P010 To establish compliance with British Society for paediatric and adolescent rheumatology (BSPAR) and the Royal College of Ophthalmology (RCOphth) guidelines for screening for uveitis in juvenile idiopathic arthritis (JIA) at a District General Hospital: a retrospective audit
Authors: Garg Kapil K , Walton Tom , Holliday Anna 
Published: April 2024

Abstract

Background/Aims
JIA associated Uveitis (JIA-U) is most common extra-articular manifestation of JIA. The prevalence of uveitis in JIA is approximately 8-30%, but may be as high as 45-57% in young patients with oligoarticular disease. Uveitis is predominantly asymptomatic and requires slit-lamp examination for diagnosis. Up to 67% of JIA-U cases develop ocular complications such as cataracts (20%), glaucoma (19%), band keratopathy (16%), macular oedema and irreversible permanent visual impairment.
The primary objective of our audit was to establish compliance of our service with BSPAR/RCOphth 2006 uveitis screening guidelines and therefore reduce the risk of visual complications in children with JIA.

Methods
A retrospective review of clinical records of children with rheumatological conditions attending our clinic was performed over five-year period. A total of 42 patients with JIA were identified. Data was collated using excel sheet audit tool.

Results
Results were analysed in accordance with the four major guideline domains as below. 1. Initial Screening exam within 6 weeks of referral: 40 out of 42 children screened within six weeks with 95% compliance rate. 2. Symptomatic patients seen within one week of referral: 4 out of 13 children seen in time with 30% compliance. 70% non-compliance was due to non-availability of ophthalmology appointment. 3. Uveitis may flare on stopping Methotrexate/DMARD’s. Patients should get screened two monthly for six months: 9 out of 13 children were screened with 70% compliance. 15% non-compliance was due to non-availability of ophthalmology appointment. 4. Ongoing screening at two-monthly intervals from onset of arthritis for six months, then 3-4 monthly: 15 out of 20 children screened with 75% compliance. 20% non-compliance was due to non-availability of ophthalmology appointment.

Conclusion
Practice at our centre as judged against the BSPAR/RCOphth guidelines was suboptimal. The main cause of non-compliance was due to staffing issue, rather than lack of healthcare professional training, delay in onward referral or non-attendance of patients. Non-availability of regular ophthalmology cover with cross-site commitment stretched the uveitis screening service at our centre. We presented this audit in our trust paediatric governance meeting. As a result of this audit, the frequency of paediatric ophthalmology clinics was increased to one a week. The paediatric nurse specialist facilitated liaison with the ophthalmology department and improved compliance with attendance. Patient database on shared drive was regularly updated with separate column for ophthalmology follow-up. The ophthalmologists were granted access to this database detailing clinic attendance and diagnosis.
Parent education, reinforced with appropriate literature and a child friendly clinic environment improved awareness and reduces non-attendance. Combined clinics with ophthalmology are being explored. We plan to re-audit the service in near future to assess the impact after above remedial measures. A similar multi-site nation-wide audit may help identify and address local and national concerns.

Disclosure
K.K. Garg: None. T. Walton: None. A. Holliday: None.