Why arthritis in children can threaten eyesight

From medicalxpress.com

Arthritis is often associated with older age, but it also affects children. One of the most common forms is juvenile idiopathic arthritis (JIA), an inflammatory condition that causes persistent joint swelling and pain.

For reasons that remain unclear, between 10% and 30% of children with JIA also develop uveitis, an inflammatory disease of the eye. In some cases, this eye inflammation does not respond to treatment and can lead to sight loss.

A recent study from our laboratory shows that immune cells called B cells, best known for producing antibodies, play a previously underappreciated role in driving this process and may point to new treatment approaches.

JIA is diagnosed when a child or young person under 16 develops inflammation in at least one joint for more than six weeks with no clear cause. Around one in 1,000 children in the UK are affected. The condition includes several subtypes, most of which are autoimmune, meaning the immune system mistakenly attacks the body's own tissues.

Outcomes vary. With treatment, some children experience long periods of remission and may outgrow the condition. For others, inflammation persists into adulthood and can cause joint damage and disability. JIA can also affect organs beyond the joints, including the skin, gut and eyes. When it involves the eye, the condition is known as JIA-associated uveitis.

Much remains unknown about why some children with JIA develop eye inflammation while others do not. It is unclear whether the same immune pathways drive disease in both joints and eyes, or why inflammation most often affects the front of the eye, known as anterior uveitis. In many cases, the condition is silent and painless, allowing damage to accumulate unnoticed. Regular eye screening is therefore essential.

                                                                                                        Credit: CC0 Public Domain

Several risk factors are well established. Girls and children who develop JIA early in life, particularly before the age of six, are more likely to develop uveitis. Children who test positive for antinuclear antibodies are also at increased risk.

Even so, the biological mechanisms linking arthritis and eye disease remain poorly understood, and the role of antibody-producing B cells has received relatively little attention.

To investigate this, our study analyzed blood samples from more than 150 children with arthritis. Certain types of B cells were more abundant in those who had developed uveitis than in children with arthritis alone. A distinctive aspect of the research was the opportunity to examine samples taken directly from affected eyes.

In some children, uveitis can lead to cataracts or glaucoma, making surgery necessary to preserve vision. During these procedures, small amounts of biological material that would normally be discarded can be collected for research. Using these samples, we found that activated B cells had migrated into the eyes of children with JIA-associated uveitis.

Laboratory experiments showed that blocking communication between B cells and another type of immune cell, known as T cells, significantly reduced inflammation. The drug used to achieve this is already being tested in clinical trials for multiple sclerosis and lupus, raising the possibility of repurposing it for children with treatment-resistant disease.

The need for new approaches is clear. Currently, one in four children with JIA-associated uveitis do not respond to the only approved biologic therapy, and by age 18 nearly a third have lost some vision in at least one eye.

These findings point to a potential new treatment pathway and highlight a broader issue in medical research. There is often a delay of many years before therapies developed for adults are tested in children, even when the underlying inflammatory mechanisms are similar.

Improving how discoveries are translated into paediatric care could significantly change outcomes for children with arthritis and uveitis. Earlier intervention, targeted therapies and faster access to treatments already being explored in adult disease may help prevent vision loss, and reduce the long-term burden on children and their families.

https://medicalxpress.com/news/2026-03-arthritis-children-threaten-eyesight.html 

The “Other” Symptoms of Psoriatic Arthritis

From creakyjoints.org

When you have psoriatic arthritis (PsA), being on the lookout for these non-skin, non-joint symptoms can help you head off serious complications. And if you have psoriasis, they might be early signs of PsA. 

If you have psoriatic arthritis (PsA), you’re probably aware that about 85 of people with PsA also have psoriasis (an inflammatory condition of the skin). As if dealing with joint pain, fatigue, and scaling, burning, and itching skin isn’t enough – you may also experience symptoms that go beyond your skin and joints. That’s because the chronic inflammation underlying your PsA can go to work body-wide, affecting organs, tissues, and body systems beyond the skin and joints. 

Reporting these symptoms to your doctor as soon as possible can help fend off more serious problems and lead to more effective relief for your PsA. It’s also essential to note: If you have psoriasis, these symptoms may be the earliest clues that you may have PsA. 

Symptoms of Psoriatic Arthritis We Don’t Always Talk About

Here’s a closer look at some of the PsA symptoms that can fly under the radar and what you should know about them. 

Nail Problems

If you have psoriasis and have not yet been diagnosed with psoriatic arthritis (PsA), or if you have unexplained joint pain without skin issues, it’s worth checking your nails. Nail pitting is one of the earliest and most common signs of PsA, affecting about 80 percent of all people with psoriasis. “It looks almost like you poked your nail with a safety pin,” says Dr. Carroll. Onycholysis, which is the splitting, easy breaking, or cracking of the nail bed, is another nail sign. 

