BMJ 1995;311:810-811 (23 September)

Letters

Managing the complications of childhood arthritis

EDITOR,--I agree with Aideen Landers that the recommendations for ocular slit lamp screening are confusing.1 The most important points to emphasise are that children with juvenile chronic arthritis are at greater risk of developing asymptomatic chronic anterior uveitis than the normal population and that irreversible complications may be prevented if the uveitis is detected early by slit lamp examination and treated effectively. Landers cited the guidelines for slit lamp screening issued by a joint working party of the Royal College of Ophthalmologists and the British Paediatric Association,2 but unfortunately these guidelines do not seem to take into account two key questions.

Firstly, how quickly can irreversible visual impairment follow the onset of chronic anterior uveitis? This should determine the frequency of screening for at risk children. Irreversible complications are likely to occur if the chronic anterior uveitis is untreated for longer than six months (this is based on anecdotal evidence . . . [Full text of this article]


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Randomised controlled trials of treatment are needed
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