) irrespective of ANA
status onset under 11 years
Age at onset/ Length of screening
•<3 yrs/ 8 years
•3-4yrs/ 6 yrs
•5-8yrs/ 3 yrs
•9-10yrs/ 1 yr

b) Polyarticular, ANA+ JIA onset < 10 years
•AGE at onset/ Length of screening
•<6 yrs/ 5 yrs
•6-9 yrs/ 2 yrs
c) Polyarticular, ANA- JIA, onset < 7 years
•All children need 5 yrs of screening

Methods
• Retrospective Data; from 1st Jan 2022 to 30th April
2023 (18 mo)
• Data Source: EPR

Results
43 JIA patients
(♂ 13, ♀ 30)
17 new cases of
JIA since Jan 2022
7 Discharged from
opthal clinic
5 (OUH, UHS,
GOSH)
2 DNA
Fall Outs/ Delayed
Opthal Appt
1 delayed referral
29 Delayed Appt/Fallouts (76%)
10 Delayed Initial Screening
15 Chased
6 Uveitis (14%)
10 delayed referral
4 never been seen since referral
(05/08/22, 06/01/23, 11/01/23,
27/02/23)

Possible Challenges
• ? Shortage of Staff
• ? Referrals not being picked up on time

Recommendations/ Action Plan
• Dedicated Uveitis screening Clinic for children with JIA
• Need for extra Paeds Ophthalmology Consultant

References
• https://www.rcophth.ac.uk/wp-
content/uploads/2022/02/2006_PROF_046_JuvenileArthritis-
updated-crest-2.pdf

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Audit Presentation - Uveitis.pptx

1. UVEITIS SCREENING IN JUVENILE IDIOPATHIC ARTHRITIS Dr Ogbudu Henrypat, ST3 Paediatrics

2. Outlines • Background • Aim of the Screening Programme • Screening Schedule • Methods • Results • Recommendations/ Action Plan • References

3. Background • Uveitis is the inflammation of Uveal tract: - Anterior (iris & ciliary body) - Posterior (Choroid) - It is a major cause of vision loss • Complications: - Cataract, glaucoma, optic atrophy, cystoid macular oedema, Band keratopathy, etc

4. - Prevalence of uveitis in Juvenile Idiopathic Arthritis (JIA) is 8-30% - Most cause of avoidable morbidity is missed examinations in the first year of the disease.

5. Aim of the Screening Programme • Early detection of uveitis allowing for early intervention.

6. Screening Schedule Screening Examination Symptomatic patients: - Within a week of referral Non-symptomatic patients: - First screening within 6 weeks of referral - 2 monthly intervals from the onset of arthritis for 6 months Missed Appointments: - Rebook as a priority

7. • 3-4 monthly screening for: a) Oligoarticular JIA, Psoriatic arthritis onset and Enthesitis related arthritis (ERA) irrespective of ANA status onset under 11 years Age at onset/ Length of screening •<3 yrs/ 8 years •3-4yrs/ 6 yrs •5-8yrs/ 3 yrs •9-10yrs/ 1 yr

8. b) Polyarticular, ANA+ JIA onset < 10 years •AGE at onset/ Length of screening •<6 yrs/ 5 yrs •6-9 yrs/ 2 yrs c) Polyarticular, ANA- JIA, onset < 7 years •All children need 5 yrs of screening

9. Methods • Retrospective Data; from 1st Jan 2022 to 30th April 2023 (18 mo) • Data Source: EPR

10. Results 43 JIA patients (♂ 13, ♀ 30) 17 new cases of JIA since Jan 2022 7 Discharged from opthal clinic 5 (OUH, UHS, GOSH) 2 DNA Fall Outs/ Delayed Opthal Appt 1 delayed referral 29 Delayed Appt/Fallouts (76%) 10 Delayed Initial Screening 15 Chased 6 Uveitis (14%) 10 delayed referral 4 never been seen since referral (05/08/22, 06/01/23, 11/01/23, 27/02/23)

11. Possible Challenges • ? Shortage of Staff • ? Referrals not being picked up on time

12. Recommendations/ Action Plan • Dedicated Uveitis screening Clinic for children with JIA • Need for extra Paeds Ophthalmology Consultant

13. References • https://www.rcophth.ac.uk/wp- content/uploads/2022/02/2006_PROF_046_JuvenileArthritis- updated-crest-2.pdf

14. Thank You!

Audit Presentation - Uveitis.pptx

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