In fact, nail issues are such a telltale sign of PsA that, according to Dr. Carroll, “when someone is coming in with new joint pain and we’re trying to figure out why they have it, and they don’t have obvious skin manifestations, I will look at the nails…sometimes that is the only skin sign.”  

This is what happened to Eddie Applegate, a TV-commercial traffic manager in Atlanta. “I was having joint pain and rashes on my face and hairline,” says Eddie, who has been living with PsA for 20 years. “I went to an urgent care doctor who looked at my nails and saw the pitting, and that helped him confirm the diagnosis of PsA. He also looked at the rash on my face and said, ‘That’s psoriasis’ — a dermatologist had earlier misdiagnosed it as acne.” 

Eye Issues

When it comes to PsA, “red eyes, changing vision, and especially painful eyes are concerning,” says Emily Carroll, MD, an internist focusing on rheumatological diseases at New York’s Mount Sinai Hospital. Those are symptoms of a condition called uveitis, or inflammation of the uvea, which is the middle layer of the eye. Left untreated, it can lead to vision loss, so it’s important to see an ophthalmologist.  

Adds Dr. Carroll, “If uveitis occurs even though a person with PsA is already taking methotrexate, this might be a reason to go to a stronger treatment, such as a biologic.”  

PsA can also be associated with less serious eye problem, including: 

• Pink eye (redness, crusting, swelling) 
• Dry eye syndrome (gritty, burning sensation) 
• Swelling of the sclera (the white part of the eye) 

Ashley Krivohlavek, 39, has had psoriasis since she was 12 years old and was diagnosed with psoriatic arthritis (PsA) when she was 30. She says that dry eyes are “especially tragic” for her, mainly because of the blow to her vanity.  

“When I was a kid, I got made fun of in school for glasses. Eventually, I started wearing contacts and was happy, but about two years after my PsA diagnosis, my ophthalmologist said, ‘You have extremely dry eye, and I don’t know if you’ll be able to wear contacts,” recalls Ashley. “The arthritis had already taken so much — I couldn’t play bass or piano anymore. I like to travel, and that wasn’t in the cards either — and now this.” 

Ashley had been able to wear contacts for special occasions until about six months ago, when she wore them to a wedding but found removing them so painful that she feared she had scratched her cornea. “My doctor told me I had zero chance to wear contacts ever again,” says Ashley, who now keeps her eyes lubricated with over-the-counter eye drops and may explore stronger options with her doctor. 

Shortness of Breath

Unfortunately, people with PsA are at higher risk of atherosclerosis, heart attack, and stroke, says Dr. Carroll. “One reason is that PsA is seen more commonly in people who have metabolic syndrome, a cluster of conditions including high cholesterol, high blood pressure, and obesity,” she explains. “But even beyond that, the inflammatory nature of PsA alone raises risk.”  

The same inflammation that attacks joints also attacks blood vessels, leading to narrower arteries and plaque buildup. So, if you experience shortness of breath when doing everyday activities, tell your doctor and have it checked out. It could be a sign of heart disease.  

Luckily, Ashley, who does arthritis advocacy work through the Global Healthy Living Foundation and helps her dad run their asphalt manufacturing business in Tulsa, OK, has no heart issues, but she says, “I’ve been very diligent about checking my heart health because of the inflammation from PsA. I got tested recently, and my endocrinologist says everything looked great.”  

Eddie’s PCP does an EKG at least once a year: “He wants to make sure we get ahead, especially because I have a family history of heart disease.” 

Swollen Digits

Even before any joint problems have been detected, PsA may reveal itself with fingers or toes so swollen they look like sausages. Known as dactylitis, it affects about half of people with PsA at some point during the course of the disease and is often a signal of joint damage. “When I was first diagnosed and not on a good treatment plan, my fingers would swell so badly, I couldn’t put bracelets or rings on,” says Ashley. “The swelling in my toes was so bad that wearing anything other than big, bulky athletic shoes was really difficult.” 

If you notice symptoms — your entire finger or toe (not just the knuckle) might be so swollen you won’t really be able to use it, and it may feel warm and painful — see your doctor right away. Prompt treatment, such as with biologics or JAK inhibitors, can help ensure dactylitis doesn’t become a chronic problem. “Finding the right treatment plan really did help a lot,” says Ashley, who started managing her PsA with a biologic two years ago. “It has given me my life back.” 

