Immune-Mediated Inflammatory Diseases Following Pediatric Uveitis Diagnosis

Abstract

IMPORTANCE Pediatric uveitis is frequently associated with immune-mediated inflammatory diseases (IMIDs); however, population-level estimates of IMID risk and immunosuppressant use are limited, as existing evidence is largely derived from tertiary-center cohorts with substantial referral bias. OBJECTIVE To estimate the incidence and risk of developing IMIDs among children and adolescents newly diagnosed with noninfectious uveitis without a prior history of IMIDs. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study includes nationwide health insurance claims data from Korea from January 2008 through February 2024. Participants included children and adolescents younger than 20 years who were newly diagnosed with uveitis in Korea between 2011 and 2022. Data were analyzed from February to November 2025. EXPOSURE Diagnosis of uveitis MAIN OUTCOMES AND MEASURES Primary outcomes were the estimated 5-year cumulative incidence of a composite of 13 predefined IMIDs and the age-and sex-adjusted standardized incidence ratios (SIRs) compared with the general pediatric population. RESULTS In this cohort study, 27 656 children and adolescents (mean [SD] age, 12.6 [4.8] years; 16 827 males [58.3%]) with incident noninfectious uveitis and no prior IMID diagnosis or immunosuppressant prescription were identified. The estimated 5-year cumulative incidence of composite IMIDs was 8.52% (95% CI, 8.16%-8.87%). The most frequently newly diagnosed IMID following uveitis was ankylosing spondylitis (2.53%; 95% CI, 2.33%-2.73%); however, the distribution of IMIDs differed across age groups. Compared with the general pediatric population, the overall SIR for IMIDs was 6.78(95% CI, 6.54-7.02). Disease-specific SIRs were the highest for sarcoidosis (444.48; 95% CI, 357.98-551.89), ankylosing spondylitis (68.9; 95% CI, 64.5-73.7), and Beh & ccedil;et disease (66.3; 95% CI, 57.8-76.0). The use of immunosuppressive therapies varied substantially by level of medical care, with a higher estimated 5-year incidence in secondary and tertiary care settings than in primary care settings (8.42%; 95% CI, 7.67%-9.16% vs 0.67%; 95% CI, 0.55%-0.79%; P < .001), along with variation in prescribed agents. CONCLUSIONS In this cohort study, children and adolescents with uveitis had an approximately 7-fold increased risk of developing IMIDs compared with the general population, with variation in disease patterns and treatment according to demographic and health care factors. These findings highlight the importance of systematic and risk-stratified screening for IMIDs in pediatric patients with uveitis.