Back Pain

Although PsA is known for causing peripheral arthritis — inflammation and stiffness in the hands, wrists, feet, knees, and ankles — it can also attack elsewhere.  

“One of the things people don’t really talk about is the spine in PsA,” says Ashley, who underwent physical therapy for her spine last summer. “Even my rheum, when I brought it up, said PsA doesn’t really do that.”  

However, a study in Annals of the Rheumatic Diseases found that about 43 percent of people with PsA also have back symptoms — also known as axial PsA or spondylitis. “It’s the worst because walking hurts, lying down hurts. It just feels very tight and almost burning, like there’s stuff rubbing together,” says Ashley.  

If you’re experiencing back pain, tell your rheumatologist — certain imaging tests can help them make an accurate diagnosis and adjust your treatment accordingly. 

https://creakyjoints.org/about-arthritis/psoriatic-arthritis/other-symptoms-psoriatic-arthritis/

Surprising Signs Psoriatic Arthritis is Impacting Your Vision

From prevention.com

The inflammation that affects your skin and joints can also damage your eyes

When you hear the word “psoriasis,” you likely think itchy, scaly red elbows. “Arthritis” conjures up painful, swollen joints. But you can have both at the same time; it’s called psoriatic arthritis, or PsA.

Like psoriasis, PsA is an autoimmune disorder where your overactive immune system attacks healthy parts of your body, causing inflammation. It can flare up anywhere, including the eyes.

According to the National Psoriasis Foundation, one of the most common eye disorders associated with PsA is uveitis (you-vee-EYE-tis). Uveitis is characterized by inflammation (redness and swelling) that occurs in the uvea, the layer and structures beneath the white of the eye. About 7 percent of those with PsA will develop the disease, a much higher percentage than found in the general population, according to the National Eye Institute.

Identifying uveitis

If you have PsA and something feels off with your eyes or vision see an ophthalmologist for an exam. “Don’t assume it’s pink eye,” says Kristin Ingraham, DO, a rheumatologist with Lehigh Valley Health Network in Allentown, PA. “Delaying a diagnosis can make flare-ups worse.”

To check for the condition, an ophthalmologist will perform a non-invasive “slit lamp” exam using a special microscope and high-intensity light to examine different structures and look for white blood cells and protein within the eye. “There should be no white blood cells inside the anterior chamber of the eye, and in uveitis you find them,” explains James Rosenbaum, M.D., professor of medicine in the Division of Arthritis and Rheumatic Diseases at Oregon Health & Science University and chief of ophthalmology at Legacy Devers Eye Institute in Portland, OR. “A lot of protein in the eye suggests the blood vessels are leaky; the protein actually diffracts the lamp’s beam of light so it’s like looking through a fog.”

It’s also vital to keep an eye out for unusual symptoms between appointments. Dr. Rosenbaum recommends keeping in mind the mnemonic R.S.V.P. If you experience any of these four issues, see an ophthalmologist stat:

R – Prolonged redness

Eye redness is very common and can be triggered by allergies, a virus, or strain. (You know, from reading the tiny text on your smartphone.) But if the redness lasts for a week or more, check-in with your doctor.

S – Sensitivity to light

“Things that don’t damage the eye, like mild conjunctivitis, don’t generally cause a sensitivity to light,” says Dr. Rosenbaum. Light sensitivity may suggest a more serious problem brewing.

V – Vision change

Blurred vision, double vision, “floaters,” or any other changes in visual acuity should be checked by an ophthalmologist.

P – Pain

Many minor conditions cause some scratchiness and discomfort but not true pain, says Dr. Rosenbaum. “True pain definitely needs to be evaluated,” he says.

The importance of uveitis treatment

Waiting too long to have your eyes checked after symptoms start can delay treatment and allow damage to occur, so definitely don’t drag your feet, says Dr. Ingraham.

Treatment for moderate inflammation from uveitis often involves steroid eye drops. For some people with more severe symptoms, the medication used to treat psoriasis or psoriatic arthritis may be used to treat or prevent uveitis. Your eye doctor and rheumatologist can work together to find your best course of treatment. “Just as a conductor of a symphony coordinates multiple musicians, rheumatologists and ophthalmologists should achieve a similar collaboration,” says Dr. Rosenbaum.

What about lifestyle factors; can they prevent eye problems related to psoriatic arthritis? “Boy, I wish,” says Dr. Rosenbaum. “If you have a way to reduce stress, to be happy, to get sleep, to eat a balanced diet, do all of those things, but don’t ignore conventional medications, which we know work well.”

https://www.prevention.com/health/health-conditions/a36291837/psoriatic-arthritis-uveitis/